Journal Club - Recent Additions

February - 2012

Previous Next    

Showing Journal 2 of 15

Fever Control Using External Cooling in Septic Shock: a Randomized Controlled Trial

Frédérique Schortgen, Karine Clabault, Sandrine Katsahian, et al Am J Resp Crit Care Med, 2012, Published ahead of print on February 23, 2012, doi


 In this French multi centre trial the application of external cooling to patients with severe sepsis and a fever led to;
- difference in temperature sustained for treatment
- decrease in vasopressor requirement by more than 50% for first 12- hrs, with the effect no longer...


Previous Comments

While this sounded really good in the abstract, the paper itself is not nearly so impressive, with an initial divergence in survival and pressor requirements, which then consistently approached each other, such that by hospital discharge there was a small, non significant survival benefit to cooling... but a paradoxically longer stay in hospital and ICU. My personal bottom line: I wouldn't use this therapy at this time unless I was really concerned that death was imminent because of unsupportable haemodynamics in the early phases of septic shock.
Matthew Bailey-27 Feb, 2012 01:16:23 PM

14 day survival is not a mortality benefit in this cohort. The difference as reported in the abstract is firstly not credible and secondly seems, as the first comment notes, to diminish with time. I'm not even going to suggest another trial because this one needs more follow up and is at the moment proof-of-concept rather than a pilot with outcome data.
LEWIS CAMPBELL-27 Feb, 2012 01:18:16 PM

I hope you don't use hydrocortisone or vasopressin as catecholamine sparing agents then, because the same would apply. 200 patients is not a small sample, and there is a highly statistically, and clinically, significant reduction in vasopressor use. While there is limited mortality benefit shown, the trial is not powered to assess this.
Jo Butler-29 Feb, 2012 01:35:14 PM

Case for the defense - a lot of what we do in medicine is unproven, based on basic sciences, small studies and experience. The mortality in ICU has fallen over the past 30 years - why? There is no single intervention in ICU medicine that is responsible - rather it is an accumulation of beneficial interventions. My point is that while mortality is not better long term, you can't survive to 90 days if you don't survive to 14. I know its a surrogate, but there is a demonstrable effect on vasopressor use and mortality in the first 14 days, so perhaps that's a good start, and if you can survive that long you might just receive some other intervention that makes your mortality better. Don't write it off just yet.
Jean Bridie-13 Mar, 2012 03:16:53 PM