Dallimore Jonathan, Ebmeier Stefan, Thayabaran Darmiga, Bellomo Rinaldo, Bernard Gordon, Schortgen Frédérique, Saxena Manoj, Beasley Richard, Weatherall Mark, Young Paul
Capital and Coast District Health Board, Wellington, New Zealand.
Medical Research Institute of New Zealand, Wellington, New Zealand.
Crit Care Resusc. 2018 Jun;20(2):150-163.
To evaluate the effect of active temperature management on mortality, intensive care unit (ICU) and hospital length of stay, as well as the relative efficacy of antipyretic medications and physical cooling devices for achieving reductions in temperature in critically ill adults.
DESIGN, SETTING AND PARTICIPANTS: Systematic review and meta-analysis of randomised controlled trials (RCTs) investigating treatments administered to febrile patients in order to reduce body temperature. Fifteen studies reporting results from 13 RCTs met our eligibility criteria.
Treatments administered to reduce body temperature were defined as physical cooling, nonsteroidal anti-inflammatory drugs, paracetamol, or any combination of these.
The primary outcome variable was all-cause mortality at the longest time point after randomisation. Secondary outcomes were ICU and hospital length of stay, and body temperature 12 hours after randomisation.
Active temperature control had no statistically significant association with mortality (odds ratio, 1.01; 95% confidence interval [CI], 0.81-1.28; P = 0.95, for fixed effects). There was no statistically significant association between active temperature management and ICU or hospital length of stay. Active temperature management was associated with a statistically significant reduction in temperature. The fixed effects estimate for the active minus control treatment for pharmaceutical management was -0.62C (95% CI, -0.72C to -0.51C; P < 0.001) and for physical cooling was -1.59C (95% CI, -1.82C to -1.35C; P < 0.001).
Active temperature management neither increased nor decreased mortality risk in critically ill adults. When the therapeutic goal is to reduce body temperature, physical cooling approaches may be more effective than pharmacological measures in critically ill adults.
评估主动体温管理对死亡率、重症监护病房（ICU）住院时间和医院住院时间的影响，以及退热药物和物理降温设备在降低危重症成年患者体温方面的相对疗效。
设计、设置和参与者：对调查用于发热患者以降低体温的治疗方法的随机对照试验（RCT）进行系统评价和荟萃分析。15项报告13项RCT结果的研究符合我们的纳入标准。
用于降低体温的治疗方法定义为物理降温、非甾体抗炎药、对乙酰氨基酚或这些方法的任何组合。
主要结局变量是随机分组后最长时间点的全因死亡率。次要结局是ICU住院时间和医院住院时间，以及随机分组后12小时的体温。
主动体温控制与死亡率无统计学显著关联（优势比，1.01；95%置信区间[CI]，0.81 - 1.28；固定效应模型下P = 0.95）。主动体温管理与ICU住院时间或医院住院时间之间无统计学显著关联。主动体温管理与体温的统计学显著降低相关。药物管理的主动治疗减去对照治疗的固定效应估计值为-0.62℃（95%CI，-0.72℃至-0.51℃；P < 0.001），物理降温的为-1.59℃（95%CI，-1.82℃至-1.35℃；P < 0.001）。
主动体温管理在危重症成年患者中既未增加也未降低死亡风险。当治疗目标是降低体温时，在危重症成年患者中，物理降温方法可能比药物措施更有效。
