Frédérique Schortgen, Karine Clabault, Sandrine Katsahian, Jerome Devaquet, Alain Mercat6, Nicolas Deye, Jean Dellamonica, Lila Bouadma, Fabrice Cook, Olfa Beji, Christian Brun-Buisson, François Lemaire and Laurent Brochard  Am. J. Respir. Crit. Care Med. May 15, 2012 vol. 185 no. 10 1088-1095
Abstract
Rationale: Fever control may improve vascular tone and decrease oxygen consumption, but fever may contribute to combat infection.

Objectives: To determine whether fever control by external cooling diminishes vasopressor requirements in septic shock.

Methods: In a multicenter randomized controlled trial, febrile patients with septic shock requiring vasopressors, mechanical ventilation, and sedation were allocated to external cooling (n = 101) to achieve normothermia (36.5–37°C) for 48 hours or no external cooling (n = 99). Vasopressors were tapered to maintain the same blood pressure target in the two groups. The primary endpoint was the number of patients with a 50% decrease in baseline vasopressor dose after 48 hours.

Measurements and Main Results: Body temperature was significantly lower in the cooling group after 2 hours of treatment (36.8 ± 0.7 vs. 38.4 ± 1.1°C; P < 0.01). A 50% vasopressor dose decrease was significantly more common with external cooling from 12 hours of treatment (54 vs. 20%; absolute difference, 34%; 95% confidence interval [95% CI], −46 to −21; P < 0.001) but not at 48 hours (72 vs. 61%; absolute difference, 11%; 95% CI, −23 to 2). Shock reversal during the intensive care unit stay was significantly more common with cooling (86 vs. 73%; absolute difference, 13%; 95% CI, 2 to 25; P = 0.021). Day-14 mortality was significantly lower in the cooling group (19 vs. 34%; absolute difference, –16%; 95% CI, −28 to −4; P = 0.013).

Conclusions: In this study, fever control using external cooling was safe and decreased vasopressor requirements and early mortality in septic shock.

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