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Point: Should Antipyretic Therapy Be Given Routinely to Febrile Patients in Septic Shock? YesAntipyretic Therapy in Septic Shock

Nicholas M. Mohr, MD; Kevin C. Doerschug, MD, FCCP
Author and Funding Information

From the Department of Emergency Medicine, Division of Critical Care, Department of Anesthesia (Dr Mohr), and the Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, Department of Internal Medicine (Dr Doerschug), University of Iowa Carver College of Medicine.

Correspondence to: Nicholas M. Mohr, MD, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, 1008 RCP, Iowa City, IA 52242; e-mail: nicholas-mohr@uiowa.edu

Financial/nonfinancial disclosures: The authors have reported to CHEST 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):1096-1098. doi:10.1378/chest.13-0916
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Fever is a highly conserved response to infection in animal species. The presence of fever implies immune competence, and although some postulate the ability to mount fever portends survival advantages, the magnitude of fever has been associated with higher mortality in sepsis.1 Unfortunately, the pathophysiologic derangements accompanying septic shock overcome the protective value of fever, and in some cases fever contributes to a cycle of vasodilatory shock, myocardial dysfunction, and organ failure that precedes death. Critical care physicians should strongly consider external cooling to minimize the harmful effects of fever, especially among the most seriously ill patients. We base this position upon the following arguments:

  • 1. A physiologic rationale exists to support fever therapy;

  • 2. Contradictory conclusions in the literature result primarily from heterogeneity of studies (eg, severity of illness, methods of cooling, and timing of interventions); and

  • 3. The strongest clinical trial supports fever treatment.

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