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BACKGROUND Cooling with water-flow blankets, which are difficult to manipulate and interfere with patients' care, may be ineffective in controlling fever.
OBJECTIVE To compare the effectiveness of cooling via convective airflow blankets with cooling via conductive water-flow blankets for treatment of fever in critically ill adults.
METHOD A 2-group experimental design was used to compare cooling via convection (n = 20) with
cooling via conduction (n = 17) in critically ill adults with an infection-related fever of 38.5'C or greater. Esophageal temperature was measured every 15 minutes until a temperature of 38.0 deg C was reached or 8 hours had elapsed Alternative cooling measures were withheld unless the temperature increased to more than 40.0 deg C. Data on nurses' satisfaction were collected, and complications related to each cooling method were examined.
RESULTS Temperatures decreased more rapidly in the airflow group (mean decrease, 0.377 deg C/h) than in the water-flow group (mean decrease, 0.163 deg C/h). A temperature of 38.0 deg C was achieved more often in the airflow group (75% vs 47.1%). Fever (temperature >38.5 deg C) recurred sooner in the waterflow group (6.6 hours) than in the airflow group (22.2 hours). Both methods were easy to use. Compared with the water-flow blanket, the airflow blanket was recommended for future use twice as often and interfered less with patients' care.
CONCLUSIONS In critically ill adults with an infection or a suspected infection, cooling with an airflow blanket is more effective and more preferred for cooling than is cooling with a water-flow blanket. (American Journal of Critical Care. 2001;10:52-59)
Fever, a hallmark of infection, is a common problem among critically ill patients. However, uncertainty about how and when to treat fever and variations in treatment methods persist. In a recent evaluation of the usefulness of studies related to treatment of fever in the intensive care unit (ICU), Henker' found insufficient research on the physiological responses to fever in critically ill patients.
In addition, Henker' reported a lack of well-defined studies on the effectiveness of various types of physical cooling methods. Historically, fever has been managed with antipyretics and/or physical cooling measures such as sponging or tepid baths, ice packs, and cooling blankets. The decision on how to treat a fever is often left...