Devemos tratar febre em doentes graves? Resumo da evidência atual de três ensaios clínicos randomizados

Abstract

Fever is a nonspecific response to various types of infectious or non-infectious insult and its significance in disease remains an enigma. Our aim was to summarize the current evidence for the use of antipyretic therapy in critically ill patients. We performed systematic review and meta-analysis of publications from 1966 to 2013. The MEDLINE and CENTRAL databases were searched for studies on antipyresis in critically ill patients. The meta-analysis was limited to: randomized controlled trials; adult human critically ill patients; treatment with antipyretics in one arm versus placebo or non-treatment in another arm; and report of mortality data. The outcomes assessed were overall intensive care unit mortality, changes in temperature, intensive care unit length of stay, and hospital length of stay. Three randomized controlled trials, covering 320 participants, were included. Patients treated with antipyretic agents showed similar intensive care unit mortality (risk ratio 0.91, with 95% confidence interval 0.65-1.28) when compared with controls. The only difference observed was a greater decrease in temperature after 24 hours in patients treated with antipyretics (-1.70±0.40 versus - 0.56±0.25ºC; p=0.014). There is no difference in treating or not the fever in critically ill patients.

Antipyretic Therapy in Critically Ill Septic Patients: A Systematic Review and Meta-Analysis

“…In fact, some studies have suggested that antipyresis in critically ill septic patients may be harmful ( 15 – 17 ). The majority of prior meta-analyses of the effect of antipyretic therapy in the critically ill have not focused on septic patients ( 18 – 20 ). Because antipyretic therapy may impact infected and noninfected patients differently ( 16 ), conclusions from these studies are difficult to interpret.…”