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Am J Respir Crit Care Med. 2012 May 15;185(10):1088-95. doi: 10.1164/rccm.201110-1820OC. Epub 2012 Feb 23.

Fever control using external cooling in septic shock: a randomized controlled trial.

Author information

1
Service de Réanimation Médicale, CHU Henri Mondor, 94000 Créteil, France. frederique.schortgen@hmn.aphp.fr

Abstract

RATIONALE:

Fever control may improve vascular tone and decrease oxygen consumption, but fever may contribute to combat infection.

OBJECTIVES:

To determine whether fever control by external cooling diminishes vasopressor requirements in septic shock.

METHODS:

In a multicenter randomized controlled trial, febrile patients with septic shock requiring vasopressors, mechanical ventilation, and sedation were allocated to external cooling (n = 101) to achieve normothermia (36.5-37°C) for 48 hours or no external cooling (n = 99). Vasopressors were tapered to maintain the same blood pressure target in the two groups. The primary endpoint was the number of patients with a 50% decrease in baseline vasopressor dose after 48 hours.

MEASUREMENTS AND MAIN RESULTS:

Body temperature was significantly lower in the cooling group after 2 hours of treatment (36.8 ± 0.7 vs. 38.4 ± 1.1°C; P < 0.01). A 50% vasopressor dose decrease was significantly more common with external cooling from 12 hours of treatment (54 vs. 20%; absolute difference, 34%; 95% confidence interval [95% CI], -46 to -21; P < 0.001) but not at 48 hours (72 vs. 61%; absolute difference, 11%; 95% CI, -23 to 2). Shock reversal during the intensive care unit stay was significantly more common with cooling (86 vs. 73%; absolute difference, 13%; 95% CI, 2 to 25; P = 0.021). Day-14 mortality was significantly lower in the cooling group (19 vs. 34%; absolute difference, -16%; 95% CI, -28 to -4; P = 0.013).

CONCLUSIONS:

In this study, fever control using external cooling was safe and decreased vasopressor requirements and early mortality in septic shock.

PMID:
22366046
DOI:
10.1164/rccm.201110-1820OC
[Indexed for MEDLINE]

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