Abstract
The need for temperature modulation (mostly cooling) in critically ill patients is based on the expected benefits associated with decreased metabolic demands. However, evidence-based guidelines for temperature management in a majority of critically ill patients with fever are still lacking. The aim of our retrospective single-site observational study was to determine the differences in ICU treatment between patients in whom their temperature remained within the target temperature range for ≥25% of time (inTT group) and patients in whom their temperature was outside the target temperature range for <24% of time (outTT group). We enrolled 76 patients undergoing invasive mechanical ventilation for respiratory failure associated with sepsis. We observed no significant differences in survival, mechanical ventilation settings and duration, vasopressor support, renal replacement therapy and other parameters of treatment. Patients in the inTT group were significantly more frequently cooled with the esophageal cooling device, received a significantly lower cumulative dose of acetaminophen and significantly more frequently developed a presence of multidrug-resistant pathogens. In our study, achieving a better temperature control was not associated with any improvement in treatment parameters during ICU stay. A lower prevalence of multidrug-resistant pathogens in patients with higher body temperatures opens a question of a pro-pyrexia approach with an aim to achieve better patient outcomes.
Highlights
For most patients who are treated in intensive care units (ICU), fever is associated with infection–pyrogenic fever [1]
The aim of our study was to determine the differences in ICU treatment between two groups of patients: patients in whom their temperature remained within the target temperature range for ≥25% of time and patients in whom their temperature was outside the target temperature range for
Fortyphysiology and chronic health evaluation score II; ECD: esophageal cooling device; temperature management (TTM): targeted one (53.9%) patients were discharged alive from ICU
Summary
Fever has been recognized as a sign of illness for more than 2000 years [1]. It is highly prevalent in patients who require ICU treatment, with at least 50% of patients developing fever at some point during their ICU stay [2]. For most patients who are treated in ICUs, fever is associated with infection–pyrogenic fever [1]. Pyrogenic fever is treated at least with antipyretics and possibly with physical cooling when core body temperature (CBT) reaches around 38–38.5 ◦ C [1]. The physiological rationale underlying temperature management in critically ill patients with fever (excluding specific patient populations) is mainly based on reduced metabolic demands associated with the reduction in basal metabolism rate after a decrease in CBT [5,6]
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