Trial reportIntensive care medicine2015
Respective impact of lowering body temperature and heart rate on mortality in septic shock: mediation analysis of a randomized trial.
Trial report in Intensive care medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00527007 (Impact of External Cooling in Septic Shock Patients), which is not on this map. Cited by 17 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Impact of External Cooling in Septic Shock Patients
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.
- Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19).Intensive care medicine · 2020Guideline
- Stroke volume reduction impairs cerebrovascular regulation through ETCOClinical autonomic research : official journal of the Clinical Autonomic Research Society · 2026Article
- Early systemic insults following severe sepsis-associated encephalopathy of critically ill patients: association with mortality and awakening-an analysis of the OUTCOMEREA database.Journal of intensive care · 2025Article
- Article
- The spectrum of sepsis-associated encephalopathy: a clinical perspective.Critical care (London, England) · 2023Review
- Article
- Cardiac and vascular effects of low-dose steroids during the early phase of septic shock: An echocardiographic study.Frontiers in cardiovascular medicine · 2022Article
- Heart Rate in Patients with SARS-CoV-2 Infection: Prevalence of High Values at Discharge and Relationship with Disease Severity.Journal of clinical medicine · 2021Article
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020).Journal of intensive care · 2021Article
- Hyperthermia is a predictor of high mortality in patients with sepsis.Critical care (London, England) · 2020Article
- Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19).Critical care medicine · 2020Article
- Hypothesis: Fever control, a niche for alpha-2 agonists in the setting of septic shock and severe acute respiratory distress syndrome?Temperature (Austin, Tex.) · 2018Review
- The Role of Oliguria and the Absence of Fluid Administration and Balance Information in Illness Severity Scores.Korean journal of critical care medicine · 2017Review
- Sepsis: find me, manage me, and stop me!Intensive care medicine · 2016Article
- Should we treat pyrexia? And how do we do it?Critical care (London, England) · 2016Review
- [Is control fever mandatory in severe infections?]Reanimation : journal de la Societe de reanimation de langue francaise · 2016Article
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020).Acute medicine & surgeryArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeWe previously showed that external cooling decreases day 14 mortality in febrile septic shock. Because cooling may participate in heart rate control, we studied the respective impact of heart rate and temperature lowering on mortality.
methodsPost hoc analysis of the Sepsiscool randomized controlled trial database (NCT00527007). Cooling was applied to maintain normothermia (36.5-37 °C) during 48 h. We assessed the time spent below different thresholds of temperature and heart rate on day 14 mortality. The best threshold was selected by AUC-ROC and tested as a potential mediator of mortality reduction. Mediation analysis was adjusted for severity and treatments influencing temperature and heart rate evolution. Sensitivity analysis was done using only patients with appropriate antimicrobial therapy.
resultsA total of 197/200 patients with adequate heart rate and temperature monitoring were analyzed. The best threshold differentiating survivors and nonsurvivors was 38.4 °C for temperature and 95 b/min for heart rate. During the 48 h of intervention, cooling significantly increased the time spent with a temperature below 38.4 °C, p = 0.001, and with a heart rate below 95 b/min, p < 0.01. The longer was the time spent with a temperature below 38.4 °C, the lower was the mortality [adjOR 0.17 (0.06-0.49), p = 0.001]. The time spent with a heart rate below 95 b/min was similar in survivors and nonsurvivors [adjOR 0.68 (0.27-1.72), p = 0.42]. Mediation analysis showed that the time spent with a temperature below 38.4 °C was a significant mediator of mortality.
conclusionThe time spent with a temperature below 38.4 °C was independently associated with patient's outcome and explained 73% of the effect of the randomization on the day 14 mortality. Heart rate lowering was not a mediator of mortality.
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