Background The lowering of body temperature is a common, almost reflexive step in the daily care of septic shock patient. However, the effect of different magnitudes of fever control on the outcome of refractory septi...Background The lowering of body temperature is a common, almost reflexive step in the daily care of septic shock patient. However, the effect of different magnitudes of fever control on the outcome of refractory septic patients with a very poor outcome is controversial and has yet to be explored. Methods This prospective trial examined sixty-five refractory septic shock patients with a core temperature higher than 38.5℃. Patients were randomly assigned to a group achieving a ＂low temperature＂ range （LT group： 36.0-37.5 ℃） or to a group achieving a ＂high temperature＂ range （HT group： 37.5-38.3 ℃） by physical methods including a water-flow cooling blanket and ice packs. A target core temperature was achieved in 1-2 hours post-treatment, and maintained for 72 hours. Averaged values of core temperature as well as hemodynamic, respiratory, and laboratory variables were analyzed at baseline and during the first 72 hours after fever control. Results Thirty-four （52.31%） patients were assigned to the LT group and thirty-one （47.69%） patients were assigned to the HT group. The mean core temperature was significantly lower in the LT group than in the HT group （36.61 vs. 37.85 ℃, respectively; P 〈 0.0001）. The average heart rate （HR） （75.5 vs. 91.9 beats/min, respectively; P 〈 0.0001） and the mean cardiac output （CO） （5.35 vs. 6.45 L/min, respectively; P = 0.002） were also statistically significant lower in the LT group than in the HT group. The averaged serum lactate level was significantly higher in the LT group compared to the HT group （5.59 vs. 2.82 mmol/L, respectively; P=0.008）. Fibrinogen and activated partial thromboplatin time were also different between the two groups. The 28 days mortality was significantly higher in the LT group than in the HT group （61.8 vs. 25.8%, respectively; P=0.003）. A Cox-regression model analysis showed that mean core temperature during the 72 h period was an independent predictor of 28 days mortality （odds ratio （OR展开更多
国际冬眠学会第10届学术大会"冷适应"(Adaptation to the cold)于1996年6月30日—7月6日在澳大利亚塔斯马尼亚(Tasmania)岛的Cradle Mountain国家公园的营地举行,会议由NSW州New England大学的F.Geiser,Wollongon大学的A.J.Hu...国际冬眠学会第10届学术大会"冷适应"(Adaptation to the cold)于1996年6月30日—7月6日在澳大利亚塔斯马尼亚(Tasmania)岛的Cradle Mountain国家公园的营地举行,会议由NSW州New England大学的F.Geiser,Wollongon大学的A.J.Hubert和Tasma-nia大学的S.Nicol组成的组委会主持。与会学者90人,来自16个国家。会议宣读论文40篇,墙报展示37篇。出版文集《Adaptation to the Cold》全文载入的论文56篇。展开更多
文摘Background The lowering of body temperature is a common, almost reflexive step in the daily care of septic shock patient. However, the effect of different magnitudes of fever control on the outcome of refractory septic patients with a very poor outcome is controversial and has yet to be explored. Methods This prospective trial examined sixty-five refractory septic shock patients with a core temperature higher than 38.5℃. Patients were randomly assigned to a group achieving a ＂low temperature＂ range （LT group： 36.0-37.5 ℃） or to a group achieving a ＂high temperature＂ range （HT group： 37.5-38.3 ℃） by physical methods including a water-flow cooling blanket and ice packs. A target core temperature was achieved in 1-2 hours post-treatment, and maintained for 72 hours. Averaged values of core temperature as well as hemodynamic, respiratory, and laboratory variables were analyzed at baseline and during the first 72 hours after fever control. Results Thirty-four （52.31%） patients were assigned to the LT group and thirty-one （47.69%） patients were assigned to the HT group. The mean core temperature was significantly lower in the LT group than in the HT group （36.61 vs. 37.85 ℃, respectively; P 〈 0.0001）. The average heart rate （HR） （75.5 vs. 91.9 beats/min, respectively; P 〈 0.0001） and the mean cardiac output （CO） （5.35 vs. 6.45 L/min, respectively; P = 0.002） were also statistically significant lower in the LT group than in the HT group. The averaged serum lactate level was significantly higher in the LT group compared to the HT group （5.59 vs. 2.82 mmol/L, respectively; P=0.008）. Fibrinogen and activated partial thromboplatin time were also different between the two groups. The 28 days mortality was significantly higher in the LT group than in the HT group （61.8 vs. 25.8%, respectively; P=0.003）. A Cox-regression model analysis showed that mean core temperature during the 72 h period was an independent predictor of 28 days mortality （odds ratio （OR
文摘国际冬眠学会第10届学术大会"冷适应"(Adaptation to the cold)于1996年6月30日—7月6日在澳大利亚塔斯马尼亚(Tasmania)岛的Cradle Mountain国家公园的营地举行,会议由NSW州New England大学的F.Geiser,Wollongon大学的A.J.Hubert和Tasma-nia大学的S.Nicol组成的组委会主持。与会学者90人,来自16个国家。会议宣读论文40篇,墙报展示37篇。出版文集《Adaptation to the Cold》全文载入的论文56篇。
