Résumé
Le contrôle de la fièvre lors des sepsis graves est couramment utilisé en réanimation, respectivement dans 66 et 70 % des états septiques graves et des chocs septiques. Pourtant, les preuves formelles quant au bénéfice d’une telle stratégie manquent. On peut s’interroger à la lumière de travaux expérimentaux parfois anciens et d’études observationnelles plus récentes des risques d’un contrôle sur le cours évolutif de l’infection, le devenir du patient, ainsi que sur l’innocuité des traitements appliqués pour obtenir le contrôle. Néanmoins, dans certaines situations, la fièvre peut être délétère, en lien avec une consommation en oxygène (O2) accrue et le risque d’ischémie tissulaire et/ou une réaction inflammatoire focale exacerbée. Chez des patients septiques, le contrôle de la fièvre fait appel à des moyens physiques (refroidissement externe et/ou interne) et/ou pharmacologiques (essentiellement le paracétamol et/ou des anti-inflammatoires non stéroïdiens). Malgré les incertitudes quant au bénéfice ou non à contrôler la température, il faut certainement s’affranchir des températures extrêmes (hypoou hyperthermie) et évaluer individuellement le rapport bénéfice/risque.
Abstract
Temperature control during severe sepsis is currently used in intensive care and involves 66% and 70% of severe sepsis and septic shock, respectively. Nevertheless, the conclusive evidence of the benefit of such a strategy is still lacking.We might wonder, with regards to experimental works and recent noninterventional studies, about the risk of a control strategy on an ongoing infectious process, the patient’s outcome, and the safety of the means implemented to obtain temperature control. On the other hand, it is also demonstrated that fever increases oxygen consumption, which may lead in some clinical situations to tissular ischemia and that fever may be associated with a deleterious focal inflammatory process. Methods to control the temperature include external and/or internal cooling and/or antipyretic medications such as paracetamol and nonsteroidal antiinflammatory drugs. In septic patients, external cooling and paracetamol are the mains means used to control temperature. Despite the uncertainties about the benefit to control or not the temperature, it could be stated that extreme temperature (hypo- or hyperthermia) should be avoided and that the benefit/risk of temperature control must be individually weighted.
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Références
Circiumaru B, Baldock G, Cohen J (1999) A prospective study of fever in the intensive care unit. Intensive Care Med 25:668–73
Laupland KB, Shahpori R, Kirkpatrick AW, et al (2008) Occurrence and outcome of fever in critically ill adults. Crit Care Med 36:1531–5
Peres Bota D, Lopes Ferreira F, Melot C, Vincent JL (2004) Body temperature alterations in the critically ill. Intensive Care Med 30:811–6
Thong WY, Strickler AG, Li S, et al (2002) Hyperthermia in the forty-eight hours after cardiopulmonary bypass. Anesth Analg 95:1489–95
Seguin P, Roquilly A, Mimoz O, et al (2012) Risk factors and outcomes for prolonged versus brief fever: a prospective cohort study. Crit Care 16:R150
Polderman KH (2008) Induced hypothermia and fever control for prevention and treatment of neurological injuries. Lancet 371:1955–69
Bohman LE, Levine JM (2014) Fever and therapeutic normothermia in severe brain injury: an update. Curr Opin Crit Care 20:182–8
Niven DJ, Laupland KB, Tabah A, et al (2013) Diagnosis and management of temperature abnormality in ICUs: a EUROBACT investigators’ survey. Crit Care 17:R289
Mackowiak PA, Wasserman SS, Levine MM, (1992) A critical appraisal of 98.6 degrees F, the upper limit of the normal body temperature, and other legacies of Carl Reinhold August Wunderlich. JAMA 268:1578–80
O’Grady NP, Barie PS, Bartlett JG, et al (2008) Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med 36:1330–49
Moran JL, Peter JV, Solomon PJ, et al (2007) Tympanic temperature measurements: are they reliable in the critically ill? A clinical study of measures of agreement. Crit Care Med 35:155–64
Lefrant J, Muller L, de La Coussaye JE, et al (2003) Temperature measurement in intensive care patients: comparison of urinary bladder, oesophageal, rectal, axillary, and inguinal methods versus pulmonary artery core method. Intensive Care Med 29:414–8
Bridges E, Thomas K (2009) Noninvasive measurement of body temperature in critically ill patients. Crit Care Nurse 29:94–7
Steinman L (2008) Nuanced roles of cytokines in three major human brain disorders. J Clin Invest 118:3557–63
Small PM, Tauber MG, Hackbarth CJ, Sande MA (1986) Influence of body temperature on bacterial growth rates in experimental pneumococcal meningitis in rabbits. Infect Immun 52:484–7
Kwiatkowski D (1989) Febrile temperatures can synchronize the growth of Plasmodium falciparum in vitro. J Exp Med 169: 357–61
Mackowiak PA, Marling-Cason M, Cohen RL (1982) Effects of temperature on antimicrobial susceptibility of bacteria. J Infect Dis 145:550–3
Evans SS, Repasky EA, Fisher DT (2015) Fever and the thermal regulation of immunity: the immune system feels the heat. Nat Rev Immunol 15:335–49
Jiang Q, Detolla L, Singh IS, et al (1999) Exposure to febrile temperature upregulates expression of pyrogenic cytokines in endotoxin-challenged mice. Am J Physiol 276:R1653–R60
Jiang Q, DeTolla L, van Rooijen N, et al (1999) Febrile-range temperature modifies early systemic tumor necrosis factor alpha expression in mice challenged with bacterial endotoxin. Infect Immun 67:1539–46
Bruemmer-Smith S, Stüber F, Schroeder S (2001) Protective functions of intracellular heat-shock protein (HSP) 70-expression in patients with severe sepsis. Intensive Care Med 27:1835–41
Su F, Nguyen ND, Wang Z, et al (2005) Fever control in septic shock: beneficial or harmful? Shock 23:516–20
Rogiers P, Sun Q, Dimopoulos G, et al (2006) Blood warming during hemofiltration can improve hemodynamics and outcome in ovine septic shock. Anesthesiology 104:1216–22
Bryant RE, Hood AF, Hood CE, Koenig MG (1971) Factors affecting mortality of Gram-negative rod bacteremia. Arch Intern Med 127:120–8
Weinstein MP, Iannini PB, Stratton CW, Eickhoff TC (1978) Spontaneous bacterial peritonitis. A review of 28 cases with emphasis on improved survival and factors influencing prognosis. Am J Med 64:592–8
Hoefs JC, Canawati HN, Sapico FL, et al (1982) Spontaneous bacterial peritonitis. Hepatology 2:399–407
Ahkee S, Srinath L, Ramirez J (1997) Community-acquired pneumonia in the elderly: association of mortality with lack of fever and leukocytosis. South Med J 90:296–8
Leroy O, Gangneux JP, Montravers P, et al (2009) Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005–2006). Crit Care Med 37:1612–8
Young PJ, Saxena M, Beasley R, et al (2012) Early peak temperature and mortality in critically ill patients with or without infection. Intensive Care Med 38:437–44
Kushimoto S, Gando S, Saitoh D, et al (2013) The impact of body temperature abnormalities on the disease severity and outcome in patients with severe sepsis: an analysis from a multicenter, prospective survey of severe sepsis. Crit Care 17:R271
Lee BH, Inui D, Suh GY, et al (2012) Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study. Crit Care 16:R33
Saxena M, Young P, Pilcher D, et al (2015) Early temperature and mortality in critically ill patients with acute neurological diseases: trauma and stroke differ from infection. Intensive Care Med 41:823–32
Mourvillier B, Tubach F, van de Beek D, et al (2013) Induced hypothermia in severe bacterial meningitis: a randomized clinical trial. JAMA 310:2174–83
Kiekkas P, Aretha D, Bakalis N, et al (2013) Fever effects and treatment in critical care: literature review. Aust Crit Care 26:130–5
Singh IS, Hasday JD (2013) Fever, hyperthermia and the heat shock response. Int J Hyperthermia 29:423–35
Duncker DJ, Klassen CL, Ishibashi Y, at al (1996) Effect of temperature on myocardial infarction in swine. Am J Physiol 270: H1189–H99
Manthous CA, Hall JB, Olson D, et al (1995) Effect of cooling on oxygen consumption in febrile critically ill patients. Am J Respir Crit Care Med 151:10–4
Poblete B, Romand JA, Pichard C, et al (1997) Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients. Br J Anaesth 78:123–7
Bernard GR, Wheeler AP, Russell JA, et al (1997) The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group. N Engl J Med 336:912–8
Axelrod P (2000) External cooling in the management of fever. Clin Infect Dis 31:S224–S9
Suzuki S, Hotchkiss JR, Takahashi T, et al (2004) Effect of core body temperature on ventilator-induced lung injury. Crit Care Med 32:144–9
Rice P, Martin E, He JR, Frank M, et al (2005) Febrile-range hyperthermia augments neutrophil accumulation and enhances lung injury in experimental Gram-negative bacterial pneumonia. J Immunol 174:3676–85
Liu E, Lewis K, Al-Saffar H, et al (2012) Naturally occurring hypothermia is more advantageous than fever in severe forms of lipopolysaccharide- and Escherichia coli-induced systemic inflammation. Am J Physiol Regul Integr Comp Physiol 302: R1372–83
Rokyta R, Matejovic M, Krouzecky A, et al (2004) Effects of continuous venovenous haemofiltration-induced cooling on global haemodynamics, splanchnic oxygen and energy balance in critically ill patients. Nephrol Dial Transplant 19:623–30
John S, Griesbach D, Baumgärtel M, et al (2001) Effects of continuous haemofiltration vs intermittent haemodialysis on systemic haemodynamics and splanchnic regional perfusion in septic shock patients: a prospective, randomized clinical trial. Nephrol Dial Transplant 16:320–7
Kimmoun A, Vanhuyse F, Levy B (2013) Improving blood oxygenation during venovenous ECMO for ARDS. Intensive Care Med 39:1161–2
Launey Y, Nesseler N, Mallédant Y, Seguin P (2011) Clinical review: fever in septic ICU patients — friend or foe? Crit Care 15:222
Young P, Saxena M, Bellomo R, et al (2015) Acetaminophen for Fever in Critically Ill Patients with Suspected Infection. N Engl J Med
Dargan PI, Jones AL (2002) Acetaminophen poisoning: an update for the intensivist. Crit Care 6:108–10
Moling O, Cairon E, Rimenti G, et al (2006) Severe hepatotoxicity after therapeutic doses of acetaminophen. Clin Ther 28:755–60
Watkins PB, Kaplowitz N, Slattery JT, et al (2006) Aminotransferase elevations in healthy adults receiving 4 grams of acetaminophen daily: a randomized controlled trial. JAMA 296:87–93
Suzuki S, Eastwood GM, Bailey M, et al (2015) Paracetamol therapy and outcome of critically ill patients: a multicenter retrospective observational study. Crit Care 19:162
Harirforoosh S, Asghar W, Jamali F (2013) Adverse effects of nonsteroidal antiinflammatory drugs: an update of gastrointestinal, cardiovascular and renal complications. J Pharm Pharm Sci 16:821–47
Scarpignato C, Hunt RH (2010) Nonsteroidal antiinflammatory drug-related injury to the gastrointestinal tract: clinical picture, pathogenesis, and prevention. Gastroenterol Clin North Am 39:433–64
Krudsood S, Tangpukdee N, Wilairatana P, et al (2010) Intravenous ibuprofen (IV-ibuprofen) controls fever effectively in adults with acute uncomplicated Plasmodium falciparum malaria but prolongs parasitemia. Am J Trop Med Hyg 83:51–5
Pichon N, Amiel JB, Francois B, et al (2007) Efficacy of and tolerance to mild induced hypothermia after out-of-hospital cardiac arrest using an endovascular cooling system. Crit Care 11:R71
Schortgen F, Clabault K, Katsahian S, et al (2012) Fever control using external cooling in septic shock: a randomized controlled trial. Am J Respir Crit Care Med 185:1088–95
Schortgen F, Charles-Nelson A, Bouadma L, et al (2015) Respective impact of lowering body temperature and heart rate on mortality in septic shock: mediation analysis of a randomized trial. Intensive Care Med 41:1800–8
Launey Y, Nesseler N, Le Cousin A, et al (2014) Effect of a fever control protocol-based strategy on ventilator-associated pneumonia in severely brain-injured patients. Crit Care 18:689
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Seguin, P., Launey, Y., Nesseler, N. et al. Faut-il contrôler la fièvre dans les infections sévères ?. Réanimation 25, 266–273 (2016). https://doi.org/10.1007/s13546-015-1168-x
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DOI: https://doi.org/10.1007/s13546-015-1168-x