Physical methods for the treatment of fever in critically ill patients: a randomized controlled trial

Salgado, Patrícia de Oliveira; Silva, Ludmila Christiane Rosa da; Silva, Priscila Marinho Aleixo; Chianca, Tânia Couto Machado

doi:10.1590/S0080-623420160000600016

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Artigo Original • Rev. esc. enferm. USP 50 (05) • Sep-Oct 2016 • https://doi.org/10.1590/S0080-623420160000600016 copy

Physical methods for the treatment of fever in critically ill patients: a randomized controlled trial^* * Extracted from the PhD dissertation "Uso de métodos físicos para tratamento do diagnóstico de enfermagem de hipertermia em pacientes adultos internados em ICU: ensaio clínico controlado randomizado", Escola de Enfermagem, Universidade Federal de Minas Gerais, 2014

Métodos físicos para tratamiento de fiebre en pacientes críticos: ensayo clínico controlado randomizado

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE

To evaluate the effects of physical methods of reducing body temperature (ice pack and warm compression) in critically ill patients with fever.

METHOD

A randomized clinical trial involving 102 adult patients with tympanic temperature ≥ 38.3°C of an infectious focus, and randomized into three groups: Intervention I - ice pack associated with antipyretic; Intervention II - warm compress associated with antipyretic; and Control - antipyretic. Tympanic temperature was measured at 15 minute intervals for 3 hours. The effect of the interventions was evaluated through the Mann-Whitney test and Survival Analysis. "Effect size" calculation was carried out.

RESULTS

Patients in the intervention groups I and II presented greater reduction in body temperature. The group of patients receiving intervention I presented tympanic temperature below 38.3°C at 45 minutes of monitoring, while the value for control group was lower than 38.3°C starting at 60 minutes, and those who received intervention II had values lower than 38.3°C at 75 minutes of monitoring.

CONCLUSION

No statistically significant difference was found between the interventions, but with the intervention group I patients showed greater reduction in tympanic temperature compared to the other groups. Brazilian Registry of Clinical Trials: RBR-2k3kbq

Descriptors
Fever; Critical Care Nursing; Evidence-Based Nursing; Evaluation of Results of Therapeutic Interventions; Intensive Care Units

Variables	Intervention I n = 34	Intervention II n = 34	Control n = 34	p-value
Variables	N	N	N	p-value
Gender n (%)				0.066^* * Chi-square Test;
Male	24 (71%)	25 (74%)	15 (44%)
Female	10 (29%)	9 (26%)	19 (56%)
Admission type n (%)				0.509^* * Chi-square Test;
Surgical	11 (32%)	5 (19%)	10 (31%)
Clinic	23 (68%)	21 (81%)	24 (69%)
Hospitalization Site n (%)				0.547^* * Chi-square Test;
Surgical ICU	7 (21%)	7 (27%)	11 (32%)
Clinical ICU	27 (79%)	19 (73%)	23 (68%)
Outcome n (%)				0.937^* * Chi-square Test;
Discharge	21 (65%)	15	21
Death	13 (35%)	11	13
Age in years M (SD)	51 (16)	54 (16)	55 (16)	0.119^ Kruskal-Wallis Test.
Length of stay in days M (SD)	58 (111)	44 (24)	37 (28)	0. 469^ Kruskal-Wallis Test.

		Tympanic Temperature
Time (minutes)	Group	N	Mean	SD^* * Standard deviation (SD);	Minimum	Median	Maximum	CI 95%^ 95% confidence interval (CI 95%);	p^* ***** Mann-Whitney.
Baseline	Control	34	38.6	0.3	38.3	38.5	39.5	38.3-38.7
	Intervention I	34	38.7	0.6	38.3	38.5	41.1	38.4-38.6	0.69
	Intervention II	34	38.9	0.6	38.3	38.6	40.1	38.4-39.1	0.03
15	Control	33	38.4	0.5	37.5	38.4	39.7	38.1-38.6
	Intervention I	34	38.5	0.8	37.3	38.3	41.1	38.0-38.7	0.64
	Intervention II	34	38.7	0.6	37.6	38.6	40.1	38.3-38.8	0.11
30	Control	33	38.4	0.6	37.3	38.3	39.9	38.0-38.7
	Intervention I	33	38.3	0.8	36.8	38.3	40.7	37.8-38.6	0.46
	Intervention II	34	38.6	0.8	36.8	38.5	40.5	38.1-38.8	0.36
45	Control	33	38.3	0.7	36.3	38.3	39.6	38.0-38.5
	Intervention I	33	38.1	1	36.0	38.1	40.7	37.6-38.5	0.27
	Intervention II	34	38.5	0.8	36.2	38.5	40.4	38.1-38.8	0.21
60	Control	33	38.2	0.7	36.6	38.3	39.7	38.0-38.6
	Intervention I	33	38.0	1	35.5	38.0	40.7	37.6-38.3	0.1
	Intervention II	33	38.3	0.7	36.8	38.2	40.6	38.0-38.6	0.95
75	Control	33	38.1	0.8	36.1	38.0	39.6	37.8-38.5
	Intervention I	33	38.0	1	35.3	38.0	40.7	37.6-38.1	0.46
	Intervention II	33	38.2	0.7	36.5	38.1	40.7	37.9-38.6	0.49
90	Control	33	38.1	0.8	36.2	38.2	39.8	37.8-38.5
	Intervention I	33	38.0	0.9	36.0	38.0	40.9	37.7-38.2	0.34
	Intervention II	33	38.2	0.8	36.9	38.1	40.6	37.7-38.4	0.92
105	Control	33	38.0	0.9	35.1	38.0	40.1	37.8-38.5
	Intervention I	32	37.9	0.9	35.3	37.9	40.7	37.8-38.2	0.41
	Intervention II	33	38.2	0.9	36.8	38.0	40.9	37.8-38.5	0.81
120	Control	33	38.0	0.9	35.0	38.0	39.9	37.8-38.4
	Intervention I	32	37.9	0.9	35.8	37.9	40.6	37.7-38.2	0.36
	Intervention II	33	38.2	0.9	37.0	38.0	40.9	37.6-38.5	0.91
135	Control	33	38.0	1	35.0	37.9	39.0	37.5-38.2
	Intervention I	32	37.9	0.9	35.3	37.9	30.0	37.6-38.2	0.55
	Intervention II	33	38.2	0.9	36.8	38.1	40.4	37.8-38.4	0.77
150	Control	33	38.0	1	35.1	38.0	40.3	37.7-38.5
	Intervention I	32	37.9	1	35.5	37.9	40.5	37.7-38.2	0.34
	Intervention II	32	38.1	0.8	36.9	38.1	40.5	37.6-38.7	0.9
165	Control	33	37.9	1	35.0	37.8	40.1	37.8-38.5
	Intervention I	32	37.9	1	36.1	37.9	41.2	37.5-38.3	0.89
	Intervention II	32	38.1	0.9	36.7	38.0	40.5	37.7-38.4	0.54
180	Control	33	37.9	1	35.1	38.0	40.1	37.5-38.5
	Intervention I	31	37.8	1	35.7	37.9	40.1	37.6-38.0	0.46
	Intervention II	32	38.0	0.9	36.6	38.0	40.4	37.7-38.3	0.92

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Patrícia de Oliveira Salgado. Rua Hélio Stanciola, 91 - Bairro Fátima. CEP 36570-000 - Viçosa, MG, Brazil. patriciaoliveirasalgado@gmail.com