PEARL: Antipyretics (NSAIDS or acetaminophen) are not associated with improved 28-day ICU mortality in septic patients.

CONTEXT: Septic patients often have fevers. Someone always wants to lower the fever with acetaminophen. For conscious, non-intubated patients, this often helps them feel less terrible. Is it of any mortality benefit? Does it harm them?

STUDY: Authors for the Cochrane Collaboration conducted a meta-analysis of 8 RCTs and 8 observational studies involving antipyretic use in ICU patients with sepsis. The primary outcome was 28-day mortality. A secondary outcome was 14-day mortality.

RESULTS: RR of 28-day mortality was 0.93 (CI spanned 1). RR of mortality before 14-days was 0.68 (CI 0.49-0.92, p=0.01). Thus, no difference was appreciated at 28 days. A statistical difference was appreciated for early mortality, but that difference was erased by 28 days.

CONCLUSIONS: Reducing your septic patients’ fevers may help them feel better and does not increase their mortality. However, do not prioritize it as a life-saving measure according to this meta-analysis.