Moderate hypothermia appears ineffective for bacterial meningitis

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1. Moderate hypothermia (32°C- 34°C) did not improve clinical outcomes of bacterial meningitis patients.

2. Among the patient sample, 86% of the hypothermia group and 74% of the control group experienced unfavorable outcomes.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Therapeutic hypothermia has been shown in animal models to decrease intracranial pressure and result in improved clinical outcomes in models of bacterial meningitis. In humans, therapeutic hypothermia is used to improve outcomes of cerebral hypoxemia. For this reason, the authors sought to study whether moderate hypothermia may be beneficial in bacterial meningitis patients.

This study demonstrated that moderate hypothermia (32°C- 34°C), was not an effective treatment and may have increased unfavorable clinical outcomes in bacterial meningitis patients. Of note, the study was terminated early due to increased mortality in the hypothermia group. Given the early termination, the study is limited by its small patient population of 98, limiting generalizability. Further studies of larger patient populations are needed to validate these results; nonetheless, the study does provide valuable information that may dissuade providers from considering hypothermia treatments for bacterial meningitis.

Click to read the study in JAMA

Relevant Reading: Induced hypothermia in adult community-acquired bacterial meningitis – more than just a possibility?

In-Depth [randomized controlled trial]: This multicenter study examined 98 individuals, split into two groups, among 49 intensive care units in France. At 3 months 25 (51%) patients in the hypothermia group and 15 (31%) patients in the control group had died (RR, 1.99, 95%CI, 1.05-3.77; p= .04). Furthermore, 47% of the hypothermia group and 32% of the control group experienced septic shock. At 3 months, 86% of the hypothermia group and 74% of the control group experienced unfavorable outcomes (RR, 2.17; 95% CI, 0.78-6.01).

By John Prendergass and Rif Rahman

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