Department of Medicine, McMaster University, Hamilton, Canada.
Department of Critical Medicine, Al Ahsa Hospital, Al Ahsa, Saudi Arabia.
J Crit Care. 2021 Feb;61:89-95. doi: 10.1016/j.jcrc.2020.10.016. Epub 2020 Oct 20.
Fever is frequently encountered in ICU. It is unclear if targeted temperature control is beneficial in critically ill patients with suspected or confirmed infection. We conducted a systemic review and meta-analysis to answer this question.
We systematically reviewed major databases before January 2020 to identify randomized controlled trials (RCTs) that compared antipyretic with placebo for temperature control in non-neurocritical ill adult patients with suspected or confirmed infection. Outcomes of interest were 28-day mortality, temperature level, hospital mortality, length of stay, shock reversal, and patient comfort.
13 RCTs enrolling 1963 patients were included. No difference in 28-day mortality between antipyretic compared with placebo (risk ratio [RR] 1.03; 95% CI 0.79-1.35). Lower temperature levels were achieved in the antipyretic group (MD [mean difference] -0.41; 95% CI -0.66 to -0.16). Antipyretic use did not affect the risk of hospital mortality (RR 0.97; 95% CI 0.73-1.30), ICU length of stay (MD -0.07; 95% CI -0.70 to 0.56), or shock reversal (RR 1.11; 95% CI 0.76-1.62).
Antipyretic therapy effectively reduces temperature in non-neurocritical ill patients but does not reduce mortality or impact other outcomes.
发热在 ICU 中经常遇到。目前尚不清楚在疑似或确诊感染的危重病患者中，目标体温控制是否有益。我们进行了系统评价和荟萃分析以回答这个问题。
我们系统地检索了 2020 年 1 月之前的主要数据库，以确定比较解热与安慰剂在疑似或确诊感染的非神经危重病成年患者中进行体温控制的随机对照试验（RCT）。感兴趣的结局是 28 天死亡率、体温水平、住院死亡率、住院时间、休克逆转和患者舒适度。
纳入了 13 项 RCT 共 1963 例患者。与安慰剂相比，解热组 28 天死亡率无差异（风险比 [RR] 1.03；95% CI 0.79-1.35）。解热组体温水平较低（MD [均数差] -0.41；95% CI -0.66 至 -0.16）。解热治疗并未影响住院死亡率（RR 0.97；95% CI 0.73-1.30）、ICU 住院时间（MD -0.07；95% CI -0.70 至 0.56）或休克逆转（RR 1.11；95% CI 0.76-1.62）。
解热治疗可有效降低非神经危重病患者的体温，但不能降低死亡率或影响其他结局。
