Point: Should antipyretic therapy be given routinely to febrile patients in septic shock? yes

Abstract

Summary In summary, fever is clearly an important adaptive response to infection. Similar native responses to septic shock include capillary leak, hypotension, myocardial dysfunction, overwhelming inflammatory response, organ failure, and death. For patients with the highest mortality, the benefit of controlling fever outweighs the harm from impairing fever-dependent immune function. Data opposing fever control are drawn primarily from patient populations having lower sever ity of illness, using drug therapy for antipyresis, or controlling temperature prior to infection. The only quality clinical trial that tests external cooling in patients with septic shock supports fever control for improving resolution from shock and for decreasing mortality. Hyperthermia therapy was popular in the early 20th century as a pre-antibiotic treatment of infection. Is interest in the therapeutic value of fever in critical illness based on clinical data, or do we think that fever is important only because "it must be"? Emerg ing data are clear - our most seriously ill patients do not toler ate fever well, and we should use temperature management as an additional therapy to optimize sepsis physiology. © 2013 American College of Chest Physicians.