Medical Research Institute of New Zealand, Wellington, New Zealand.
Crit Care Resusc. 2011 Jun;13(2):125-31.
Antipyretic medications are widely used in critically ill patients with infection despite evidence supporting a protective, adaptive role of fever.
To assess the mortality risk of antipyretic medications among critically ill patients with infection.
A systematic search of MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and PubMed was undertaken to identify randomised controlled trials (RCTs) of antipyretic use among critically ill patients with suspected or confirmed infection that reported mortality. A quantitative meta-analysis of the risk of death was carried out with calculation of the pooled risk of death and standard evaluation of heterogeneity.
Six RCTs investigating the use of paracetamol (1) and non-steroidal anti-inflammatory medications (5) met the inclusion criteria for meta-analysis. The trials were heterogeneous in terms of study populations and interventions, were not primarily designed to evaluate antipyretic effect on mortality risk, and significant confounding was present from the use of other concomitant antipyretic strategies. The pooled estimates of odds ratios for mortality with antipyretic treatment were 0.96 (95% CI, 0.68-1.34) and 1.08 (95% CI, 0.60-1.96) for fixed effects and random effects, respectively, and the I-squared value was 34.9 (95% CI, 0.0-73.9).
The studies included in this review were insufficient to allow a robust estimate of the effect of pharmacological antipyresis on mortality in critically ill patients with suspected infection. Further RCTs are required to resolve this important area of clinical uncertainty.
尽管有证据表明发热具有保护和适应性作用，但退热药物在感染性危重症患者中仍被广泛应用。
评估感染性危重症患者使用退热药物的死亡风险。
系统检索 MEDLINE、Embase、Cochrane 对照试验中心注册库和 PubMed，以确定报道病死率的针对疑似或确诊感染的危重症患者使用退热药物的随机对照试验（RCT）。采用荟萃分析方法对死亡风险进行定量分析，计算汇总死亡风险并评估异质性。
纳入了 6 项 RCT 研究，涉及对乙酰氨基酚（1 项）和非甾体类抗炎药物（5 项）的使用，这些试验在研究人群和干预措施方面存在异质性，并非主要设计用于评估退热对死亡风险的影响，且存在其他伴随的退热策略使用的显著混杂因素。固定效应和随机效应的汇总估计病死率的优势比分别为 0.96（95%CI，0.68-1.34）和 1.08（95%CI，0.60-1.96），I²值为 34.9（95%CI，0.0-73.9）。
本综述纳入的研究不足以对疑似感染的危重症患者使用药物退热对病死率的影响进行稳健估计。需要进一步的 RCT 来解决这一重要的临床不确定性领域。
