The Application Of The Target Temperature Management In Sepsis Patients With Fever

Objectives: The aim of the present study is to observe the effects of the target temperature management in clinical features,hemodynamic changes,laboratory parameters and clinical outcomes for sepsis patients with fever,in order to evaluate its therapeutic value.Methods: The study was a prospective,randomized controlled study.Patients were observed in the Second Affiliated Hospital of Soochow University and Taicang First People's Hospital Critical Care Medicine between June 1,2015 to July 30,2016.The patients meet the following inclusion criteria for this study:(1)patients met the diagnostic criteria for Sepsis-3.0;(2)18 age ? Age ?85 years of age;(3)expected ICU stay ?48 hours;(4)core body temperature ?39.0 ?.For patients who met the inclusion criteria,based on the random number table grouping different degrees of temperature management,namely low and high temperature management group.The temperature management only managed to take surface physical cooling methdos,including the use of temperature control blanket,ice packs or ice caps and the like.A target core temperature was achieved in 6 hours post-treatment,and maintained for 24 hours.At the beginning of the body temperature management,body temperature managed 12 hours and 24 hours.We recording the patient's vital signs,hemodynamic parameters,vasoactive drug dose and laboratory indicators,respectively.At the same time we observed the length of stay in ICU,anti-infection treatment costs and clinical outcomes,compared between the two groups of patients whether have differences or not.Results: 63 patients met the inclusion criteria were admitted to the study.Among them,48 cases were male and 15 were female.31 patients(49.21%)were assigned to the LT group(LT group: 36.5?-38.0?)and 32 patients(50.79%)were assigned to the HT group(HT group: 38.5?-39.5C).During the 24 hours of target temperature management,the mean core temperature,the average heart rate,the mean each stroke volume and the cardiac output were significantly lower in the LT group than in the HT group(P value all<0.05);The number of patients with a 50% decrease in the baseline vasopressor dose were lower in the LT group than in the HT group(P value <0.01).The averaged serum lactate level was significantly higher in the LT group compared to the HT group(P value <0.05);The C-Reactive Protein(CRP),Calcitonin(PCT),Interleukin-6(IL-6)and Tumor Necrosis Factor-?(TNF-?)were decreased quickly in the LT group compared to the HT group(P value all<0.05),whereas the Interleukin-4(IL-4)and IL-10 were higher in the LT group than in the HT group(P value all <0.05);the CD4-T Lymphocyte(CD4+),CD8-T Lymphocyte(CD8+)and Human Leukocyte Antigen-DR(HLA-DR)in the LT group were higher than in the HT group(P value all<0.05).The length of stay in ICU and the anti-infection treatment costs were higher in the LT group(P value<0.05).Comparison of 28 natural survival rate of patients in two groups,LT group patients survival rate 71%(22/31case),HT group patients survival rate 81.3%(26/32case),the study showed that although the survival curves of the patients in LT group and HT group were separated with time,the difference of survival rate between the two groups was not statistically significant(Log Rank(Mantel-Cox),?~2=1.082,P =0.298).Conclusion: For sepsis patients with fever,low-temperature management of patients resulted in a low level of pro-inflammatory cytokines,while the quantity of lymphocyte subsets are high.However,with high-temperature management of a patient's fever,the blood circulation improved and the length of stay in ICU was shorter than the low-temperature management group.The ICU anti-infection treatment costs were also lower.Excessive temperature control on sepsis patients with fever may be harmful.