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Table 1 Comparison of physiologic and metabolic changes associated with hemorrhagic shock with those changes specific to hemorrhagic shock combined spontaneous hypothermia or induced therapeutic hypothermia.

From: Hypothermia in bleeding trauma: a friend or a foe?

  Hemorrhagic Shock Hemorrhagic Shock Complicated by Spontaneous Hypothermia Therapeutic Mild Hypothermia in Hemorrhagic Shock Emergency Preservation Resuscitation in Hemorrhagic Shock
Cardiac Hypotension, tachycardia
Hypovolemic shock
Cardiac depression
Bradycardia
Arrhythmias with worsening hypothermia - J waves
Bradycardia
Decreased risk of cardiac arrest
Induced cardiac arrest on CPB with low flow state
Respiratory Variable Central respiratory depression Variable
Carefully monitored
Patient intubated and monitored on ventilator
Metabolic Increase oxygen requirements Switch from aerobic to anaerobic metabolism Energy (ATP) depletion
Supply/demand mismatch
Reduced metabolic requirements
allowing supply to meet demand
ATP reserved with reduced metabolism.
No oxygen or substrates requirements
Coagulopathy Trauma-induced consumptive coagulopathy
Reperfusion dilutional coagulopathy
Decrease platelets and coagulation factors activity Continuous monitoring of PT and PTT Irrelevant
Mental Status Variable Progressive depression in mental status and eventually coma with flat EEG Patient deliberately sedated and paralyzed Patient deliberately sedated and paralyzed
Immune system Initiation of inflammatory response with multiple organ damage Blunted cytokine production and neutrophil migration with increased risk of infections Decreased immune and inflammatory response
Antibiotic prophylaxis
Antibiotics coverage and sepsis precaution during hypothermia induction
Shivering Not observed early in hemorrhage Increased attempt to produce heat increases energy demand and over-utilizes ATP Muscular blockade to control shivering. Muscular blockade to control shivering
Hyperglycemia Irrelevant Decreased insulin production and resistance leads to hyperglycemia Controlled and reversible Controlled and reversible
  1. ATP = Adenosine Tri-Phosphate. EEG = Electroencephalogram.