Antipyretic Therapy Research Articles

Temperature and ST-segment morphology remote monitoring: new perspectives for implantable cardiac monitors in Brugada syndrome.

Patients with Brugada syndrome (BrS) face an increased risk of ventricular arrhythmias and sudden cardiac death. Implantable cardiac monitors (ICMs) have emerged as effective tools for detecting arrhythmias in BrS. Technological advancements, including temperature sensors and improved subcutaneous electrocardiogram (subECG) signal quality, hold promise for further enhancing their utility in this population. We present a case of a 40-year-old man exhibiting a BrS type 2 pattern on 12-lead ECG, who underwent ICM insertion (BIOMONITOR IIIm, BIOTRONIK) due to drug-induced BrS type 1 pattern and a history of syncope, with a negative response to programmed ventricular stimulation. The device contains an integrated temperature sensor and can transmit daily vital data, such as mean heart rate and physical activity. Several months later, remote alerts indicated a temperature increase, along with transmitted subECGs suggesting a fever-induced BrS type 1 pattern. The patient was promptly advised to commence antipyretic therapy. Over the following days, remotely monitored parameters showed decreases in mean temperature, physical activity, and mean heart rate, without further recurrence of abnormal subECGs. ICMs offer valuable insights beyond arrhythmia detection in BrS. Early detection of fever using embedded temperature sensors may improve patient management, while continuous subECG morphological analysis has the potential to enhance risk stratification in BrS patients.

Acetaminophen and Ibuprofen in Pediatric Central Nervous System Malaria

A third of children who survive malaria with neurological involvement (central nervous system [CNS] malaria) develop sequelae. A higher maximum temperature (Tmax) and seizures are risk factors for sequelae. To compare aggressive antipyretic therapy using scheduled acetaminophen and ibuprofen vs usual care with acetaminophen alone given only for a temperature of 38.5 °C or higher. This randomized clinical trial was conducted at inpatient pediatric services of 1 tertiary care and 1 district hospital in Zambia and a tertiary care center in Malawi. Included were children aged 2 to 11 years with CNS malaria (excluding those with creatinine >1.2 mg/dL), who were enrolled from 2019 to 2022. Data analysis took place from December 2022 to April 2023. The aggressive antipyretic group received acetaminophen (30 mg/kg load, then 15 mg/kg) plus ibuprofen, 10 mg/kg, every 6 hours, regardless of clinical temperature for 72 hours. The usual care group received 15 mg/kg of acetaminophen as needed every 6 hours for a temperature of 38.5 °C or higher. The primary outcome variable was Tmax over 72 hours, the total duration of follow-up. Secondary outcomes included seizures and parasite clearance. Five hundred fifty-three patients were screened, 226 (40.9%) were ineligible, and 57 (10.3%) declined. A total 256 participants (n = 128/group) had a mean (SD) age of 4.3 (2.1) years; 115 (45%) were female, and 141 (55%) were male. The aggressive antipyretic group had a lower Tmax, 38.6 vs 39.2 °C (difference, -0.62 °C; 95% CI, -0.82 to -0.42; P < .001) and lower odds of experiencing multiple or prolonged seizures, 10 (8%) vs 34 children (27%) in the usual care group (odds ratio [OR], 0.26; 95% CI, 0.12 to 0.56). No group difference in parasite clearance time was detected. Severe adverse events occurred in 40 children (15%), 25 (20%) in the usual care group and 15 (12%) in the aggressive antipyretic group, including 13 deaths (10 [8%] and 3 [2%], respectively). Increased creatinine resulted in study drug discontinuation in 8 children (6%) in the usual care group and 13 children (10%) in the aggressive antipyretic group (OR, 1.74; 95% CI, 0.63 to 5.07). This study found that aggressive antipyretic therapy reduced mean Tmax to temperature levels comparable with the Tmax among children without neurological impairments in prior observational studies and improved acute seizure outcomes with no prolongation of parasitemia. ClinicalTrials.gov Identifier: NCT03399318.

Reducing the Risk of Birth Defects Associated with Maternal Influenza: Insights from a Hungarian Case—Control Study

Influenza viruses can cause several complications during pregnancy. Therefore, we aimed to investigate the effects of influenza on the development of congenital abnormalities (CAs) by analyzing the database of the Hungarian Case–Control Surveillance of Congenital Abnormalities (HCCSCA). In our multicenter, case–control, population-based study, we processed clinician-reported outcomes and diagnoses collected in the HCCSCA. The case group included newborns with different non-chromosomal birth defects, while the controls were newborns without CAs. Maternal influenza, as a risk factor for CAs, was analyzed by using a logistic regression model and odds ratios with 95% confidence intervals (CIs). Our results showed that maternal influenza in the first trimester was associated with increased odds of developing non-chromosomal CAs (OR: 1.41, CI: 1.28–1.55). There were increased odds of neural tube defects (OR: 2.22, CI: 1.78–2.76), orofacial clefts (OR: 2.28, CI: 1.87–2.78), and congenital heart defects (OR: 1.28, CI: 1.10–1.49) after influenza infection. In all cases, we found a protective effect of folic acid supplementation in the first trimester. In summary, the odds of non-chromosomal birth defects are higher after maternal influenza in the first trimester, and folic acid or pregnancy vitamin supplementation and antipyretic therapy may reduce the effect of maternal influenza during the first trimester.

Fever and antipyretic therapy in the septic patient in the intensive care unit: an update

Fever and antipyretic therapy in the septic patient in the intensive care unit: an update

Hyperthermia in children: from etiology to pathogenetic therapies. A review

Fever is the most common symptom of most infectious diseases and, to a moderate extent, has a protective-compensatory effect with increased blood bactericidality and activation of immune mechanisms. A pathological variant of fever, in which there is a rapid and inadequate increase in body temperature, accompanied by microcirculation disorder, metabolic disorders, increasing dysfunction of vital organs and systems, in particular, the damage to the central nervous system is hyperthermic syndrome, which requires active antipyretic and symptomatic therapy. Polysystemic dysfunctions associated with hyperthermia and the course of the infectious process can change the metabolic status of antipyretic drugs and sensitivity to their action, which can increase the frequency and severity of side effects, including the development of hypothermia and/or a sharp decrease in body temperature. This will be prevented by a pathegenetic approach to the correction of hyperthermia using antipyretic drugs, the action of which is based on the stimulation of natural, endogenous anti-inflammatory and antipyretic mechanisms.

Practical approach to the patient with fever in the intensive cardiac care unit: diagnostic framework and therapy notes

The management of the patient with fever in the intensive cardiac care unit begins with a thorough evaluation of the patient, particularly symptoms, clinical history and physical examination, to provide information regarding the origin of the fever. The global evaluation of the patient should be integrated with blood and microbiological tests, in particular blood culture and swab. The laboratory, microbiologic or radiologic tests could be more or less detailed and targeted depending on the type of suspected infection and clinical conditions of the patient. When therapy is necessary, it is crucial to switch, as soon as possible, from broad spectrum antibiotic therapy to antibiotic therapy based on the results of the microbiological exams. Antibiotic therapy could be associated with antipyretic and specific organ support therapy when necessary.

Acute Management Of Appendicitis Patients: Case Study

Appendicitis is infection bacteria, and the cause is a blockage in the lumen of the appendix such as lymphatic tissue hyperplasia, fekalit, and askaris worms and the presence of erosion of the appendix mucosa due to parasites such as E histolytica. At the same time, the signs and symptoms are dull pain in the epigastric area around the umbilicus and shifting to the lower right quadrant at Mc Burney's point, nausea, vomiting, decreased appetite, constipation, and fever. This scientific paper examines the relationship between acute pain and Appendicitis through nursing care. The research design used was a case study that explored the problem of nursing care for patients with Appendicitis with acute pain at Dr. Adjidarmo, Rangkasbitung, for three days with Mr. I. Data collection can be done through interviews, observation, physical examination, and documentation. The study results were that the patient complained of difficulty having bowel movements and lower right abdominal pain, like being stabbed with a pain scale of 7 (0-10) intermittent, and lack of appetite and could only finish ¼ portion of food. Body temperature 37.8 ° C, weight 40 kg, height 155 cm, BMI = 17 with low body weight interpretation, laboratory results of leukocytes 11.463 / Ul. Problems that arise are acute pain, hyperthermia, nutritional deficits, and constipation. The implementation reduces pain, lowers the temperature, improves nutritional status, and increases high-fiber foods, in addition to collaborating with the medical team in administering antibiotics, anti-pain, antipyretic, and anti-nausea therapy, as well as collaborating with the Nutrition team in administering a high-fiber diet. Nursing problems can be resolved on the third day with the criteria for decreased pain results with a pain scale of 2 (0-10), no fever with a temperature range of 36 °C - 37 °C and the results of the Leukocyte laboratory examination become 9.670 /Ul, increased appetite so that spend one portion of food and no constipation occurs.

E48 Thinking about auto inflammatory diseases in front of a periodicity of fever in children: a case report

Abstract Introduction Auto-inflammatory diseases (AIDs) are caused by mutations in genes involved in the regulation of innate immunity. The prototypical diseases are the hereditary recurrent fevers (HRFs), whose intermittent inflammatory manifestations are similar between the different diseases; they preferentially affect the serous membranes, skin, eyes, joints, muscles and sometimes the central nervous system. Their onset is often early in life. Objectives To think of an auto inflammatory disease in front of a periodic fever in children Method We report the case of a child with periodic fever. Results A 4-year-old boy with no particular family or personal history, who presented at the age of 1 year with episodes of high fever without evident cause lasting from 7 to 14 days, with a monthly recurrence. There was associated pharyngitis, bilateral cervical lymphadenopathy, oral aphthosis, abdominal pain, sometimes with arthralgia, vomiting, diarrhoea and skin rash. During the fever episode the inflammatory work-up is frankly positive with neutrophilic hyperleukocytosis and an elevated C-reactive protein. The duration and characteristics of the episodes are not modified by the usual antibiotic and antipyretic therapy. Viral serologies for CMV, EBV, parvovirus B19 and HIV are negative. Recurrent bacterial infections of the upper airways were ruled out in view of the periodic character, the negativity of the procalcitonin and throat swabs and the inefficiency of the antibiotic therapy during the attacks. The immune deficiency test came back normal. Autoinflammatory diseases in the absence of autoimmune signs were strongly suggested. Urinary mevalonate kinase/mevalonic acid during the episode was normal. Cyclic neutropenia was eliminated in the presence of PNN hyperleukocytosis at each episode. Genetic study of familial Mediterranean fever syndrome, cryopyrin-caps associated periodic syndrome and TRAPS syndrome came back normal. Our patient met al.l the Vanoni criteria for Marshall's syndrome. He received a single dose of prednisone 1 mg/kg which resulted in a spectacular defervescence in &amp;lt; 24 h and disappearance of other symptoms in a few days and their absence between attacks. This corticosteroid therapy was subsequently prescribed at each attack, which allowed rapid control and a reduction in the duration of the attacks. Discussion and conclusion The exact etiopathogenesis and diagnostic biomarkers of Marshall's disease are still unknown. It is rather a diagnosis of exclusion based mainly on clinical criteria. It is retained in our patient in view of the presence of all diagnostic criteria and the therapeutic test. There is no consensus on the treatment of Marshall's at present. Antipyretics can be used but are only partially effective. Single dose corticosteroids result in cessation of attacks; tonsillectomy is a secondary treatment option. Colchicine is promising for preventing or reducing the frequency of attacks. Marshall's syndrome is a self-limiting autoinflammatory disease of early childhood with spontaneous resolution without impact on the child's growth and development and without major sequelae in most cases within 3–5 years of onset.

Systemic Lupus Concealed in the Shadow of a Primary Membranous Nephropathy Diagnosis

A 43-year-old male patient followed for 27 years in a Nephrology consultation with negative autoimmune diagnostic workup and a histologically proven membranous nephropathy (MN), interpreted as a primary MN. During the follow-up he had multiple relapses, requiring continuous immunosuppression. Eventually, end-stage renal disease developed and the patient started hemodialysis (HD) in January 2018. Soon after initiating HD, he was admitted to the ward due to persistent fever of unknown origin, refractory to antipyretic and antibiotic therapy, but responsive to prednisolone (40 mg/day). Again, the diagnostic workup was negative and the patient was discharged with a corticosteroid taper over 16 weeks. In a posterior admission, after prednisolone suspension, the patient presented to the emergency room with persistent fever, involuntary weight loss, pruriginous macular rash and inflammatory joint pain. As the anti-nuclear antibody and anti-dsDNA came up positive and there was complement consumption, a diagnosis of a systemic lupus flare was established. His stay was complicated by sudden respiratory distress associated with hemoptysis and hemoglobin drop, with a confirmed diffuse alveolar hemorrhage. Daily plasma exchange and intensive immunosuppression was necessary and the patient evolved into complete clinical remission with partial serological response. Usually, patients with systemic lupus erythematosus (SLE) develop clinical and serological remission upon initiating HD, reducing the number of flares and need for medication. This case depicts a lupus flare after starting HD, on a previously serologically negative patient, complicated with a rare type of lung parenchyma involvement, which is associated with a high mortality and required intensive immunosuppression for disease control. One can speculate whether or not the initial glomerulopathy was the first manifestation of SLE, previously controlled due to the continuous use of immunosuppression.

Клінічна оцінка використання інгаляцій 6% N-ацетилцистеїну у 3% розчині NaCL (ФЛУ-АЦИЛ бронхо) в лікуванні дітей з гострим бронхітом

Purpose - to propose an optimization of treatment of acute bronchitis in children by introducing inhalation of FLU-ACIL broncho before therapy. Materials and methods. An open, prospective, multicenter, non-interventional, comparative (with active control) study with two therapeutic groups was conducted. The experience of therapy of 45 children with moderate acute bronchitis aged 2-12 years old was summarized. The main group included 30 children who received inhalation of Flu-Acyl Broncho in the complex treatment: 5 ml 2 times a day 3-4 hours before bedtime for 7-10 days; the comparison group included 15 children who received oral acetylcysteine/ambroxol for 7-12 days. If it is necessary, antipyretic therapy with ibuprofen or paracetamol was used. The period from the onset of the disease to participation in the study was about 2-4 days. The study did not include children with concomitant acute middle ear diseases, acute sinusitis, acute allergic diseases and children with symptoms of obstruction. The results of examination and treatment of patients were analyzed using the software package «Statistica 6.0 for Windows». Results and conclusions. Comprehensive treatment of acute bronchitis in children with the administration of the inhalation Flu-Acyl Broncho, sterile solution for nebulizer and instillation, has a positive clinical effect, leads to faster relief (p&lt;0.01) and disappearance (p&lt;0.05) of cough compared to oral mucolytics. The additional anti-inflammatory and mucolytic effect of the inhalation route of administration of Flu-Acyl Broncho on the nasopharyngeal mucosa improves the results of treatment of children with concomitant acute respiratory pathology of the upper respiratory tract. This is manifested in faster, compared to oral mucolytics, elimination of rhinitis (p&lt;0.001) and sore throat (p&lt;0.05). All studies were performed in accordance with the ethical principles adopted by the Declaration of Helsinki and Good Clinical Practice (GCP) for medical research conducted on human subjects. Approval was obtained from the ethics committee of the Children’s Clinical Hospital No. 5 of Sviatoshynskyi district of Kyiv. No conflict of interests was declared by the authors.

Warming up for a better fever: a randomized pilot study in pediatric oncology

BackgroundFever in children is a major problem in pediatric oncology. Usual management leads to immediate antibiotic and antipyretic therapy, although there is consensus that antipyretic therapy should not be utilized with the sole aim of reducing body temperature. Increased body temperature during fever appears to be an effective modifier in terms of viral replication and enhanced host defense mechanisms against pathogens. Therefore, it might be beneficial to support febrile patients by applying gentle heat during the onset of fever to help the body to reach its new thermoregulatory set point.MethodsA randomized pilot study over 6 months will be conducted in a pediatric oncology department in an academic hospital in Germany. This study is a preparation for a multicenter clinical trial with two parallel groups concerning the efficacy of heat application vs. treatment as usual. One of the inclusion criteria is body temperatures ≥ 38.0 °C in n = 24 cases of patients receiving chemotherapy aged 18 months to 17 years. The first intervention consists of gentle heat application with hot water bottles at any sign of illness and onset of fever. The aim is to achieve a warm periphery equilibrated to trunk temperature of less than 0.5 °C. The second intervention is the avoidance of antipyretics. The control group receives the standard antipyretic treatment from the participating hospital. The purposes of this pilot study are proof of principle of intervention, evaluation of safety, feasibility, definition of endpoints, and to receive basic data for sample size calculation and needed resources.DiscussionThe main goal is to improve the care of children with cancer by providing the best possible support for febrile episodes. If fever support by heat reduces discomfort, administration of antipyretics and maybe even antibiotics, this would be an advancement in oncological fever management. This pilot study is intended to provide a basis for a main, multicenter, randomized trial and demonstrate the practicability of heat application in febrile patients in pediatric oncology.Trial registrationGerman Clinical Trials Register (DRKS), DRKS00028273. Registered on 14 April 2022

P333 INFECTIVE ENDOCARDITIS ON TRICUSPID VALVE CAUSED BY S. AUREUS METHICILLIN RESPONSIVE: RESOLUTION AND RECURRENCE OF DISEASE

Abstract Introduction Tricuspid valve endocarditis accounts for 5–10% of endocarditis cases and is more frequent in intravenous drug abusers. Recurrence of endocarditis occurs not infrequently in patients treated with conservative therapy. Clinical Case In June 2021, a 32–year–old man with a history of intravenous drug abuse came to our observation. He had been presenting for about a week high fever with shaking shivering resistant to antipyretic and antibiotic therapy and laboratory tests with neutrophilic leukocytosis with increase in CRP and procalcitonin. Trans–thoracic echocardiogram was performed and it showed mild tricuspid regurgitation with the presence of filamentous mobile isoechoic formations adhering to the valve leaflets compatible with endocarditic vegetations. A trans–esophageal echocardiogram was performed that confirmed the transthoracic finding of endocarditis on the tricuspid valve with evidence of 11 mm mobile oval vegetation adhering to the posterior flap; blood cultures were positive for methicillin susceptible S. Aureus and antibiotic therapy with oxacillin was administered as a continuous infusion for 6 weeks. The cardiac surgery center was consulted and the surgeons did not indicate any intervention because of the normofunction of the tricuspid valve and the absence of embolic phenomena on total body CT. Subsequent laboratory tests showed negative inflammation indices and negative surveillance blood cultures. Control ETE was planned with the confirmation of complete resolution of endocardial lesions. In September the patient affered the emergency room for an accidental fall from a work vehicle: transthoracic and trans–esophageal echocardiograms were repeated for the concomitant finding of hyperpyrexia and cough with an increase in CRP and procalcitonin. They showed the presence of new larger endocarditic lesions on tricuspid valve with moderate regurgitation. Blood cultures were negative. Antibiotic therapy with oxacillin was reintroduced and the patient was transferred to the infectious disease clinic in prevision of cardiac surgery.

Temperature Management in the ICU.

Temperature abnormalities are recognized as a marker of human disease, and the therapeutic value of temperature is an attractive treatment target. The objective of this synthetic review is to summarize and critically appraise evidence for active temperature management in critically ill patients. We searched MEDLINE for publications relevant to body temperature management (including targeted temperature management and antipyretic therapy) in cardiac arrest, acute ischemic and hemorrhagic stroke, traumatic brain injury, and sepsis. Bibliographies of included articles were also searched to identify additional relevant studies. English-language systematic reviews, meta-analyses, randomized trials, observational studies, and nonhuman data were reviewed, with a focus on the most recent randomized control trial evidence. Data regarding study methodology, patient population, temperature management strategy, and clinical outcomes were qualitatively assessed. Temperature management is common in critically ill patients, and multiple large trials have been conducted to elucidate temperature targets, management strategies, and timing. The strongest data concerning the use of therapeutic hypothermia exist in comatose survivors of cardiac arrest, and recent trials suggest that appropriate postarrest temperature targets between 33°C and 37.5°C are reasonable. Targeted temperature management in other critical illnesses, including acute stroke, traumatic brain injury, and sepsis, has not shown benefit in large clinical trials. Likewise, trials of pharmacologic antipyretic therapy have not demonstrated improved outcomes, although national guidelines do recommend treatment of fever in patients with stroke and traumatic brain injury based on observational evidence associating fever with worse outcomes. Body temperature management in critically ill patients remains an appealing therapy for several illnesses, and additional studies are needed to clarify management strategies and therapeutic pathways.

A case of recurrent liver failure during febrile episode

Infantile liver failure syndrome 2 is a rare autosomal recessive genetic condition which manifests as recurrent acute liver failure episodes triggered by febrile illness. Clinical exome test which showed a homozygous sequence variant in the NBAS gene. The liver enzymes totally deranged during a febrile episopde and may make a complete recovery with conservative treatment like antipyretic therapy and other supportive measures.

The antipyretic effectiveness of dipyrone in the intensive care unit: A retrospective cohort study.

IntroductionDipyrone (metamizol) is regularly used in critical care for pain and fever treatment, especially in Germany and Spain. However, indication for antipyretic therapy in critically ill patients is currently unclear and data for both the risk and benefit of dipyrone treatment in the intensive care environment are scarce. We hypothesized that antipyretic efficiency of dipyrone would not exceed antipyretic efficiency of acetaminophen. We therefore aimed to compare temperature courses in critically ill patients receiving either intravenous dipyrone, acetaminophen or no antipyretic medication.Material and methodsWe included 937 intensive care unit (ICU) patients with body temperature recordings of at least 37.5°C. We investigated temperature decrease associated with dipyrone or acetaminophen and additionally compared it to an untreated control group.ResultsWithin the eight-hour study interval, maximum body temperature decrease in patients without antipyretic medication was -0.6°C (IQR: -1.0 to -0.4°C; n = 315). Maximal decrease in body temperature was higher both with dipyrone (-0.8°C (IQR: -1.2 to -0.4°C); p = 0.016; n = 341) and acetaminophen (-0.9°C (IQR: -1.6 to -0.6°C); p<0.001; n = 71), but did not differ between dipyrone and acetaminophen (p = 0.066). As compared to untreated patients, dipyrone only led to a marginal additional decrease in body temperature of only -0.1°C. Maximum of antipyretic effectiveness was reached four hours after administration.ConclusionAntipyretic effectiveness of dipyrone in ICU patients may be overestimated. Given the lack of prospective data, clinical evidence for antipyretic dipyrone therapy in the ICU is insufficient and warrants further critical evaluation.

Treatment of fever in acute upper respiratory tract infections in children

Introduction. The WHO recommends using acetaminophen (paracetamol) and ibuprofen in fever treatment in children and does not recommend their use in sequence to avoid overdose. However, in recent years, preparations containing both medicinal components have appeared, which allows fever to be relieved safely and the daily dosage of the medicines to be reduced.Objective. To obtain additional data on the efficacy and safety of antipyretic drug combination in comparison with mono drugs in children with the febrile syndrome in acute upper respiratory tract infectionsMaterials and methods. Single-center non-interventional (observational) comparative study was conducted in children from 3 to 12 years of age with acute respiratory infections accompanied by fever. Children were divided into 3 groups: the treatment group (83 children) received a combined antipyretic drug in the form of dispensable tablets (100 mg ibuprofen and 125 mg paracetamol); control group 1 (42 children) received paracetamol in the form of suspension; control group 2 (43 children) received ibuprofen in the form of suspension. The clinical efficacy and safety of antipyretic therapy and also the satisfaction of the patients’ parents, were evaluated in the dynamics.Results. The results showed similar efficacy and safety of all three medications, but the daily dose of medications with the combined dispersible tablets was lower, more so for paracetamol and somewhat less so for ibuprofen. In the combined dispersible tablets group, the proportion of patients with a temperature &lt; 37.2 °C was statistically significantly higher 1 hour after administration than in the paracetamol and ibuprofen drug groups. Ibuprofen only compared with the study drug in terms of efficacy after 2 hours, while paracetamol was already effective after 3 hours.Conclusions. The study showed that the combined drug in the form of dispersible tablets (100 mg of ibuprofen and 125 mg of paracetamol) showed statistically significant efficacy parameters, is safe and well-tolerated by patients.

A review of the role and mechanisms of action of baclofen in the management of central hyperthermia

Baclofen was previously known for its efficacy to treat spasticity but this agent has been studied and reported to have several other uses including its role in central hyperthermia. Central hyperthermia is associated with increased morbidity, mortality, and the impact of neuronal damage on the central nervous system. Until now there is no established guideline for the management of central hyperthermia which generally does not respond to standard antipyretic therapy. In this literature review, we will discuss the basic concepts of central hyperthermia and the role and mechanism of action of baclofen as an option for central hyperthermia therapy.

Passive antipyretic therapy is not as effective as invasive hypothermia for maintaining normothermia after cardiac arrest.

Targeted temperature management is a class I indication in comatose patients after a cardiac arrest. While the literature has primarily focused on innovative methods to achieve target temperatures, pharmacologic therapy has received little attention. We sought to examine whether pharmacologic therapy using antipyretics is effective in maintaining normothermia in post cardiac arrest patients. Patients ≥18 years who were resuscitated after an in-hospital or out-of-hospital cardiac arrest and admitted at our institution from January 2012 to September 2015 were retrospectively included. Patients were divided into groups based on the method of temperature control that was utilized. The primary outcome was temperature control <38 °C during the first 48 h after the cardiac arrest. 671 patients were identified in Group 1 (no hypothermia), 647 in Group 2 (antipyretics), 44 in Group 3 (invasive hypothermia), and 51 in Group 4 (invasive hypothermia and antipyretics). Mean patient age was 59 (SD ±15.7) years with 40.6% being female. Using Group 1 as the control arm, 57.7% of patients maintained target temperature with antipyretics alone (p < 0.001), compared to 69.3% in the control group and 82.1% in the combined hypothermia groups 3&4 (p = 0.01). Patients receiving both invasive hypothermia and antipyretics (Group 4), had the greatest mean temperature decrease of 5.2 °C. Among patients undergoing targeted temperature management, relying solely on as needed use of antipyretics is not sufficient to maintain temperatures <38 °C. However, antipyretics could be used as an initial strategy if given regularly and/or in conjunction with more aggressive cooling techniques.

Пирексия и антипиретическая терапия у больных при критических состояниях

Повышение температуры ядра тела является одним из наиболее часто встречающихся аномальных признаков у пациентов, поступивших в ОИТ, и это связано с увеличением смертности среди некоторых групп пациентов с тяжелыми заболеваниями. Повышенная температура тела обнаруживается примерно у 50 % взрослых пациентов, поступивших в отделение интенсивной терапии (ОИТ). Повышенная температура тела классифицируется как пирексия или гипертермия. Пирексия (также ее называют лихорадкой) рассматривается как адаптивный ответ на физиологический стресс, который регулируется через эндогенные пирогенные и антипиретические пути и связан с увеличением гипоталамического заданного значения. Гипертермические синдромы включают: гипертермию окружающей среды, в том числе тепловой удар; гипертермию, вызванную лекарственными средствами; нейролептический злокачественный синдром; синдром серотонина и эндокринные причины, включая тиреотоксикоз, феохромоцитому и надпочечниковый криз. Многие эпизоды пирексии вызваны инфекциями. Наиболее распространенными источниками инфекции являются нижние дыхательные пути, внутрибрюшные инфекции, инфекции мочевых путей и другие, которые включают инфекцию кожи и мягких тканей, костей или суставов, центральной нервной системы, этмоидных и верхнечелюстных пазух. Пирексия из-за неинфекционной этиологии также является распространенной причиной лихорадки у пациентов в ОИТ. Для борьбы с пирексией могут использоваться антипиретики, главным образом парацетамол и нестероидные противовоспалительные препараты, а также физические методы охлаждения. Лечение с помощью жаропонижающих препаратов распространено в ОИТ. Было показано, что исследования жаропонижающей терапии, которые включали как септических, так и несептических пациентов, не обнаружили значительного улучшения 28-дневной госпитальной летальности у взрослых критических пациентов с сепсисом или без него. Дополнительные исследования улучшат понимание патофизиологии пирексии и будут способствовать развитию данного направления.

Анализ осведомленности врачей относительно принципов коррекции лихорадки у детей

Актуальность. Лихорадка у детей является одной из наиболее частых причин обращения родителей к врачу. Цель: проанализировать состояние осведомленности врачей относительно принципов лечения лихорадки у детей, методов оптимальной дозировки жаропонижающих препаратов и особенностей применения жаропонижающей терапии у отдельных категорий пациентов по специально разработанным анкетам. Материалы и методы. В опросе принимало участие 108 врачей. Анкета состояла из 20 вопросов. Результаты. Врачи отмечают, что для снижения температуры тела у ребенка только 66,0 % родителей используют средства, рекомендованные врачом, остальные опираются на личный опыт и рекомендации провизоров. 64,2 % респондентов в качестве жаропонижающего препарата первой линии указали ибупрофен. Показанием к применению жаропонижающих препаратов 90,6 % врачей считали повышение температуры тела до 38,5 °С и более. Вместе с тем 26,4 % врачей применяют эту группу препаратов после вакцинации; 17,0 % респондентов допускают применение жаропонижающих препаратов при температуре тела у ребенка меньше 38,5 °С, прежде всего при фебрильных судорогах в анамнезе, а также при болевом синдроме и плохом самочувствии. 50,9 % респондентов комбинируют применение ацетаминофена и ибупрофена в случае неэффективности одного из них, используя второй препарат в промежутках между приемами первого. Наиболее сложными вопросами для врачей были особенности применения жаропонижающих препаратов у детей с сопутствующей патологией. Выводы. С учетом полученных данных считаем необходимым проводить дальнейшую работу среди врачей относительно осведомленности о принципах и показаниях к использованию антипиретической терапии у детей.