"The benefits and risks of fever control in patients with severe sepsis remains a matter of controversy," said lead author Frédérique Schortgen, MD, PhD, of the Henri Mondor Hospital in Créteil, France. "In our study, external cooling to achieve normothermia in patients with septic shock was safe, accelerated hemodynamic stabilization, decreased vasopressor requirements, increased the rate of shock reversal, and decreased early mortality."
The findings were published online ahead of print publication in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.
In the multicenter trial, 200 febrile adults with septic shock from seven participating ICUs, all of whom were receiving vasopressor treatment, mechanical ventilation and sedation, were randomized to external cooling (n = 101) or no external cooling (n = 99). Patients underwent cooling for 48 hours to maintain a core body temperature between 36.5°C and 37°C. Vasopressors were tapered to maintain a mean arterial pressure target of 65 mmHg or more in both groups.
After two hours of treatment, body temperature was significantly lower in the cooling group. The percentage of patients with a 50 percent vasopressor dose decrease vs. baseline was significantly higher in the cooling group from 12 hours of treatment; this difference was not significant at 48 hours. Shock reversal during the ICU stay was significantly more common in the cooling group, as was day-14 mortality. All comparisons remained significant after adjustment for baseline vasopressor dose and sepsis severity scores.
The study had several limitations. Patients in the cooling group had a lower baseline dose of vasopressors, perhaps indicating lower illness severity, although all other variables associated with outcomes in sepsis were well balanced between the two treatment groups. In addition, the study was not blinded, and life-supporting treatments given before inclusion during the early stage of sepsis were not recorded.
"Although cooling prevented early deaths in our patients, mortality reduction was not significant at ICU or hospital discharge, and we cannot make definitive conclusions on the effects of cooling on mortality from our data" said Dr. Schortgen. "Larger studies are needed to confirm the positive effects of cooling on mortality we observed and to examine whether fever control provides any additional benefits in patients with severe sepsis."
About the American Journal of Respiratory and Critical Care Medicine:With an impact factor of 10.191, the AJRRCM is a peer-reviewed journal published by the American Thoracic Society.It aims to publish the most innovative science and the highest quality reviews, practice guidelines and statements in the pulmonary, critical care and sleep-related fields.
Nathaniel Dunford | EurekAlert!
New study from the University of Halle: How climate change alters plant growth
12.01.2018 | Martin-Luther-Universität Halle-Wittenberg
Disarray in the brain
18.12.2017 | Universität zu Lübeck
What enables electrons to be transferred swiftly, for example during photosynthesis? An interdisciplinary team of researchers has worked out the details of how...
For the first time, scientists have precisely measured the effective electrical charge of a single molecule in solution. This fundamental insight of an SNSF Professor could also pave the way for future medical diagnostics.
Electrical charge is one of the key properties that allows molecules to interact. Life itself depends on this phenomenon: many biological processes involve...
At the JEC World Composite Show in Paris in March 2018, the Fraunhofer Institute for Laser Technology ILT will be focusing on the latest trends and innovations in laser machining of composites. Among other things, researchers at the booth shared with the Aachen Center for Integrative Lightweight Production (AZL) will demonstrate how lasers can be used for joining, structuring, cutting and drilling composite materials.
No other industry has attracted as much public attention to composite materials as the automotive industry, which along with the aerospace industry is a driver...
Scientists at Tokyo Institute of Technology (Tokyo Tech) and Tohoku University have developed high-quality GFO epitaxial films and systematically investigated their ferroelectric and ferromagnetic properties. They also demonstrated the room-temperature magnetocapacitance effects of these GFO thin films.
Multiferroic materials show magnetically driven ferroelectricity. They are attracting increasing attention because of their fascinating properties such as...
The oceans are the largest global heat reservoir. As a result of man-made global warming, the temperature in the global climate system increases; around 90% of...
08.01.2018 | Event News
11.12.2017 | Event News
08.12.2017 | Event News
18.01.2018 | Life Sciences
18.01.2018 | Life Sciences
18.01.2018 | Earth Sciences