Discussion
gastrointestinal symptoms, tumor necrosis, abdominal pain, infections, hyperthermia, nausea, vomiting
TUMOR NECROSIS, EVENT, INFECTIONS, ADVERSE EVENT, BLIND, HEAT
Growing data support beneficial effects from warming patients with severe infections, and there are increasing research efforts being undertaken to better understand the mechanistic underpinnings for the clinical effects reported. Challenges in warming patients to febrile-range hyperthermia will need to be adequately addressed to fully explore hyperthermia as a treatment. This pilot study suggests that core warming provided by a commercially available esophageal heat transfer system appears safe and can provide febrile-range temperatures to patients with COVID-19 undergoing mechanical ventilation.Core body temperature is far more tightly regulated than other physiological parameters (including blood pressure and heart rate), and because of the existence of robust thermal defense mechanisms, warming patients to above normal temperatures can be difficult (Sessler, A single adverse event attributed to the use of the device was reported as an episode of nausea, vomiting, and abdominal pain. No differences in sedation level were noted between cohorts in this study, and all patients received sedation levels sufficient to maintain mechanical ventilation, making this event unlikely to be related to sedation level, but a clear etiology or definitive attribution to the device remains uncertain. COVID-19 is known to have gastrointestinal symptoms, which makes it difficult to rule out as a factor (Kwei-Nsoro et al., Further studies are in development, which aim to investigate further mechanistic underpinnings behind the effects of elevated temperature in severe infections. Given the known challenges in warming patients to above-normal body temperature, a multimodal temperature management strategy may be required, and is being anticipated, in subsequent investigations.Limitations of this study include the small sample size, the inability to blind health care providers treating enrolled patients, and the lack of measurement of specific immune factors such as interleukin (IL)-1, IL-6, tumor necrosis factor, and interferon.