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Antipyretic treatment does not improve survival of critically ill patients with infection

Published:September 04, 2019DOI:https://doi.org/10.1016/j.aucc.2019.07.003
      Although patient care for fever constitutes a core competency for healthcare professionals employed in the intensive care unit (ICU), the continuing controversy about risk–benefit ratio of fever and its management renders antipyretic treatment decisions difficult.
      • Kiekkas P.
      • Aretha D.
      • Bakalis N.
      • Karpouhtsi I.
      • Marneras C.
      • Baltopoulos G.I.
      Fever effects and treatment in critical care: literature review.
      Considering that fever has evolved as part of the acute-phase response to provide adaptive advantages during infection, its suppression can be detrimental.
      • Egi M.
      • Makino S.
      • Mizobuchi S.
      Management of fever in critically ill patients with infection.
      The findings of multicenter observational studies conducted on critically ill patients with infection or sepsis have supported the protective role of febrile temperatures because these were associated with significantly lower mortality.
      • Young P.J.
      • Saxena M.
      • Beasley R.
      • Bellomo R.
      • Bailey M.
      • Pilcher D.
      • et al.
      Early peak temperature and mortality in critically ill patients with or without infection.
      • Lee B.H.
      • Inui D.
      • Suh G.Y.
      • Kim J.Y.
      • Kwon J.Y.
      • Park J.
      • et al.
      Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study.
      Similarly, a recent meta-analysis of randomised studies on adult ICU septic patients revealed that antipyretic treatment did not confer benefits in terms of mortality, acquisition of nosocomial infections, or shock reversal.
      • Drewry A.M.
      • Ablordeppey E.A.
      • Murray E.T.
      • Stoll C.R.T.
      • Izadi S.R.
      • Dalton C.M.
      • et al.
      Antipyretic therapy in critically ill septic patients: a systematic review and meta-analysis.
      However, antipyretic treatment may be of merit for patients with limited physiological reserves because fever manifestation is followed by increased metabolic burden and oxygen consumption.
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