According to a study by French researchers, fever control using external cooling in sedated septic shock patients is safe and lowers premature death and vasopressor requirements. The study was published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

Frédérique Schortgen, MD, PhD, of the Henri Mondor Hospital in Créteil, France, and lead researcher of the study, explained:

“The benefits and risks of fever control in patients with severe sepsis remains a matter of controversy. 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.”

In the multi-center trial, the researchers enrolled 200 febrile adults with septic shock from 7 participating ICUs to participate in the study. At the time of enrollment, all participants were receiving vasopressor treatment, sedation, and mechanical ventilation.

The researchers randomly assigned 99 participants to no external cooling and 101 participants to external cooling. Participants assigned to the cooling group, underwent cooling for 48 hours to maintain a core body temperature between 36.5°C and 37°C. In both the cooling and non-cooling groups, vasopressors were tapered to maintain a mean arterial pressure target of 65 mmHg.

The researchers found that body temperature was considerably lower among participants in the cooling group after two hours of treatment. The number of participants with a 50% vasopressor dose decrease vs. baseline was considerably higher among patients in the cooling group after 12 hours of treatment, although it was not significant at 48 hours. In addition, they found that shock reversal during ICU stay was considerably more prevalent in the cooling group, as well as day-14 mortality. After adjustment for baseline vasopressor dose and sepsis severity scores, all comparisons remained significant.

Limitations of the study included:

  • The study was not blinded
  • Life-supporting treatments given prior to inclusion during the early stage of sepsis were not documented
  • Participants in the cooling group had a lower baseline dose of vasopressors, possibly suggesting lower illness severity, even though all other variables linked to outcomes in sepsis were well balanced between both groups

Dr. Schortgen, explained:

“Although cooling prevented early deaths in our patients, mortality reduction was not significant at ICU or hospital discharge, and we cannot make definitive conclusions on the effects of cooling on mortality from our data. 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.”

Written by Grace Rattue