Better Control of Body Temperature Is Not Associated with Improved Hemodynamic and Respiratory Parameters in Mechanically Ventilated Patients with Sepsis

Abstract

The need for temperature modulation (mostly cooling) in critically ill patients is based on the expected benefits associated with decreased metabolic demands. However, evidence-based guidelines for temperature management in a majority of critically ill patients with fever are still lacking. The aim of our retrospective single-site observational study was to determine the differences in ICU treatment between patients in whom their temperature remained within the target temperature range for ≥25% of time (inTT group) and patients in whom their temperature was outside the target temperature range for <24% of time (outTT group). We enrolled 76 patients undergoing invasive mechanical ventilation for respiratory failure associated with sepsis. We observed no significant differences in survival, mechanical ventilation settings and duration, vasopressor support, renal replacement therapy and other parameters of treatment. Patients in the inTT group were significantly more frequently cooled with the esophageal cooling device, received a significantly lower cumulative dose of acetaminophen and significantly more frequently developed a presence of multidrug-resistant pathogens. In our study, achieving a better temperature control was not associated with any improvement in treatment parameters during ICU stay. A lower prevalence of multidrug-resistant pathogens in patients with higher body temperatures opens a question of a pro-pyrexia approach with an aim to achieve better patient outcomes.

Therapeutic hyperthermia for the treatment of infection—a narrative review

“…There is very little direct data on the use of TH from modern era clinical studies. However, a number of studies have been performed in the field of temperature modulation in patients with sepsis, ranging from therapeutic hypothermia to avoidance of fever to therapeutic hyperthermia ( Table 1 ) ( Mourvillier et al, 2013 ; Young et al, 2015 ; Itenov et al, 2018 ; Drewry et al, 2022 ; Markota et al, 2022 ). The direct mechanisms of action of temperature modulation are mostly not discussed or elaborated on in clinical studies; however, the effects or associations of temperature modulation are presented as different clinical outcomes depending on various target temperatures.…”

“…There are no guidelines regarding target temperatures for general ICU patient population (i.e., mostly patients without signs of central nervous system disease), so target temperatures are determined by the treating clinicians. In a single-center retrospective study of 76 patients published in 2022 no differences in use of vasopressors, parameters of mechanical ventilation or survival were found between patients with body temperature ±0.5°C within target temperature for ≥25% of time (and lower body temperature), and patients with body temperature outside target temperature for <24% of time (and higher body temperature) ( Markota et al, 2022 ). Significant differences were found in the use of paracetamol, esophageal cooling, and greater prevalence of multidrug resistant pathogens, which were all greater in the group of patients with ≥25% of time within target temperature range.…”

“…A higher proportion of time within target range can be explained by the use of paracetamol and esophageal cooling. Greater prevalence of multidrug resistant pathogens in the group of patients who were ≥25% of time within target temperature range and had lower temperature could be in part explained by lower temperature itself, but other factors could also have contributed, e.g., probably more patient interventions were required in the group of patients who were ≥25% of time within target temperature range which could have contributed to the acquisition of multidrug resistant pathogens ( Markota et al, 2022 ).…”

Temperature control in sepsis

“…In an original design, preventing very high fever (T > 39°C) did not prevent organ dysfunction (67). In two studies about septic patients undergoing mechanical ventilations, better temperature control did not improve hemodynamic or respiratory conditions (68,69). But this effect could be canceled out at very high temperatures, as shown in the retrospective study by Evans et al, in which maximum temperature > 39.4°C lost its beneficial effect on survival (70).…”

Nursing strategies for the mechanically ventilated patient

“…The veterinary technician should be monitoring trends and providing heat support or cooling as necessary (21,70). Potential causes for an increase in temperature may include new infection (pyrexia), patient/ventilator dyssynchrony or worsening of the underlying disease process (66)(67)(68)(70)(71)(72). Hyperthermia has been associated with delayed weaning from ventilatory support in humans (71, 73).…”