Temperature control in critically ill patients with fever: A meta-analysis of randomized controlled trials

Sakkat, Abdullah; Alquraini, Mustafa; Aljazeeri, Jafar; Farooqi, Mohammed A.; Alshamsi, Fayez; Alhazzani, Waleed

doi:10.1016/j.jcrc.2020.10.016

Cited by 14 publications

(13 citation statements)

References 31 publications

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“…Similar results were reported in a recent meta-analysis of 13 randomized controlled trials that compared antipyretic with placebo in non-neurocritically ill patients. Treatment with antipyretics decreased body temperature; however, there was no observed difference in mortality [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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

Markota

Skok

Kalamar

et al. 2022

JCM

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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.

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Section: Discussionmentioning

confidence: 99%

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

Markota

Skok

Kalamar

et al. 2022

JCM

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“…By now, it is the consensus of numerous experts that the actual goal of antipyretic therapy is not to normalize core body temperature but to reduce discomfort in children with fever who seem distressed [14][15][16]. This consensus is reaching the intensive wards too [17,18]. The usual treatment of fever is in most settings antipyresis from the very first moment, pharmacologically as well as by physical cooling [19].…”

Section: Fever Managementmentioning

confidence: 99%

Warming up for a better fever: a randomized pilot study in pediatric oncology

Krafft

Raak

Jenetzky

et al. 2022

Pilot Feasibility Stud

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Background Fever in children is a major problem in pediatric oncology. Usual management leads to immediate antibiotic and antipyretic therapy, although there is consensus that antipyretic therapy should not be utilized with the sole aim of reducing body temperature. Increased body temperature during fever appears to be an effective modifier in terms of viral replication and enhanced host defense mechanisms against pathogens. Therefore, it might be beneficial to support febrile patients by applying gentle heat during the onset of fever to help the body to reach its new thermoregulatory set point. Methods A randomized pilot study over 6 months will be conducted in a pediatric oncology department in an academic hospital in Germany. This study is a preparation for a multicenter clinical trial with two parallel groups concerning the efficacy of heat application vs. treatment as usual. One of the inclusion criteria is body temperatures ≥ 38.0 °C in n = 24 cases of patients receiving chemotherapy aged 18 months to 17 years. The first intervention consists of gentle heat application with hot water bottles at any sign of illness and onset of fever. The aim is to achieve a warm periphery equilibrated to trunk temperature of less than 0.5 °C. The second intervention is the avoidance of antipyretics. The control group receives the standard antipyretic treatment from the participating hospital. The purposes of this pilot study are proof of principle of intervention, evaluation of safety, feasibility, definition of endpoints, and to receive basic data for sample size calculation and needed resources. Discussion The main goal is to improve the care of children with cancer by providing the best possible support for febrile episodes. If fever support by heat reduces discomfort, administration of antipyretics and maybe even antibiotics, this would be an advancement in oncological fever management. This pilot study is intended to provide a basis for a main, multicenter, randomized trial and demonstrate the practicability of heat application in febrile patients in pediatric oncology. Trial registration German Clinical Trials Register (DRKS), DRKS00028273. Registered on 14 April 2022

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“…In the case of a difference of 2% vs. 16%, 57 patients are needed in each arm, for a total of 114 patients in the study. Power analysis was computed using PASS 13 Power Analysis and Sample Size Software (2014). NCSS, LLC.…”

Section: Sample Size Calculation and Statistical Analysismentioning

confidence: 99%

“…Two large randomised controlled trials (RCTs) in septic patients showed that the treatment of fever delays early deaths, but neither study proved any decrease in in-hospital mortality (11,12). Furthermore, a recent meta-analysis of RCTs on the bene ts of antipyretic interventions in septic patients did not provide any evidence that these interventions would lead to better survival (13). Despite the uncertainty as to whether the treatment of fever in septic, neurologically intact patients is bene cial, the use of antipyretic interventions in these patients remains common clinical practice (9,14,15).…”

Section: Introductionmentioning

confidence: 99%

Control of Fever in Septic Patients: the Results of a Randomised Controlled Trial

Kula¹,

Káňová²,

Varady³

et al. 2021

Preprint

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Background: Fever is a defence against infection. However, its benefit might be masked by cardiorespiratory maladaptation to thermal stress. The aim of this study was to evaluate the effect of fever control on the outcomes of septic patients who were presumed to have a sufficient cardiorespiratory reserve.Methods: Septic patients with a presumed sufficient cardiorespiratory reserve and fever (>38.3°C) of infectious etiology were randomised to one of the two study arms. In the aggressive arm, the antipyretic intervention was started immediately when the body temperature rose above 38.3°C, in the conservative arm only when it exceeded 39.5°C. Both pharmacological (ibuprofen) and physical antipyretic methods were used. The total SOFA score on day 7 was selected as the primary endpoint. Non-parametric tests were used for statistics when comparing variables between the study arms.Results: A total of 5998 patients were screened for fever of infectious etiology. 609 patients met inclusion criteria, of whom 154 patients were randomised. A significantly higher body temperature and longer duration of febrile episode was reached in the conservative arm. The SOFA score was significantly lower on day 7 when the conservative approach was applied. In-hospital mortality did not differ between the arms. When analysing a subgroup of patients with ICU stay < 4 days, a significantly lower SOFA score on day 3 and a tendency for lower in-hospital mortality was observed in the aggressive arm. In contrast, among patients with ICU stay ≥ 6 days, a significantly lower SOFA score on day 7 and significantly lower in-hospital mortality was found in the conservative arm.Conclusions: The conservative approach to the treatment of fever in septic patients with sufficient cardiorespiratory reserve was associated with a lower total SOFA score on day 7 compared to the aggressive approach. However, both approaches may positively influence outcome of septic patients: the aggressive approach seems to be beneficial in the early stage of sepsis, and the conservative approach in the stage of sepsis remission.Trial registration: The study was retrospectively registered at http://www.clinicaltrials.gov (Ref. No. NCT04227652).

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Temperature control in critically ill patients with fever: A meta-analysis of randomized controlled trials

Cited by 14 publications

References 31 publications

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

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

Warming up for a better fever: a randomized pilot study in pediatric oncology

Control of Fever in Septic Patients: the Results of a Randomised Controlled Trial

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