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Table 1 Main RCTs comparing antipyretics with no treatment in adult critically ill patients

From: Should we treat pyrexia? And how do we do it?

 

Study

Patients

Number

Temperature criteria at inclusion

Baseline temperature in the treatment group

Antipyretic method

Duration of treatment

Primary end point

Main results

SIRS and Sepsis

Gozolli et al. [41]

SIRS

38

≥38.5 °C

39 (SD 0.3)

Surface cooling

Up to fever resolution (≤37.5 °C)

Temperature difference

Similar temperature and comfort evolution

Bernard et al. [15]

Severe sepsis

455

Nonea

37.9 (SE 0.2)

NSAID: IV ibuprofen 10 mg/kg/6 h

48 h

30-day mortality

Lower temperature in the treatment group

No difference in mortality

Memis et al. [50]

Severe sepsis

40

Nonea

37.8 (SD 0.75)

NSAID: IV lornoxicam 8 mg/12 h

72 h

Anti-inflammatory effects

Similar temperature evolution

Schortgen et al. [27]

Septic shock

200

≥38.3 °C

38.8 (IQR 38.6–39.2)

TTM 36.5–37 °C with surface cooling

48 h

Dose of vasopressor

Less vasopressor requirement and 14-day mortality in the treatment group

Janz [48]

Severe sepsis

40

Nonea

37.7 (IQR 37–38.5)

IV paracetamol 1 g/6 h

3 days

Antioxidant effect

Lower maximal temperature in the treatment group

Young et al. [29]

Suspected infection

700

≥38 °C

38.5 (SD 0.5)

IV paracetamol 1 g/ 6 h

Up to fever resolution (<37.5 °C, 24 h) or day 28

ICU-free days up to day 28.

Lower temperature in the treatment group

No difference in ICU-free days

Acute brain injury

den Hertog et al. [35]

Stroke

1400

Between 36 and 39 °C

36.9 (SD 0.6)

Enteral paracetamol 1 g/4 h

72 h

Modified Rankin scale at 3 months

Lower temperature in the treatment group

No difference in neurological outcome

Saxena et al. [46]

TBI

41

Between 36 and 39 °C

37.3 (SD 0.8)

IV paracetamol 1 g/4 h

72 h

Temperature difference

No difference in temperature

  1. aAntipyretics were given with the aim of testing the anti-inflammatory effects of NSAIDs
  2. IQR 25th–75th interquartile range, IV intravenous, NSAID non-steroidal anti-inflammatory drug, SD standard deviation, SE standard error, SIRS systemic inflammatory response syndrome, TBI traumatic brain injury