Intensive fever control using a therapeutic normothermia protocol in patients with febrile early septic shock: A randomized feasibility trial and exploration of the immunomodulatory effects

Objectives: Fever control has been shown to reduce short-term mortality in patients with septic shock. This study aimed to explore the feasibility of early intensive fever control in patients with septic shock and to assess the immunomodulatory effects of this intervention. Methods: In this single-c...

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Main Authors: Jutamas Saoraya, Khrongwong Musikatavorn, Patima Puttaphaisan, Atthasit Komindr, Nattachai Srisawat
Format: Article
Language:English
Published: SAGE Publishing 2020-06-01
Series:SAGE Open Medicine
Online Access:https://doi.org/10.1177/2050312120928732
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author Jutamas Saoraya
Khrongwong Musikatavorn
Patima Puttaphaisan
Atthasit Komindr
Nattachai Srisawat
author_facet Jutamas Saoraya
Khrongwong Musikatavorn
Patima Puttaphaisan
Atthasit Komindr
Nattachai Srisawat
author_sort Jutamas Saoraya
collection DOAJ
description Objectives: Fever control has been shown to reduce short-term mortality in patients with septic shock. This study aimed to explore the feasibility of early intensive fever control in patients with septic shock and to assess the immunomodulatory effects of this intervention. Methods: In this single-center, randomized, open-label trial, febrile patients with septic shock presenting to the emergency department were assigned to either a standard fever control or therapeutic normothermia group. Therapeutic normothermia involved intensive fever control in maintaining normothermia below 37°C. The primary outcome was the feasibility of fever control for 24 h. Secondary outcomes included changes in immunomodulatory biomarkers and adverse events. Results: Fifteen patients were enrolled and analyzed. Fever control was comparable in both groups, but significantly more patients in the therapeutic normothermia group experienced shivering ( p  = 0.007). Both groups demonstrated increased C-reactive protein and unchanged neutrophil chemotaxis and CD11b expression. The therapeutic normothermia group revealed significant decreased IL-6 and IL-10. The standard fever control group significantly expressed increased monocytic human leukocyte antigen. There were no significant differences between the groups in terms of immunomodulation. Conclusions: Therapeutic normothermia was feasible in patients with febrile septic shock but was not superior to standard fever control in terms of average body temperature and host defense function. Shivering was more frequent in the therapeutic normothermia group. Trial registration: Thai Clinical Trials Registry number: TCTR20160321001
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spelling doaj.art-97d1409622b443ed9502b6cd0bbbf4f22022-12-22T02:44:39ZengSAGE PublishingSAGE Open Medicine2050-31212020-06-01810.1177/2050312120928732Intensive fever control using a therapeutic normothermia protocol in patients with febrile early septic shock: A randomized feasibility trial and exploration of the immunomodulatory effectsJutamas Saoraya0Khrongwong Musikatavorn1Patima Puttaphaisan2Atthasit Komindr3Nattachai Srisawat4Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandDepartment of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandDepartment of Emergency Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, ThailandFaculty of Medicine, Chulalongkorn University, Bangkok, ThailandCenter for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USAObjectives: Fever control has been shown to reduce short-term mortality in patients with septic shock. This study aimed to explore the feasibility of early intensive fever control in patients with septic shock and to assess the immunomodulatory effects of this intervention. Methods: In this single-center, randomized, open-label trial, febrile patients with septic shock presenting to the emergency department were assigned to either a standard fever control or therapeutic normothermia group. Therapeutic normothermia involved intensive fever control in maintaining normothermia below 37°C. The primary outcome was the feasibility of fever control for 24 h. Secondary outcomes included changes in immunomodulatory biomarkers and adverse events. Results: Fifteen patients were enrolled and analyzed. Fever control was comparable in both groups, but significantly more patients in the therapeutic normothermia group experienced shivering ( p  = 0.007). Both groups demonstrated increased C-reactive protein and unchanged neutrophil chemotaxis and CD11b expression. The therapeutic normothermia group revealed significant decreased IL-6 and IL-10. The standard fever control group significantly expressed increased monocytic human leukocyte antigen. There were no significant differences between the groups in terms of immunomodulation. Conclusions: Therapeutic normothermia was feasible in patients with febrile septic shock but was not superior to standard fever control in terms of average body temperature and host defense function. Shivering was more frequent in the therapeutic normothermia group. Trial registration: Thai Clinical Trials Registry number: TCTR20160321001https://doi.org/10.1177/2050312120928732
spellingShingle Jutamas Saoraya
Khrongwong Musikatavorn
Patima Puttaphaisan
Atthasit Komindr
Nattachai Srisawat
Intensive fever control using a therapeutic normothermia protocol in patients with febrile early septic shock: A randomized feasibility trial and exploration of the immunomodulatory effects
SAGE Open Medicine
title Intensive fever control using a therapeutic normothermia protocol in patients with febrile early septic shock: A randomized feasibility trial and exploration of the immunomodulatory effects
title_full Intensive fever control using a therapeutic normothermia protocol in patients with febrile early septic shock: A randomized feasibility trial and exploration of the immunomodulatory effects
title_fullStr Intensive fever control using a therapeutic normothermia protocol in patients with febrile early septic shock: A randomized feasibility trial and exploration of the immunomodulatory effects
title_full_unstemmed Intensive fever control using a therapeutic normothermia protocol in patients with febrile early septic shock: A randomized feasibility trial and exploration of the immunomodulatory effects
title_short Intensive fever control using a therapeutic normothermia protocol in patients with febrile early septic shock: A randomized feasibility trial and exploration of the immunomodulatory effects
title_sort intensive fever control using a therapeutic normothermia protocol in patients with febrile early septic shock a randomized feasibility trial and exploration of the immunomodulatory effects
url https://doi.org/10.1177/2050312120928732
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