Core Warming of Coronavirus Disease 2019 Patients Undergoing Mechanical Ventilation: A Pilot Study

Nathaniel P. Bonfanti, Nicholas M. Mohr, David C. Willms, Roger J. Bedimo, Emily Gundert, Kristina L. Goff, Erik B. Kulstad, Anne M. Drewry

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Fever is a recognized protective factor in patients with sepsis, and growing data suggest beneficial effects on outcomes in sepsis with elevated temperature, with a recent pilot randomized controlled trial (RCT) showing lower mortality by warming afebrile sepsis patients in the intensive care unit (ICU). The objective of this prospective single-site RCT was to determine if core warming improves respiratory physiology of mechanically ventilated patients with coronavirus disease 2019 (COVID-19), allowing earlier weaning from ventilation, and greater overall survival. A total of 19 patients with mean age of 60.5 (–12.5) years, 37% female, mean weight 95.1 (–18.6) kg, and mean body mass index 34.5 (–5.9) kg/m2 with COVID-19 requiring mechanical ventilation were enrolled from September 2020 to February 2022. Patients were randomized 1:1 to standard of care or to receive core warming for 72 hours through an esophageal heat exchanger commonly utilized in critical care and surgical patients. The maximum target temperature was 39.8°C. A total of 10 patients received usual care and 9 patients received esophageal core warming. After 72 hours of warming, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) ratios were 197 (–32) and 134 (–13.4), cycle thresholds were 30.8 (–6.4) and 31.4 (–3.2), ICU mortalities were 40% and 44%, 30-day mortalities were 30% and 22%, and mean 30-day ventilator-free days were 11.9 (–12.6) and 6.8 (–10.2) for standard of care and warmed patients, respectively (p = NS). This pilot study suggests that core warming of patients with COVID-19 undergoing mechanical ventilation is feasible and appears safe. Optimizing time to achieve febrile-range temperature may require a multimodal temperature management strategy to further evaluate effects on outcome. Identifier: NCT04494867.

Original languageEnglish
Pages (from-to)225-229
Number of pages5
JournalTherapeutic Hypothermia and Temperature Management
Issue number4
StatePublished - Dec 1 2023


  • COVID-19
  • esophageal warming
  • induced hyperthermia
  • respiratory insufficiency
  • sepsis
  • virus replication


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