Determinants of Pneumonia Risk During Endovascular Hypothermia

Therapeutic hypothermia is a promising neuroprotective therapy with multiple mechanisms of action. Previously, we demonstrated the feasibility of thrombolysis combined with endovascular hypothermia and an antishivering regimen, but pneumonia occurred more often in cooled patients. We sought to identify whether any factors could be identified that increased pneumonia risk. We examined 26 patients who underwent endovascular hypothermia. Pneumonia was assessed and scored as present by the treating physician without prespecified definitions or surveillance protocols. Using logistic regression, we examined the risk of pneumonia; the effects of age, weight, body mass index (BMI), body surface area, respiration rate, heart rate, blood pressure, baseline National Institutes of Health Stroke Scale (NIHSS), gender, shivering, and area under the curve below 34°C; and total meperidine dose, individually and in a multivariable model. Pneumonia was reported by site investigators in 13 subjects (50%). In univariate analyses, BMI and baseline NIHSS emerged as the baseline variables that were independently associated with risk of pneumonia. Multivariable logistic regression analysis identified baseline NIHSS as marginally associated with risk of pneumonia, after adjustment for BMI (OR: 1.19, 95% CI: 0.98, 1.43; p=0.0740). In a group of hypothermia patients suffering a 50% reported incidence of pneumonia, we found no variables that explained risk other than baseline NIHSS. Future trials should include rigorous definitions of pneumonia and prespecified surveillance methods to minimize case ascertainment bias. Measures to prevent pneumonia are needed in all patients treated with hypothermia.