An article appearing online recently in the American Journal of Respiratory and Critical Care Medicine affirms a benefit for external cooling in sedated patients with septic shock. Septic shock is an inflammatory state resulting from the spread of infectious agents in the bloodstream, which can cause fever, low blood pressure and organ failure. The concept of cooling septic shock patients is controversial, as fever may play a role in the body's defense against pathogens, however, reducing fever can help elevate dangerously low blood pressure.
The current study included 200 adults with septic shock and fever who were receiving an infusion of vasopressor drugs to normalize their blood pressure. One hundred one subjects underwent external cooling under sedation for 48 hours, resulting in a reduction in body temperature to 36.5˚ to 37°C. Vasopressor dose was lowered to maintain normal blood pressure when indicated.
Participants undergoing cooling began to experience a reduction in body temperature after two hours. At twelve hours, those treated with cooling had a significantly greater need for a decrease in medication dose. This group also had a higher prevalence of shock reversal during their intensive care unit stay, and lower mortality at two weeks.
"The benefits and risks of fever control in patients with severe sepsis remains a matter of controversy," stated 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."
"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."
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