Is it worth treating fever in intensive care unit patients? Preliminary results from a randomized trial of the effect of external cooling

Background: Antipyresis is a common clinical practice in intensive care, al though it is unknown if fever is harmful, beneficial, or a negligible adver se effect of infection and inflammation. Methods: In a randomized study, rectal temperature and discomfort were asse ssed in 38 surgical intensive care unit patients without neurotrauma or sev ere hypoxemia and with fever (temperature greater than or equal to 38.5 deg reesC) and systemic inflammatory response syndrome. Eighteen patients recei ved external cooling while 20 received no antipyretic treatment. Results: Temperature and discomfort decreased similarly in both groups afte r 24 hours. No significant differences in recurrence of fever, incidence of infection, antibiotic therapy, intensive care unit and hospital length of stay, or mortality were noted between the groups. Conclusions: These results suggest that the systematic suppression of fever may not be useful in patients without severe cranial trauma or significant hypoxemia. Letting fever take its natural course does not seem to harm pat ients with systemic inflammatory response syndrome or influence the discomf ort level and may save costs.