Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand.
Medical Research Institute of New Zealand, Wellington, New Zealand.
Intensive Care Med. 2019 Oct;45(10):1382-1391. doi: 10.1007/s00134-019-05729-4. Epub 2019 Oct 1.
It is unknown whether protocols targeting systematic prevention and treatment of fever achieve lower mean body temperature than usual care in intensive care unit (ICU) patients. The objective of the Randomised Evaluation of Active Control of temperature vs. ORdinary temperature management trial was to confirm the feasibility of such a protocol with a view to conducting a larger trial.
We randomly assigned 184 adults without acute brain pathologies who had a fever in the previous 12 h, and were expected to be ventilated beyond the calendar day after recruitment, to systematic prevention and treatment of fever or usual care. The primary outcome was mean body temperature in the ICU within 7 days of randomisation. Secondary outcomes included in-hospital mortality, ICU-free days and survival time censored at hospital discharge.
Compared with usual temperature management, active management significantly reduced mean temperature. In both groups, fever generally abated within 72 h. The mean temperature difference between groups was greatest in the first 48 h, when it was generally in the order of 0.5 °C. Overall, 23 of 89 patients assigned to active management (25.8%) and 23 of 89 patients assigned to usual management (25.8%) died in hospital (odds ratio 1.0, 95% CI 0.51-1.96, P = 1.0). There were no statistically significant differences between groups in ICU-free days or survival to day 90.
Active temperature management reduced body temperature compared with usual care; however, fever abated rapidly, even in patients assigned to usual care, and the magnitude of temperature separation was small.
Australian and New Zealand Clinical Trials Registry Number, ACTRN12616001285448.
目前尚不清楚针对发热的系统预防和治疗方案是否比重症监护病房（ICU）患者的常规护理能更有效地降低平均体温。主动控制体温与常规体温管理试验的目的是确认这种方案的可行性，以便开展更大规模的试验。
我们将 184 名无急性脑部病变且在过去 12 小时内发热、预计在入组后日历日后仍需通气的成年人随机分为系统发热预防和治疗组或常规护理组。主要结局为随机分组后 7 天内 ICU 内的平均体温。次要结局包括住院期间死亡率、ICU 无天数和以出院为截点的生存时间。
与常规体温管理相比，主动管理可显著降低平均体温。在两组中，发热通常在 72 小时内消退。组间体温差异最大的是在前 48 小时，一般在 0.5°C 左右。总的来说，主动管理组 89 名患者中有 23 名（25.8%）和常规管理组 89 名患者中有 23 名（25.8%）在住院期间死亡（比值比 1.0，95%置信区间 0.51-1.96，P=1.0）。两组间 ICU 无天数或 90 天生存时间无统计学差异。
与常规护理相比，主动体温管理可降低体温；然而，发热迅速消退，即使在接受常规护理的患者中也是如此，且体温分离幅度较小。
澳大利亚和新西兰临床试验注册中心编号，ACTRN12616001285448。
