Wednesday, January 16, 2013

Should we artificially lower temperature in septic patients? It's complicated.

In general the lowering of body temperature in febrile patients via antipyretics or external methods is useless in terms of outcomes and may be harmful. Exceptions include heat stroke and other hyperthermia syndromes, stroke patients and post cardiac arrest patients.

The issue recently became more nuanced when publication of this paper from the blue journal added another possible exception: patients in septic shock treated with external cooling, in whom a decrease in pressor requirements and mortality was observed. On the other hand the use of antipyretics in septic patients across the board was associated with increased mortality in this study.

It is intuitive that external cooling would reduce pressor requirement because it induces vasoconstriction.

1 comment:

Yaya said...

Well, it is a really interesting topic academically and in my daily medical practice. Academically i have been hearing/reading different and sometimes paradoxical things in this regard over the past 5-6 years. i remember in some of my rotations I was blamed for not giving antipyretics to patients with fever and in some others blamed for giving antipyretics!!! Furhtermore one of the most terrifying finding for our nurses in a patient is fever and the automatic question after it is:"Dr. we must give him/her something to control the fever". Well it takes a few minutes to explain the first nurse that fever is a presumed defence mechanism against the infection and i prefer not to give antipyretics for a slight fever. Well the first nurse looks sceptically at me and goes out. I begin to think about the possible causes/foci of fever,and begin with the routine fever work-up. in a few hours comes another nurse and asks the same question. and again and again. Eventually i give up and give the patient something to bring the temperature down.