TY - JOUR
T1 - Antipyretic therapy in critically ill septic patients
T2 - A systematic review and meta-Analysis
AU - Drewry, Anne M.
AU - Ablordeppey, Enyo A.
AU - Murray, Ellen T.
AU - Stoll, Carolyn R.T.
AU - Izadi, Sonya R.
AU - Dalton, Catherine M.
AU - Hardi, Angela C.
AU - Fowler, Susan A.
AU - Fuller, Brian M.
AU - Colditz, Graham A.
N1 - Publisher Copyright:
© 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Objective: This meta-Analysis aimed to examine the impact of antipyretic therapy on mortality in critically ill septic adults. Data Sources: Literature searches were implemented in Ovid Medline, Embase, Scopus, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, and ClinicalTrials.gov through February 2016. Study Selection: Inclusion criteria were observational or randomized studies of septic patients, evaluation of antipyretic treatment, mortality reported, and English-language version available. Studies were excluded if they enrolled pediatric patients, patients with neurologic injury, or healthy volunteers. Criteria were applied by two independent reviewers. Data Extraction: Two reviewers independently extracted data and evaluated methodologic quality. Outcomes included mortality, frequency of shock reversal, acquisition of nosocomial infections, and changes in body temperature, heart rate, and minute ventilation. Randomized and observational studies were analyzed separately. Data Synthesis: Eight randomized studies (1,507 patients) and eight observational studies (17,432 patients) were analyzed. Antipyretic therapy did not reduce 28-day/hospital mortality in the randomized studies (relative risk, 0.93; 95% CI, 0.77-1.13; I2 = 0.0%) or observational studies (odds ratio, 0.90; 95% CI, 0.54-1.51; I2 = 76.1%). Shock reversal (relative risk, 1.13; 95% CI, 0.68-1.90; I2 = 51.6%) and acquisition of nosocomial infections (relative risk, 1.13; 95% CI, 0.61-2.09; I2 = 61.0%) were also unchanged. Antipyretic therapy decreased body temperature (mean difference, -0.38°C; 95% CI, -0.63 to -0.13; I2 = 84.0%), but not heart rate or minute ventilation. Conclusions: Antipyretic treatment does not significantly improve 28-day/hospital mortality in adult patients with sepsis.
AB - Objective: This meta-Analysis aimed to examine the impact of antipyretic therapy on mortality in critically ill septic adults. Data Sources: Literature searches were implemented in Ovid Medline, Embase, Scopus, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, and ClinicalTrials.gov through February 2016. Study Selection: Inclusion criteria were observational or randomized studies of septic patients, evaluation of antipyretic treatment, mortality reported, and English-language version available. Studies were excluded if they enrolled pediatric patients, patients with neurologic injury, or healthy volunteers. Criteria were applied by two independent reviewers. Data Extraction: Two reviewers independently extracted data and evaluated methodologic quality. Outcomes included mortality, frequency of shock reversal, acquisition of nosocomial infections, and changes in body temperature, heart rate, and minute ventilation. Randomized and observational studies were analyzed separately. Data Synthesis: Eight randomized studies (1,507 patients) and eight observational studies (17,432 patients) were analyzed. Antipyretic therapy did not reduce 28-day/hospital mortality in the randomized studies (relative risk, 0.93; 95% CI, 0.77-1.13; I2 = 0.0%) or observational studies (odds ratio, 0.90; 95% CI, 0.54-1.51; I2 = 76.1%). Shock reversal (relative risk, 1.13; 95% CI, 0.68-1.90; I2 = 51.6%) and acquisition of nosocomial infections (relative risk, 1.13; 95% CI, 0.61-2.09; I2 = 61.0%) were also unchanged. Antipyretic therapy decreased body temperature (mean difference, -0.38°C; 95% CI, -0.63 to -0.13; I2 = 84.0%), but not heart rate or minute ventilation. Conclusions: Antipyretic treatment does not significantly improve 28-day/hospital mortality in adult patients with sepsis.
KW - Acetaminophen
KW - Antipyretics
KW - Fever
KW - Mortality
KW - Sepsis
UR - http://www.scopus.com/inward/record.url?scp=85013384798&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000002285
DO - 10.1097/CCM.0000000000002285
M3 - Review article
C2 - 28221185
AN - SCOPUS:85013384798
SN - 0090-3493
VL - 45
SP - 806
EP - 813
JO - Critical care medicine
JF - Critical care medicine
IS - 5
ER -