• Paul J Young, Rinaldo Bellomo, Gordon R Bernard, Daniel J Niven, Frederique Schortgen, Manoj Saxena, Richard Beasley, and Mark Weatherall.
• Intensive Care Unit, Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand. Paul.Young@ccdhb.org.nz.
• Intensive Care Med. 2019 Apr 1; 45 (4): 468-476.

PurposeOne potential way to protect patients from the physiological demands that are a consequence of fever is to aim to prevent fever and to treat it assiduously when it occurs. Our primary hypothesis was that more active fever management would increase survival among patient subgroups with limited physiological reserves such as older patients, patients with higher illness acuity, and those requiring organ support.MethodsWe conducted an individual-level patient data meta-analysis of randomised controlled trials to compare the outcomes of ICU patients who received more active fever management with the outcomes of patients who received less active fever management. The primary outcome variable of interest was the unadjusted time to death after randomisation.ResultsOf 1413 trial participants, 707 were assigned to more active fever management and 706 were assigned to less active fever management. There was no statistically significant heterogeneity in the effect of more active compared with less active fever management on survival in any of the pre-specified subgroups that were chosen to identify patients with limited physiological reserves. Overall, more active fever management did not result in a statistically significant difference in survival time compared with less active fever management [hazard ratio 0.91; (95% CI 0.75-1.10), P = 0.32].ConclusionsOur findings do not support the hypothesis that more active fever management increases survival compared with less active fever management overall or in patients with limited physiological reserves.

14 keywords...

hide…