Fever Control Using External Cooling in Septic Shock A Randomized Controlled Trial

Rationale: Fever control may improve vascular tone and decrease oxygen consumption, but fever may contribute to combat infection. Objectives: To determine whether fever control by external cooling diminishes vasopressor requirements in septic shock. Methods: In a multicenter randomized controlled trial, febrile patients with septic shock requiring vasopressors, mechanical ventilation, and sedation were allocated to external cooling (n = 101) to achieve normothermia (36.5-37 degrees C) for 48 hours or no external cooling (n = 99). Vasopressors were tapered to maintain the same blood pressure target in the two groups. The primary endpoint was the number of patients with a 50% decrease in baseline vasopressor dose after 48 hours. Measurements and Main Results: Body temperature was significantly lower in the cooling group after 2 hours of treatment (36.8 +/- 0.7 vs. 38.4 +/- 1.1 degrees C; P < 0.01). A 50% vasopressor dose decrease was significantly more common with external cooling from 12 hours of treatment (54 vs. 20%; absolute difference, 34%; 95% confidence interval [95% Cl], -46 to -21; P < 0.001) but not at 48 hours (72 vs. 61%; absolute difference, 11%; 95% Cl, -23 to 2). Shock reversal during the intensive care unit stay was significantly more common with cooling (86 vs. 73%; absolute difference, 13%; 95% Cl, 2 to 25; P = 0.021). Day-14 mortality was significantly lower in the cooling group (19 vs. 34%; absolute difference, -16%; 95% Cl, -28 to -4; P = 0.013). Conclusions: In this study, fever control using external cooling was safe and decreased vasopressor requirements and early mortality in septic shock.