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Point/Counterpoint Editorials |

Rebuttal From Drs Drewry and HotchkissRebuttal From Drs Drewry and Hotchkiss

Anne M. Drewry, MD; Richard S. Hotchkiss, MD
Author and Funding Information

From the Department of Anesthesiology (Drs Drewry and Hotchkiss), the Department of Surgery (Dr Hotchkiss), and the Department of Medicine (Dr Hotchkiss), Washington University School of Medicine.

Correspondence to: Anne M. Drewry, MD, Department of Anesthesiology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110; e-mail: drewrya@anest.wustl.edu


Funding/Support: Dr Drewry receives support from the Washington University Institute of Clinical and Translational Sciences [Grant UL1TR000448] from the National Center for Advancing Translational Sciences. Dr Hotchkiss receives support from the National Institutes of Health [Grants GM44118 and GM55194].

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Hotchkiss received grant support from MedImmune, LLC; Bristol-Myers Squibb; and Aurigene Discovery Technologies. Dr Drewry has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(4):1102-1103. doi:10.1378/chest.13-0919
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We commend Drs Mohr and Doerschug1 on their well-constructed argument in favor of antipyretic therapy for patients with septic shock. However, based on current evidence, we adamantly maintain that fever should not routinely be treated in all patients with septic shock. Although both our groups seem to agree that pharmacologic antipyretic therapy is unlikely to benefit these patients, we differ in our interpretation of the clinical evidence regarding external cooling. Only one large clinical trial specifically designed to investigate the benefit of external cooling in patients with septic shock exists. Schortgen et al2 randomized 200 febrile patients with severe septic shock to 48 h of external cooling or to no fever control. The number of patients with at least a 50% vasopressor dose reduction at 12 h was greater in the group that received external cooling. Although there was a nonsignificant trend toward decreased ICU mortality in the external cooling group, there was no difference in mortality at hospital discharge. Based on these results, Drs Mohr and Doerschug conclude that “febrile patients with septic shock should be cooled using external cooling to normothermia to optimize clinical outcome.”1 We respectfully disagree.

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