Respective impact of lowering body temperature and heart rate on mortality in septic shock: mediation analysis of a randomized trial

Schortgen, Frédérique; Charles-Nelson, Anaïs; Bouadma, Lila; Bizouard, Geoffray; Brochard, Laurent; Katsahian, Sandrine

doi:10.1007/s00134-015-3987-7

Cited by 31 publications

(21 citation statements)

References 41 publications

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“…Data from critically ill patients in general are available. We reviewed the literature and identified 12 RCTs (1785 patients) that examined the effect of fever control in the critically ill population, excluding neurological indication for temperature control [160][161][162][163][164][165][166][167][168][169][170][171]; active temperature management (pharmacologic or non-pharmacologic) did not reduce the risk of death (RR 1.03, 95% CI 0.81-1.31), ICU length of stay (MD − 0.07 days, 95% CI − 0.70-0.56), but it was effective in reducing body temperature (MD − 0.36 °C, 95% CI − 0.42 lower to − 0.29). Given the safety of acetaminophen and lack of harm in the body of evidence, increasing patient comfort through fever management maybe important.…”

Section: Rationalementioning

confidence: 99%

Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)

et al. 2020

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Background: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around the world. Urgent guidance for clinicians caring for the sickest of these patients is needed. Methods:We formed a panel of 36 experts from 12 countries. All panel members completed the World Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are relevant to the management of COVID-19 in the ICU. We searched the literature for direct and indirect evidence on the management of COVID-19 in critically ill patients in the ICU. We identified relevant and recent systematic reviews on most questions relating to supportive care. We assessed the certainty in the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, then generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of best practice recommendations. Results:The Surviving Sepsis Campaign COVID-19 panel issued 54 statements, of which 4 are best practice statements, 9 are strong recommendations, and 35 are weak recommendations. No recommendation was provided for 6 questions. The topics were: (1) infection control, (2) laboratory diagnosis and specimens, (3) hemodynamic support, (4) ventilatory support, and (5) COVID-19 therapy.Recommendation 9. For the acute resuscitation of adults with COVID-19 and shock, we suggest using a conservative over a liberal fluid strategy. Weak recommendation, low-quality evidence.

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Section: Rationalementioning

confidence: 99%

Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)

et al. 2020

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“…The mortality outcome was similar. In a post hoc analysis, it was confirmed that temperature control was a main mediator of early mortality [ 28 ]. The benefits of cooling could be explained by specific patients’ profiles and the cooling strategy used.…”

Section: Should We Treat Pyrexia?mentioning

confidence: 99%

Should we treat pyrexia? And how do we do it?

Doyle

Schortgen

2016

Crit Care

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The concept of pyrexia as a protective physiological response to aid in host defence has been challenged with the awareness of the severe metabolic stress induced by pyrexia. The host response to pyrexia varies, however, according to the disease profile and severity and, as such, the management of pyrexia should differ; for example, temperature control is safe and effective in septic shock but remains controversial in sepsis. From the reported findings discussed in this review, treating pyrexia appears to be beneficial in septic shock, out of hospital cardiac arrest and acute brain injury.Multiple therapeutic options are available for managing pyrexia, with precise targeted temperature management now possible. Notably, the use of pharmacotherapy versus surface cooling has not been shown to be advantageous. The importance of avoiding hypothermia in any treatment strategy is not to be understated.Whilst a great deal of progress has been made regarding optimal temperature management in recent years, further studies will be needed to determine which patients would benefit the most from control of pyrexia and by which means this should be implemented. This narrative review is part of a series on the pathophysiology and management of pyrexia.

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“…It is known that the fever response may be dangerous for patients suffering from cardiopulmonary diseases or sepsis, which can enhance neurological damage, cerebral edema, cardiac ischemia and tissue hypoxia (7) . Therefore, it should be taken into consideration that with the subsequent increase in oxygen consumption due to fever, the respiratory quotient and the cardiac output add a significant load on the clinical status of critically ill patients who may be unable to have their compensatory mechanisms stimulated for the increased metabolic demand (14) . Thus, the use of physical methods for cooling the body temperature often occurs in attempt to reduce clinical complications, which confers benefits to antipyretic therapy of hospitalized patients in the ICU (7,15) .…”

Section: Discussionmentioning

confidence: 99%

Physical methods for the treatment of fever in critically ill patients: a randomized controlled trial

Salgado

Silva

et al. 2016

Rev. esc. enferm. USP

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Objective:To evaluate the effects of physical methods of reducing body temperature (ice pack and warm compression) in critically ill patients with fever. Method: A randomized clinical trial involving 102 adult patients with tympanic temperature ≥ 38.3°C of an infectious focus, and randomized into three groups: Intervention I -ice pack associated with antipyretic; Intervention II -warm compress associated with antipyretic; and Control -antipyretic. Tympanic temperature was measured at 15 minute intervals for 3 hours. The effect of the interventions was evaluated through the Mann-Whitney test and Survival Analysis. "Effect size" calculation was carried out. Results: Patients in the intervention groups I and II presented greater reduction in body temperature. The group of patients receiving intervention I presented tympanic temperature below 38.3°C at 45 minutes of monitoring, while the value for control group was lower than 38.3°C starting at 60 minutes, and those who received intervention II had values lower than 38.3°C at 75 minutes of monitoring. Conclusion: No statistically significant difference was found between the interventions, but with the intervention group I patients showed greater reduction in tympanic temperature compared to the other groups.

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Respective impact of lowering body temperature and heart rate on mortality in septic shock: mediation analysis of a randomized trial

Abstract: The time spent with a temperature below 38.4 °C was independently associated with patient's outcome and explained 73% of the effect of the randomization on the day 14 mortality. Heart rate lowering was not a mediator of mortality.

Cited by 31 publications

References 41 publications

Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)

Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)

Should we treat pyrexia? And how do we do it?

Physical methods for the treatment of fever in critically ill patients: a randomized controlled trial

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