title: Should we treat fever in critically ill patients? A summary of the current evidence from three randomized controlled trials.
abstract: Fever is a nonspecific response to various types of infectious or non-infectious insult and its significance in disease remains an enigma. Our aim was to summarize the current evidence for the use of antipyretic therapy in critically ill patients. We performed systematic review and meta-analysis of publications from 1966 to 2013. The MEDLINE and CENTRAL databases were searched for studies on antipyresis in critically ill patients. The meta-analysis was limited to: randomized controlled trials; adult human critically ill patients; treatment with antipyretics in one arm versus placebo or non-treatment in another arm; and report of mortality data. The outcomes assessed were overall intensive care unit mortality, changes in temperature, intensive care unit length of stay, and hospital length of stay. Three randomized controlled trials, covering 320 participants, were included. Patients treated with antipyretic agents showed similar intensive care unit mortality (risk ratio 0.91, with 95% confidence interval 0.65-1.28) when compared with controls. The only difference observed was a greater decrease in temperature after 24 hours in patients treated with antipyretics (-1.70±0.40 versus - 0.56±0.25ºC; p=0.014). There is no difference in treating or not the fever in critically ill patients.
authors: Faculdade de Medicina do ABC, Santo André, SP, Brasil.
authors: Ary
authors: A
authors: Serpa Neto
authors: Faculdade de Medicina do ABC, Santo André, SP, Brasil.
authors: Victor Galvão Moura
authors: VG
authors: Pereira
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.
authors: Giancarlo
authors: G
authors: Colombo
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.
authors: Farah Christina de la Cruz
authors: FC
authors: Scarin
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.
authors: Camila Menezes Souza
authors: CM
authors: Pessoa
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.
authors: Leonardo Lima
authors: LL
authors: Rocha
mesh_terms: D000328:Adult; D000368:Aged; D058633:Antipyretics / Q000627:therapeutic use*; D016638:Critical Illness; D005334:Fever / Q000188:drug therapy*; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058633:Antipyretics
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