Induced hypothermia in patients with septic shock and respiratory failure (CASS): a randomised, controlled, open-label trial.

Itenov. Lancet Respiratory Medicine 2018;6(3); 183-192

Clinical Question

-  In septic and mechanically ventilated patients aged 50 or over, does 24 hours of induced hypothermia followed by 48 hours of normothermia improve 30-day mortality compared to routine care?

N = 436, 10 ICUs in Denmark & Netherlands & USA

Authors’ Conclusions

-  In patients aged 50 and over with septic shock and requiring mechanical ventilation, induced hypothermia for 24 hours followed by 48 hours of normothermia did not improve 30 day mortality compared to routine care
-  It also increased morbidity with more days on a ventilator and on renal replacement therapy, more vasoactive medication and increased inflammatory markers

The Bottom Line

-  In patients over 50 with severe sepsis on a ventilator, induced hypothermia did not improve mortality or any other aspect of organ dysfunction
-  In fact, the results of this trial trend towards increased mortality and morbidity
-  Taking these results alongside the inherent issues with hypothermia, not to mention the labour-intensive nature of this intervention, I will not be changing my current management of septic patients until further work proves a benefit