Hyperthermia in the pediatric intensive care unit--is it malignant hyperthermia?

OBJECTIVE

To determine the characteristics of calls made to the Malignant Hyperthermia Association of the United States (MHAUS) Hotline regarding pediatric patients in the intensive care unit setting.

AIM: Retrospective, cohort study conducting analysis of included cases to identify the cause of elevated temperature in the pediatric intensive care unit.

BACKGROUND

The etiology of hyperthermia in the pediatric intensive care unit (ICU) is multifactorial and often difficult to diagnose.

METHODS/MATERIALS: Review of all MHAUS logs for the years 1997-2005 for children, 18 years of age and younger, with elevated temperature presenting in the intensive care setting.

RESULTS

Sixty-three of 1883 (3.3%) calls met inclusion criteria and these cases were characterized. Patient temperature values ranged from 38.0 to 45.0 degrees C. Malignant hyperthermia (MH) was considered 'definite' in five cases and 'probable' in three cases. An infectious diagnosis was given to 16 cases, and a central fever was diagnosed in nine cases. The diagnosis was unknown in the remaining 30 cases. Dantrolene was administered prior to the Hotline call in 32 cases. The recommendation to continue or stop dantrolene varied according to the clinical situation. In six cases, the Hotline expert recommended initiation of dantrolene. In 17 cases, the Hotline expert recommended initiation or continuation of dantrolene as a nonspecific antipyretic, even though MH was not considered as a leading diagnosis.

CONCLUSIONS

Cases of elevated temperature in children in an intensive care unit setting reported to the MHAUS Hotline were rarely considered to be MH related. Although MH does not represent a significant portion of diagnoses related to hyperthermia, when hyperthermia occurs in children exposed to anesthetic agents, MH should be considered in the differential diagnosis.