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Title: Randomised evaluation of active control of temperature versus ordinary temperature management (REACTOR) trial.
Austin Authors: Young, Paul J;Bailey, Michael J;Bass, Frances;Beasley, Richard W;Freebairn, Ross C;Hammond, Naomi E;van Haren, Frank M P;Harward, Meg L;Henderson, Seton J;Mackle, Diane M;McArthur, Colin J;McGuinness, Shay P;Myburgh, John A;Saxena, Manoj K;Turner, Anne M;Webb, Steve A R;Bellomo, Rinaldo 
Affiliation: Intensive Care Unit, Christchurch Hospital, Christchurch, New Zealand
Intensive Care Unit, Hawke's Bay Hospital, Hastings, New Zealand
Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia
School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
Intensive Care Unit, Bankstown Hospital, Sydney, NSW, Australia
Intensive Care Unit, The Canberra Hospital, Canberra, ACT, Australia
School of Medicine, Australian National University, Canberra, ACT, Australia
Faculty of Health, University of Canberra, Canberra, ACT, Australia
Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW, Australia
Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
Medical Research Institute of New Zealand, Wellington, New Zealand
Issue Date: Oct-2019 2019-10
Publication information: Intensive Care Medicine 2019; 45(10): 1382-1391
Abstract: It is unknown whether protocols targeting systematic prevention and treatment of fever achieve lower mean body temperature than usual care in intensive care unit (ICU) patients. The objective of the Randomised Evaluation of Active Control of temperature vs. ORdinary temperature management trial was to confirm the feasibility of such a protocol with a view to conducting a larger trial. We randomly assigned 184 adults without acute brain pathologies who had a fever in the previous 12 h, and were expected to be ventilated beyond the calendar day after recruitment, to systematic prevention and treatment of fever or usual care. The primary outcome was mean body temperature in the ICU within 7 days of randomisation. Secondary outcomes included in-hospital mortality, ICU-free days and survival time censored at hospital discharge. Compared with usual temperature management, active management significantly reduced mean temperature. In both groups, fever generally abated within 72 h. The mean temperature difference between groups was greatest in the first 48 h, when it was generally in the order of 0.5 °C. Overall, 23 of 89 patients assigned to active management (25.8%) and 23 of 89 patients assigned to usual management (25.8%) died in hospital (odds ratio 1.0, 95% CI 0.51-1.96, P = 1.0). There were no statistically significant differences between groups in ICU-free days or survival to day 90. Active temperature management reduced body temperature compared with usual care; however, fever abated rapidly, even in patients assigned to usual care, and the magnitude of temperature separation was small. Australian and New Zealand Clinical Trials Registry Number, ACTRN12616001285448.
DOI: 10.1007/s00134-019-05729-4
ORCID: 0000-0002-3428-3083
PubMed URL: 31576434
Type: Journal Article
Subjects: Antipyresis
Appears in Collections:Journal articles

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