Hypermetabolism in critically ill patients with COVID-19 and the effects of hypothermia: A case series

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 h. 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.