oa Editorial from Editor-in-Chief

Therapeutic Hypothermia (TH) is a treatment approach that has made its way back to the guidelines for survivors of cardiac arrest in recent years [1, 2]. The use of this technique to preserve neurological function in patients who were successfully resuscitated after a cardiac arrest, is becoming a popular practice, or at least it is finally not seen as a “madscience experiment”, but as an evidence-based treatment option [3-5]. Other suggested indications for TH included: cerebrovascular accidents, spinal trauma and surgery, neonatal hypoxemia and seizures among others [6-8]. One indication that has a promising future, is the use of TH in patients with the Acute Respiratory Distress Syndrome (ARDS) [6, 9-11]. This is a common condition seen in Intensive Care Units (ICUs), which despite of aggressive therapies, still continues to have high rates of morbidity and mortality (35-50%) [12-17]. The only marginal improvement in the management of ARDS over the past two decades, is the one demonstrated by the ARDS-Net trial using lower tidal volumes in assisted mechanical ventilation [18]. Why do we suggest TH as a treatment for ARDS? This is an idea that has been surging over the past two decades. Villar and Slutsky published a pilot study in 1993 that evaluated this therapeutic intervention [9]. Nineteen patients were randomized to receive either conventional treatment or conventional treatment plus TH. A significant decrease in mortality rates was noted in the TH group (67% vs 100% p< 0.05) [9]. There are several theoretical benefits of using TH, the first one is that by decreasing core body temperature, the metabolic rate and oxygen requirements will be decreased [3, 8, 19]. Additionally there will be an improvement in the oxygen consumption/delivery equilibrium, thus improving the patient's respiratory function [20, 21]. There are also in vitro studies and animal models that have shown a significant decrease of bacterial dissemination and reduction of the exaggerated response of the immune system [10, 21, 22]. Both authors of this editorial have used TH in patients with ARDS demonstrating significant improvement in the Alveolar-arterial Oxygen gradient and survival (Varon J, Espina I, personal communication). Even though the science, theory and so-far-limited clinical evidence supporting TH for patients with ARDS is lacking, we believe that this therapeutic approach cannot be simply overlooked. The future of acute lung injury and ARDS management would benefit from a large-scale study assessing the impact of TH in the overall mortality and the clinical status of these patients....