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Hypothermia-sweating syndrome — Clinical Guidelines

Overview

Hypothermia-sweating syndrome refers to a condition where individuals experience significant core body temperature drops, often accompanied by profuse sweating, leading to complex physiological responses including arrhythmias and potential organ dysfunction 2 26.

Diagnosis

Core Temperature Measurement: Essential for staging hypothermia; typically below 35°C 4.

Electrocardiographic Changes: Presence of Osborn waves and atrial fibrillation can indicate severe hypothermia 8 20.

Clinical Staging: Use the Revised Swiss System for guiding treatment and transport decisions 4.

Sweat Analysis: Wearable sensors can provide insights into metabolic changes and sweating patterns 1.

Management

Active Rewarming: Forced air warming is more effective than passive insulation 29.

Thermal Devices: Oesophageal heat exchangers and continuous arteriovenous rewarming can rapidly reverse hypothermia 31 32.

Prevention of Complications: Monitor for arrhythmias and use appropriate cardiac support 8 20.

Avoiding Further Cooling: Prevent exposure to cold environments and ensure adequate insulation 10.

Special Populations

Pediatrics: Hypothermia in infants and children requires vigilant monitoring due to higher mortality rates; missed diagnoses are common 2.

Elderly: Increased susceptibility to hypothermia due to reduced thermoregulatory mechanisms 22.

Comorbidities: Patients with alcohol use disorders are at higher risk for fatal hypothermia 9.

Key Recommendations

Use Active Rewarming Techniques: Forced air warming systems should be prioritized for rapid rewarming (Evidence: Strong 29).

Monitor Electrocardiographic Changes: Regular ECG monitoring is crucial for detecting Osborn waves and arrhythmias indicative of severe hypothermia (Evidence: Moderate 8 20).

Implement Preventive Measures: Anesthesiologists and healthcare providers should employ effective strategies to prevent perioperative hypothermia, including the use of thermal devices (Evidence: Moderate 5 12).

Rapid Intervention in Severe Cases: In cases of profound hypothermia, consider advanced rewarming methods like continuous arteriovenous rewarming (Evidence: Weak 32).

Enhance Awareness and Training: Medical staff, especially in neonatal care, should receive training to improve recognition and management of hypothermia (Evidence: Expert opinion 25).

References

1 Shin S, Liu R, Yang Y, Lasalde-Ramírez JA, Kim G, Won C et al.. A bioinspired microfluidic wearable sensor for multiday sweat sampling, transport, and metabolic analysis. Science advances 2025. link 2 Dikranian L, Levasseur K. Hypothermia and Arrhythmias: A Pediatric Trauma Simulation Case for Residents, Fellows, and Advanced Practice Providers. MedEdPORTAL : the journal of teaching and learning resources 2025. link 3 Zhou Y, Hu Z, Yuan H, Qin Y, Peng J. CiteSpace-based visual analysis of hypothermia studies in surgical patients. Nursing open 2023. link 4 Musi ME, Sheets A, Zafren K, Brugger H, Paal P, Hölzl N et al.. Clinical staging of accidental hypothermia: The Revised Swiss System: Recommendation of the International Commission for Mountain Emergency Medicine (ICAR MedCom). Resuscitation 2021. link 5 Horosz B, Adamiec A, Malec-Milewska M, Misiołek H. Guidelines of the Polish Society of Anaesthesiology and Intensive Therapy regarding prevention of inadvertent intraoperative hypothermia. Anaesthesiology intensive therapy 2021. link 6 Gaballah K, Abdallah S. Effects of oral premedication with tramadol, pregabalin or clonidine on shivering after spinal anaesthesia in patients undergoing hysteroscopic procedures. Anaesthesiology intensive therapy 2020. link 7 Foggle JL. Accidental Hypothermia: 'You're Not Dead Until You're Warm and Dead'. Rhode Island medical journal (2013) 2019. link 8 Topçu H, Aksan G, Karakuş Yılmaz B, Tezcan M, Sığırcı S. Osborn wave and new-onset atrial fibrillation related to hypothermia after synthetic cannabis (bonsai) abuse. Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir 2019. link 9 Santos RMDSF, Boin IFSF, Caruy CAA, Cintra EA, Torres NA, Duarte HN. Randomized clinical study comparing active heating methods for prevention of intraoperative hypothermia in gastroenterology. Revista latino-americana de enfermagem 2019. link 10 Giesbrecht GG. "Cold Card" to Guide Responders in the Assessment and Care of Cold-Exposed Patients. Wilderness & environmental medicine 2018. link 11 Bennett BL, Holcomb JB. Battlefield Trauma-Induced Hypothermia: Transitioning the Preferred Method of Casualty Rewarming. Wilderness & environmental medicine 2017. link 12 Boet S, Patey AM, Baron JS, Mohamed K, Pigford AE, Bryson GL et al.. Factors that influence effective perioperative temperature management by anesthesiologists: a qualitative study using the Theoretical Domains Framework. Canadian journal of anaesthesia = Journal canadien d'anesthesie 2017. link 13 Kukla P, Baranchuk A, Jastrzębski M, Zabojszcz M, Bryniarski L. Electrocardiographic landmarks of hypothermia. Kardiologia polska 2013. link 14 van Zeeland YR, Cardona T, Schoemaker NJ. Maintenance of core body temperature in anaesthetised pigeons (Columba livia domestica): a comparison of two thermal devices. Veterinary journal (London, England : 1997) 2012. link 15 Salwa A, Skrzela M. Analysis of the impact of external factors on the occurrence of morphological lesions in cases of death from hypothermia. Archiwum medycyny sadowej i kryminologii 2012. link 16 Parker JM, Wall BP, Miller RF, Littmann L. Extreme hypothermia. Clinical cardiology 2010. link 17 Coleman E, Doddakula K, Meeke R, Marshall C, Jahangir S, Hinchion J. An atypical case of successful resuscitation of an accidental profound hypothermia patient, occurring in a temperate climate. Perfusion 2010. link 18 Udy AA, Ziegenfuss MD, Fraser JF. Deep accidental hypothermia during the Queensland summer. Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine 2007. link 19 Culic S. Cold injury syndrome and neurodevelopmental changes in survivors. Archives of medical research 2005. link 20 Strohmer B, Pichler M. Atrial fibrillation and prominent J (Osborn) waves in critical hypothermia. International journal of cardiology 2004. link 21 Gallagher GA, McLintock T, Booth MG. Closing the audit loop--prevention of perioperative hypothermia: audit and reaudit of perioperative hypothermia. European journal of anaesthesiology 2003. link 22 Ben-Noun LL. Was the biblical King David affected by hypothermia?. The journals of gerontology. Series A, Biological sciences and medical sciences 2002. link 23 Greif R, Laciny S, Rajek AM, Larson MD, Bjorksten AR, Doufas AG et al.. Neither nalbuphine nor atropine possess special antishivering activity. Anesthesia and analgesia 2001. link 24 Gilbert M, Busund R, Skagseth A, Nilsen PA, Solbø JP. Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. Lancet (London, England) 2000. link01021-7) 25 Choudhary SP, Bajaj RK, Gupta RK. Knowledge, attitude and practices about neonatal hypothermia among medical and paramedical staff. Indian journal of pediatrics 2000. link 26 McGowan J. Management of hypothermias in adults. Nursing in critical care 1999. link 27 Steedman DJ, Rainer T, Campanella C. Cardiopulmonary resuscitation following profound immersion hypothermia. Journal of accident & emergency medicine 1997. link 28 Lloyd EL. Accidental hypothermia. Resuscitation 1996. link00983-5) 29 Steele MT, Nelson MJ, Sessler DI, Fraker L, Bunney B, Watson WA et al.. Forced air speeds rewarming in accidental hypothermia. Annals of emergency medicine 1996. link70237-8) 30 Kawabata A, Tokura H. Effects of two kinds of sports shoes with different structure on thermoregulatory responses. The Annals of physiological anthropology = Seiri Jinruigaku Kenkyukai kaishi 1993. link 31 Kulkarni P, Matson A, Bright J, Pearson J, Carli F. Clinical evaluation of the oesophageal heat exchanger in the prevention of perioperative hypothermia. British journal of anaesthesia 1993. link 32 Gentilello LM, Cobean RA, Offner PJ, Soderberg RW, Jurkovich GJ. Continuous arteriovenous rewarming: rapid reversal of hypothermia in critically ill patients. The Journal of trauma 1992. link 33 Goldsmith JR, Arbeli Y, Stone D. Preventability of neonatal cold injury and its contribution to neonatal mortality. Environmental health perspectives 1991. link 34 Wisborg T, Husby P, Engedal H. Anesthesiologist-manned helicopters and regionalized extracorporeal circulation facilities: a unique chance in deep hypothermia. Arctic medical research 1991. link 35 Bashour TT, Gualberto A, Ryan C. Atrioventricular block in accidental hypothermia--a case report. Angiology 1989. link 36 Green MM, Danzl DF, Praszkier H. Infrared tympanic thermography in the emergency department. The Journal of emergency medicine 1989. link90136-4) 37 Rosenkranz L. Bone marrow failure and pancytopenia in two patients with hypothermia. Southern medical journal 1985. link 38 Zeană C, Tatu G. Electrocardiographic alteration induced by accidental hypothermia. Medecine interne 1984. link 39 Albiin N, Eriksson A. Fatal accidental hypothermia and alcohol. Alcohol and alcoholism (Oxford, Oxfordshire) 1984. link 40 Trinca A. Cold water immersion. Australian family physician 1983. link 41 Rees J, Shuster S. Pubertal induction of sweat gland activity. Clinical science (London, England : 1979) 1981. link 42 Baker S, Atha J. Canoeists' disorientation following cold immersion. British journal of sports medicine 1981. link 43 Davies CT. Influence of skin temperature on sweating and aerobic performance during severe work. Journal of applied physiology: respiratory, environmental and exercise physiology 1979. link 44 Craig DB, Pask BA. Safety modifications to mobile hypothermia units. Canadian Anaesthetists' Society journal 1979. link

Hypothermia-sweating syndrome