Temperature control in critically ill patients with fever: A meta-analysis of randomized controlled trials

Fever is frequently encountered in ICU. It is unclear if targeted temperature control is beneficial in critically ill patients with suspected or confirmed infection. We conducted a systemic review and meta-analysis to answer this question. We systematically reviewed major databases before January 2020 to identify randomized controlled trials (RCTs) that compared antipyretic with placebo for temperature control in non-neurocritical ill adult patients with suspected or confirmed infection. Outcomes of interest were 28-day mortality, temperature level, hospital mortality, length of stay, shock reversal, and patient comfort. 13 RCTs enrolling 1963 patients were included. No difference in 28-day mortality between antipyretic compared with placebo (risk ratio [RR] 1.03; 95% CI 0.79–1.35). Lower temperature levels were achieved in the antipyretic group (MD [mean difference] -0.41; 95% CI -0.66 to −0.16). Antipyretic use did not affect the risk of hospital mortality (RR 0.97; 95% CI 0.73–1.30), ICU length of stay (MD -0.07; 95% CI -0.70 to 0.56), or shock reversal (RR 1.11; 95% CI 0.76–1.62). Antipyretic therapy effectively reduces temperature in non-neurocritical ill patients but does not reduce mortality or impact other outcomes. •Fever control does not impact mortality or other important clinical outcomes.•Treatment of fever in critically ill patients should be individualized, weighing potential harms and benefits.•Antipyretics effectively reduce temperature in febrile non-neurocritical ill patients with suspected or confirmed infection.