Therapeutic Temperature Modulation for a Critically Ill Patient with COVID-19

Abstract

We report a rapidly deteriorating coronavirus disease 2019 (COVID-19) patient, a-58-year-old woman, with severe acute respiratory distress syndrome and shock with hyperpyrexia up to 41.8°C, probably due to the cytokine storm syndrome. Considering extracorporeal membrane oxygenation (ECMO) as the last resort, we applied therapeutic temperature modulation for management of hyperpyrexia. The patient demonstrated rapid improvement in oxygenation and shock after achieving normothermia, and fully recovered from COVID-19 three weeks later. Therapeutic temperature modulation may have successfully offloaded the failing cardiorespiratory system from metabolic cost and hyperinflammation induced by hyperpyrexia. The therapeutic temperature modulation can safely be applied in a specific group of patients with cytokine storm syndrome and hyperpyrexia, which may reduce the number of patients requiring ECMO in the global medical resource shortage.

Keywords: COVID-19; Fever; SARS-CoV-2; Therapeutic Temperature Modulation.

Fig. 1. Chest radiographs on (A) Day 1, (B) Day 2, (C) Day 3, (D) Day 5, (E) Day 8, and (F) Day 22 of hospitalization.

Fig. 2. Body temperature, the ratio of partial pressure of arterial oxygen and fraction of inspired oxygen (PaO₂/FiO₂), and heart rate during hyperpyrexia with subsequent changes indicating the effect of therapeutic temperature modulation.