April 24, 2019

EJRC - Review by the ESICM Journal Review Club

An individual patient data meta‑analysis of randomised controlled trials


Fever occurs commonly in intensive care (ICU) and its management is still under debate. The purpose of this individual patient data meta-analysis was to evaluate whether a more active fever management would increase the survival in critically ill patients.



The authors included 1,413 patients from randomised controlled trials.  707 were assigned to more active fever management and 706 were assigned to less active fever management.

The primary outcome was the time to death after randomisation and the secondary outcome was mortality at ICU discharge, ICU and hospital length of stay, and body temperature at 6, 12, 24, 48, and 72 h following randomisation.

The authors did not find any statistically significant difference in survival time and length of stay comparing more active with less active fever management. This conclusion was probably driven by the heterogeneity in treatment effects found in the different studies.



More active fever management does not ameliorate the survival and length of stay in critically ill patients. According to this conclusion, fever control should be individualised in ICU.


This article review was prepared and submitted by Professor Maria Vargas, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples (Italy), on behalf of the ESICM Journal Review Club.



1) Young PJ, Saxena M, Beasley R, Bellomo R, Bailey M, Pilcher D, Finfer S, Harrison D, Myburgh J, Rowan K (2012) Early peak temperature and mortality in critically ill patients with or without infection. Intensive Care Med 38:437–444

2) Drewry AM, Ablordeppey EA, Murray ET, Stoll CRT, Izadi SR, Dalton CM, Hardi AC, Fowler SA, Fuller BM, Colditz GA (2017) Antipyretic therapy in critically ill septic patients: a systematic review and meta-analysis. Crit Care Med 45:806–813

Comment on this news