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      Hypermetabolism in Critically Ill Patients with COVID-19 and the Effects of Hypothermia: A Case Series

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          Abstract

          Background

          We have observed that critically ill patients with COVID-19 are in an extreme hypermetabolic state. This may be a major contributing factor to the extraordinary ventilatory and oxygenation demands seen in these patients. We aimed to quantify the extent of the hypermetabolic state and report the clinical effect of the use of hypothermia to decrease the metabolic demand in these patients.

          Methods

          Mild hypothermia was applied on four critically ill patients with COVID-19 for 48 hours. Metabolic rates, carbon dioxide production and oxygen consumption were measured by indirect calorimetry.

          Results

          The average resting energy expenditure (REE) was 299% of predicted. Mild hypothermia decreased the REE on average of 27.0% with resultant declines in CO 2 production (VCO 2) and oxygen consumption (VO 2) by 29.2% and 25.7%, respectively. This decrease in VCO 2 and VO 2 was clinically manifested as improvements in hypercapnia (average of 19.1% decrease in pCO 2 levels) and oxygenation (average of 50.4% increase in pO 2).

          Conclusion

          Our case series demonstrates the extent of hypermetabolism in COVID-19 critical illness and suggests that mild hypothermia reduces the metabolic rate, improves hypercapnia and hypoxia in critically ill patients with COVID-19.

          Highlights

          • •

            COVID-19 critical illness induces an extreme hypermetabolic state.

          • •

            Hypothermia attenuates the hypermetabolic response seen in patients with COVID-19.

          • •

            Hypothermia in patients with COVID-19 may improve carbon dioxide and oxygen levels.

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          Most cited references14

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          Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

          Safiya Richardson, Jamie Hirsch, Mangala Narasimhan … (2020)
          There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).
          Article 0 comments Cited 4647 times – based on 0 reviews     Review now
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            Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

            Chaomin Wu, Xiaoyan Chen, Yanping Cai … (2020)
            Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Risk factors for the clinical outcomes of COVID-19 pneumonia have not yet been well delineated.
            Article 0 comments Cited 3642 times – based on 0 reviews     Review now
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              Covid-19 in Critically Ill Patients in the Seattle Region — Case Series

              Pavan K. Bhatraju, Bijan J Ghassemieh, Michelle Nichols … (2020)
              Abstract Background Community transmission of coronavirus 2019 (Covid-19) was detected in the state of Washington in February 2020. Methods We identified patients from nine Seattle-area hospitals who were admitted to the intensive care unit (ICU) with confirmed infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Clinical data were obtained through review of medical records. The data reported here are those available through March 23, 2020. Each patient had at least 14 days of follow-up. Results We identified 24 patients with confirmed Covid-19. The mean (±SD) age of the patients was 64±18 years, 63% were men, and symptoms began 7±4 days before admission. The most common symptoms were cough and shortness of breath; 50% of patients had fever on admission, and 58% had diabetes mellitus. All the patients were admitted for hypoxemic respiratory failure; 75% (18 patients) needed mechanical ventilation. Most of the patients (17) also had hypotension and needed vasopressors. No patient tested positive for influenza A, influenza B, or other respiratory viruses. Half the patients (12) died between ICU day 1 and day 18, including 4 patients who had a do-not-resuscitate order on admission. Of the 12 surviving patients, 5 were discharged home, 4 were discharged from the ICU but remained in the hospital, and 3 continued to receive mechanical ventilation in the ICU. Conclusions During the first 3 weeks of the Covid-19 outbreak in the Seattle area, the most common reasons for admission to the ICU were hypoxemic respiratory failure leading to mechanical ventilation, hypotension requiring vasopressor treatment, or both. Mortality among these critically ill patients was high. (Funded by the National Institutes of Health.)
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                Author and article information

                Contributors
                Pey-Jen Yu
                Journal
                Journal ID (nlm-ta): Metabol Open
                Journal ID (iso-abbrev): Metabol Open
                Title: Metabolism Open
                Publisher: Published by Elsevier Inc.
                ISSN (Electronic): 2589-9368
                Publication date PMC-release: 26 July 2020
                Publication date (Electronic): 26 July 2020
                Electronic Location Identifier: 100046
                Affiliations
                [1]Division of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell Health, 300 Community Drive, 1DSU, Manhasset, NY, 11030
                Author notes
                [∗ ]Corresponding author. Division of Cardiovascular and Thoracic Surgery North Shore University Hospital, 300 Community Drive, Manhasset, NY, 11030 Tel.: +1 (516) 562 4970; fax: +1 (516) 562 3786 pyu2@ 123456northwell.edu
                Article
                Publisher ID: S2589-9368(20)30026-8 Publisher ID: 100046
                DOI: 10.1016/j.metop.2020.100046
                PMC ID: 7382710
                PubMed ID: 32808941
                SO-VID: 81c67cd4-88ff-43ad-9c1c-e459a315a390
                Copyright © © 2020 Published by Elsevier Inc.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 17 June 2020
                Date revision received : 21 July 2020
                Date accepted : 24 July 2020
                Categories
                Subject: Article

                Keywords: coronavirus (covid-19),metabolism,hypothermia,hypercapnia,hypoxia,case report
                Data availability:
                Keywords: coronavirus (covid-19), metabolism, hypothermia, hypercapnia, hypoxia, case report

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