scholarly journals Diaphragm echodensity in mechanically ventilated patients: a description of technique and outcomes

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Benjamin Coiffard ◽  
Stephen Riegler ◽  
Michael C. Sklar ◽  
Martin Dres ◽  
Stefannie Vorona ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Healthy Subjects ◽  
Prolonged Mechanical Ventilation ◽  
Skewed Distribution ◽  
Initial Increase ◽  
Diaphragm Thickness ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Over Time ◽  
Ventilated Patients

Abstract Background Acute increases in muscle sonographic echodensity reflect muscle injury. Diaphragm echodensity has not been measured in mechanically ventilated patients. We undertook to develop a technique to characterize changes in diaphragm echodensity during mechanical ventilation and to assess whether these changes are correlated with prolonged mechanical ventilation. Methods Diaphragm ultrasound images were prospectively collected in mechanically ventilated patients and in 10 young healthy subjects. Echodensity was quantified based on the right-skewed distribution of grayscale values (50th percentile, ED50; 85th percentile, ED85). Intra- and inter-analyzer measurement reproducibility was determined. Outcomes recorded included duration of ventilation and ICU complications (including reintubation, tracheostomy, prolonged ventilation, or death). Results Echodensity measurements were obtained serially in 34 patients comprising a total of 104 images. Baseline (admission) diaphragm ED85 was increased in mechanically ventilated patients compared to younger healthy subjects (median 56, interquartile range (IQR) 42–84, vs. 39, IQR 36–52, p = 0.04). Patients with an initial increase in median echodensity over time (≥ + 10 in ED50 from baseline) had fewer ventilator-free days to day 60 (n = 13, median 46, IQR 0–52) compared to patients without this increase (n = 21, median 53 days, IQR 49–56, unadjusted p = 0.03). Both decreases and increases in diaphragm thickness during mechanical ventilation were associated with increases in ED50 over time (adjusted p = 0.03, conditional R2 = 0.80) and the association between increase in ED50 and outcomes persisted after adjusting for changes in diaphragm thickness. Conclusions Many patients exhibit increased diaphragm echodensity at the outset of mechanical ventilation. Increases in diaphragm echodensity during the early course of mechanical ventilation are associated with prolonged mechanical ventilation. Both decreases and increases in diaphragm thickness during mechanical ventilation are associated with increased echodensity.

scholarly journals Effects of ABCDE Bundle Implementation on Reduction of Delirium among Mechanically Ventilated Patients at Damietta Hospital, Egypt

2021 ◽  
pp. 1-14
Author(s):  
Khalil NS ◽  
El-Kady EM ◽  
Abdel-kader FA ◽  
EL-shafey MM
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Post Intervention ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Early Exercise ◽  
Abcde Bundle ◽  
Ventilated Patients

Background: One of the principal complications in intensive care unit particularly those connected to mechanical ventilation is delirium. Delirium. It is associated with increased mortality, prolonged mechanical ventilation, and prolonged hospital length of stay (LOS). The ABCDE is a bundle intervention that stands for awakening, breathing coordination, delirium monitoring/management, and early exercise/mobility bundle that has been proposed as a multi-component intervention to reduce the incidence of delirium. Aim of the study: This study aimed to evaluate the effect of implementing the ABCDE bundle on the reduction of delirium among mechanically ventilated patients at Damietta hospital. Material and Methods: A quasi-experimental pre/post-intervention design was used to conduct this study. A purposive sample of 65 adult male and female mechanically ventilated patients aged between 18 and 60 years was recruited. Sedation and Delirium instruments measures were utilized in data collection. Result: significant differences were found in delirium scores among the studied patients (x2= 52.52; p-value=0.001). So, the mechanically ventilated patients who exposed to the implementation of the ABCDE bundle were experienced fewer delirium signs than before the ABCDE bundle implementation. Conclusion: Based on the findings of the current study, it can be concluded ABCDE bundle implementation reduced the occurrence of delirium among mechanically ventilated patients. Recommendations: ABCDE bundle should be recommended on mechanically ventilated patients. Keywords: ABCDE bundle; Mechanically Ventilated Patients; Critically Ill Patients

scholarly journals Influence of Dexmedetomidine on Diaphragm Function and Postoperative Outcomes in ICU Patients with Mechanical Ventilation

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Chengda Zhao ◽  
Meihua Huang ◽  
Baiyun Wang ◽  
Huanhui Zhong ◽  
Wen Meng
Keyword(s):  
Mechanical Ventilation ◽  
Success Rate ◽  
Ventilator Weaning ◽  
Postoperative Outcomes ◽  
Control Group ◽  
Diaphragm Thickness ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Diaphragm Function ◽  
Ventilated Patients

Objective. To probe into the influence of dexmedetomidine (DEX) on diaphragm function and postoperative outcomes of mechanically ventilated patients in the intensive care unit (ICU). Methods. 84 patients with mechanical ventilation (MV) in the ICU of our hospital were selected as the research participants, including 38 patients in the control group (CG) sedated with midazolam (MZ) and 46 patients in the research group (RG) with DEX sedation. Ramsay sedation score, visual analogue scale (VAS), and restlessness score (RS) were used to evaluate their state before sedation (T0), as well as 2 h (T1), 6 h (T2), and 24 h (T3) after sedation, and the alterations of mean arterial pressure (MAP) and heart rate (HR) were recorded. Serum cortisol (Cor), adrenocorticotropic hormone (ACTH), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin- (IL-) 1β, IL-6, and tumor necrosis factor-α (TNF-α) were measured before and 24 h after sedation. The end-inspiratory diaphragm thickness (DTei) and end-expiratory diaphragm thickness (DTee) were measured within 2 h after the initiation of MV and 5 min after the spontaneous breathing test (SBT), and the diaphragm thickening fraction (DTF) was calculated. Finally, the ventilator weaning, MV time, and the incidence of adverse reactions (ADs) of the two groups were counted. Results. T0 and T3 witnessed no distinct difference in Ramsay, VAS, and RS scores between the two arms ( P > 0.05 ), but at T1 and T2, RG had better sedation state and lower VAS and RS scores than CG ( P < 0.05 ), with more stable vital signs ( P < 0.05 ). After sedation, the contents of oxidative stress and inflammatory factors in RG were lower, while DTee, DTei, and DTF were higher, versus CG ( P < 0.05 ). Moreover, RG presented higher success rate of first ventilator weaning, less MV time, and lower incidence of ADs than CG ( P < 0.05 ). Conclusions. DEX is effective in mechanically ventilated patients in the ICU, which can protect patients against diaphragm function damage, improve the success rate of ventilator weaning, and benefit the postoperative outcome, with excellent and rapid sedation effect and less stress damage to patients.

scholarly journals Complications in mechanically ventilated patients of Guillain–Barre syndrome and their prognostic value

2017 ◽  
Vol 08 (01) ◽  
pp. 068-073 ◽  
Author(s):  
Archana Becket Netto ◽  
Arun B. Taly ◽  
Girish B. Kulkarni ◽  
G. S. Uma Maheshwara Rao ◽  
Shivaji Rao
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Tertiary Care ◽  
Guillain Barre Syndrome ◽  
Case Record ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Guillain Barré Syndrome ◽  
Guillain Barré ◽  
Ventilated Patients

ABSTRACT Introduction: The spectrum of various complications in critically ill Guillain–Barre syndrome (GBS) and its effect on the prognosis is lacking in literature. This study aimed at enumerating the complications in such a cohort and their significance in the prognosis and mortality. Materials and Methods: Retrospective case record analysis of all consecutive mechanically ventilated patients of GBS in neurology Intensive Care Unit (ICU) of a tertiary care institute for 10 years was done. Demographic, laboratory, and treatment details and outcome parameters were recorded. Results: Among the 173 patients were 118 men and 55 women (2.1:1), aged 1–84 years. The average number of ICU complications per patient was 6.8 ± 1.8 (median = 7, range = 1–12). The most common complication was tracheobronchitis (128). Other pulmonary complications were found in 36 patients. The next was metabolic hyponatremia (115) hypokalemia (67), hypocalcemia (13), stress hyperglycemia (10), hyperkalemia (8), hypernatremia (9). Sepsis (40), UTI (47), dysautonomia (27), hypoalbuminemia (76), anemia (75), seizures (8), paralytic ileus (5), bleeding (4), anoxic encephalopathy (3), organ failures (12), deep vein thrombosis (7), and drug rashes (1) were also noted. The complications, considered significant in causing death, Hughes scale ≤ 3 at discharge, prolonged mechanical ventilation (>21 days) and hospitalization (>36 days) were pneumonia, hyponatremia, hypokalemia, urinary infection, tracheobronchial infections, hypoalbuminemia, sepsis, anemia dysautonomia. Conclusion: Active monitoring and appropriate and early intervention by the clinician will improve the quality of life of these patients and reduce the cost of prolonged mechanical ventilation and ICU stay.

scholarly journals Change in diaphragm and intercostal muscle thickness in mechanically ventilated patients: a prospective observational ultrasonography study

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Nobuto Nakanishi ◽  
Jun Oto ◽  
Yoshitoyo Ueno ◽  
Emiko Nakataki ◽  
Taiga Itagaki ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Muscle Thickness ◽  
Apache Ii Score ◽  
Intercostal Muscle ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Icu Stay ◽  
Length Of Icu Stay ◽  
Ventilated Patients

Abstract Background Diaphragm atrophy is observed in mechanically ventilated patients. However, the atrophy is not investigated in other respiratory muscles. Therefore, we conducted a two-center prospective observational study to evaluate changes in diaphragm and intercostal muscle thickness in mechanically ventilated patients. Methods Consecutive adult patients who were expected to be mechanically ventilated longer than 48 h in the ICU were enrolled. Diaphragm and intercostal muscle thickness were measured on days 1, 3, 5, and 7 with ultrasonography. The primary outcome was the direction of change in muscle thickness, and the secondary outcomes were the relationship of changes in muscle thickness with patient characteristics. Results Eighty patients (54 males and 26 females; mean age, 68 ± 14 years) were enrolled. Diaphragm muscle thickness decreased, increased, and remained unchanged in 50 (63%), 15 (19%), and 15 (19%) patients, respectively. Intercostal muscle thickness decreased, increased, and remained unchanged in 48 (60%), 15 (19%), and 17 (21%) patients, respectively. Decreased diaphragm or intercostal muscle thickness was associated with prolonged mechanical ventilation (median difference (MD), 3 days; 95% CI (confidence interval), 1–7 and MD, 3 days; 95% CI, 1–7, respectively) and length of ICU stay (MD, 3 days; 95% CI, 1–7 and MD, 3 days; 95% CI, 1–7, respectively) compared with the unchanged group. After adjusting for sex, age, and APACHE II score, they were still associated with prolonged mechanical ventilation (hazard ratio (HR), 4.19; 95% CI, 2.14–7.93 and HR, 2.87; 95% CI, 1.53–5.21, respectively) and length of ICU stay (HR, 3.44; 95% CI, 1.77–6.45 and HR, 2.58; 95% CI, 1.39–4.63, respectively) compared with the unchanged group. Conclusions Decreased diaphragm and intercostal muscle thickness were frequently seen in patients under mechanical ventilation. They were associated with prolonged mechanical ventilation and length of ICU stay. Trial registration UMIN000031316. Registered on 15 February 2018

scholarly journals Anxiety and Agitation in Mechanically Ventilated Patients

2011 ◽  
Vol 22 (2) ◽  
pp. 157-173 ◽  
Author(s):  
Judith Ann Tate ◽  
Annette Devito Dabbs ◽  
Leslie A. Hoffman ◽  
Eric Milbrandt ◽  
Mary Beth Happ
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Secondary Analysis ◽  
The Body ◽  
Future Research ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Symptom Recognition ◽  
Patient Responses ◽  
Ventilated Patients

During an ethnography conducted in an intensive care unit (ICU), we found that anxiety and agitation occurred frequently and were important considerations in the care of 30 patients weaning from prolonged mechanical ventilation. We conducted a secondary analysis to (a) describe characteristics of anxiety and agitation experienced by mechanically ventilated patients, (b) explore how clinicians recognized and interpreted anxiety and agitation, and (c) describe strategies and interventions used to manage anxiety and agitation with mechanically ventilated patients. We constructed the Anxiety/Agitation in Mechanical Ventilation Model to illustrate the multidimensional features of symptom recognition and management. Patients’ ability to interact with the environment served as a basis for identification and management of anxiety or agitation. Clinicians’ attributions about anxiety or agitation, and “knowing the patient,” contributed to their assessment of patient responses. Clinicians chose strategies to overcome either the stimulus or the patient’s appraisal of risk of the stimulus. This article contributes to the body of knowledge about symptom recognition and management in the ICU by providing a comprehensive model to guide future research and practice.

scholarly journals Selection strategy for sedation depth in critically ill patients on mechanical ventilation

2021 ◽  
Vol 21 (S2) ◽  
Author(s):  
Longxiang Su ◽  
Chun Liu ◽  
Fengxiang Chang ◽  
Bo Tang ◽  
Lin Han ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Dimensionality Reduction ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Latent Profile Analysis ◽  
Profile Analysis ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Sedation And Analgesia ◽  
Ventilated Patients

Abstract Background Analgesia and sedation therapy are commonly used for critically ill patients, especially mechanically ventilated patients. From the initial nonsedation programs to deep sedation and then to on-demand sedation, the understanding of sedation therapy continues to deepen. However, according to different patient’s condition, understanding the individual patient’s depth of sedation needs remains unclear. Methods The public open source critical illness database Medical Information Mart for Intensive Care III was used in this study. Latent profile analysis was used as a clustering method to classify mechanically ventilated patients based on 36 variables. Principal component analysis dimensionality reduction was used to select the most influential variables. The ROC curve was used to evaluate the classification accuracy of the model. Results Based on 36 characteristic variables, we divided patients undergoing mechanical ventilation and sedation and analgesia into two categories with different mortality rates, then further reduced the dimensionality of the data and obtained the 9 variables that had the greatest impact on classification, most of which were ventilator parameters. According to the Richmond-ASS scores, the two phenotypes of patients had different degrees of sedation and analgesia, and the corresponding ventilator parameters were also significantly different. We divided the validation cohort into three different levels of sedation, revealing that patients with high ventilator conditions needed a deeper level of sedation, while patients with low ventilator conditions required reduction in the depth of sedation as soon as possible to promote recovery and avoid reinjury. Conclusion Through latent profile analysis and dimensionality reduction, we divided patients treated with mechanical ventilation and sedation and analgesia into two categories with different mortalities and obtained 9 variables that had the greatest impact on classification, which revealed that the depth of sedation was limited by the condition of the respiratory system.

scholarly journals Effectiveness of Communication Board on Level of Satisfaction Over Communication among Mechanically Venitlated Patients

2020 ◽  
Vol 5 (9) ◽  
pp. 311-316
Author(s):  
Dr. Metilda ◽  
Dr. A. Jaganath
Keyword(s):  
Mechanical Ventilation ◽  
Control Group ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Level Of Satisfaction ◽  
Significant Difference ◽  
Group 15 ◽  
Experimental Group ◽  
Ventilated Patients ◽  
Communication Board

Mechanical ventilation is widely used to treat patients with critical conditions. This treatment is usually applied for difficulty in breathing. The use of mechanical ventilation devices has unique benefits to the patient. However, it can also cause various problems. Reduction in communication rank as one of the most negative experiences in mechanically ventilated patients. Effective communication with ventilator-based patients is essential. Nursing management of a mechanically ventilated patient is challenging on many levels, requiring a wealth of high technical skills. The Patient Communications Board improves communication, maintains information and creates a comfortable, attractive setting for patient, family and health care workers. The research methodology used for the study is a Quasi experimental approach, post-test only design with a comparison group to assess the effect of the communication board on the level of satisfaction over communication among clients on mechanical ventilator. The sample was selected by purposive sampling technique and included 30 (experimental group-15, control group-15), mechanically ventilated patients in PESIMR hospital, Kuppam. The control group patients were provided with routine communication methods, while the experimental group were communicated with communication board. The level of satisfaction on communication was assessed by a 15items rating scale. Data was analysed using both the descriptive and inferential statistics. There was a significant difference in the level of satisfaction on communication among the patients who were communicated using communication board compared to the routine method of communication. The communication board had significantly improved the communication pattern and increased the satisfaction among the patients who are mechanically ventilated.

The Feasibility of Objective Sleep-Quality Assessment in an ICU Setting

2021 ◽  
Vol 104 (2) ◽  
pp. 304-309
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Sleep Quality ◽  
Acute Respiratory Failure ◽  
Critically Ill ◽  
Sleep Stages ◽  
Poor Sleep ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Background: Sleep disruptions frequently occur in hospitalized patients, especially with critically ill, mechanically ventilated patients. Severely altered sleep architectures result in unclassifiable sleep stages as listed by the conventional Rechtschaffen and Kales (R&K) criteria, and a new classification for sleep scoring including atypical sleep (AS) and pathological wakefulness (PW) has recently been proposed. Objective: To demonstrate the feasibility of performing objective sleep qualification in patients receiving mechanical ventilation due to acute respiratory failure. Materials and Methods: In the present prospective cohort study, polysomnography was performed in 38 patients requiring invasive mechanical ventilation due to acute respiratory failure at the respiratory care unit (RCU) of Siriraj Hospital between February and December 2017. Their sleep stages were analyzed by conventional rules and the new classifications of AS and PW. The associations between the presence of AS or PW and the patients’ characteristics were analyzed. Correlations between sleep quality and clinical parameters were also determined. Results: Most of the patients had poor sleep quality with median sleep efficiency (IQR) of 35.9% (18.5, 62.3) and significantly decreased slowwave sleep [median (IQR) 0.4% (0.00, 5.70)] and REM [median (IQR) 1.3% (0.00, 6.43)]. According to the new classifications, 14 out of 38 (prevalence of 36.8%) mechanically ventilated patients had AS. The prevalence of PW and either AS or PW were 36.8% and 52.6%, respectively. A higher baseline respiratory rate was observed among patients who had either AS or PW at 24 versus 20 breaths/minute (p=0.02), while a longer duration of mechanical ventilator support was found in patients with PW at nine versus five (p=0.003). Patient-ventilator asynchrony was also noted in all patients. Conclusion: Sleep quality among critically ill and mechanically ventilated patients was severely disturbed. A higher prevalence of AS and PW were noted. The technical feasibility of sleep recording in Thai intensive care unit (ICU) settings was established. Keywords: Polysomnography, Atypical sleep, ICU

Psychophysiologic responses of mechanically ventilated patients to music: a pilot study

1995 ◽  
Vol 4 (3) ◽  
pp. 233-238 ◽  
Author(s):  
LL Chlan
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Repeated Measures ◽  
Mood States ◽  
Profile Of Mood States ◽  
Music Listening ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Over Time ◽  
Ventilated Patients

BACKGROUND: Although mechanically ventilated patients experience numerous stressors, they have not been included in music therapy stress reduction and relaxation studies. OBJECTIVE: To examine selected psychophysiologic responses of mechanically ventilated patients to music. METHODS: A two-group experimental design with pretest, posttest, and repeated measures was used. Twenty mechanically ventilated patients were randomized to a music-listening group or a nonmusic (headphones only) group. Physiologic dependent measures--heart rate and rhythm, respiratory rate, systolic and diastolic blood pressure, oxygen saturation, and airway pressure--were collected at timed intervals. Psychologic data were collected before and after intervention using the Profile of Mood States. RESULTS: Using repeated measures analysis of variance, results for heart rate and respiratory rate over time and over time between groups were significant. Between-group differences were significant for respiratory rate. Significant differences were found via t test for the music group's Profile of Mood States scores. No adverse cardiovascular responses were noted for either group. CONCLUSIONS: Data indicated that music listening decreased heart rate, respiratory rate, and Profile of Mood States scores, indicating relaxation and mood improvement.

scholarly journals 2200 The effect of antipyretics and fever on the mortality of mechanically ventilated patients

2018 ◽  
Vol 2 (S1) ◽  
pp. 30-31
Author(s):  
Emily M. Evans ◽  
Rebecca J. Doctor ◽  
Brian M. Fuller ◽  
Richard S. Hotchkiss ◽  
Anne M. Drewry
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Severity Of Illness ◽  
Primary Analysis ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Before And After ◽  
Patients At Risk ◽  
Forward Stepwise ◽  
Ventilated Patients

OBJECTIVES/SPECIFIC AIMS: (1) To evaluate clinical outcomes in mechanically ventilated patients with and without fever. We hypothesize that, after adjusting for confounding factors such as age and severity of illness: (a) In septic patients, fever will be associated with improved clinical outcomes. (b) In nonseptic patients, fever will be associated with worse clinical outcomes. (2) To examine the relationship between antipyretics and mortality in mechanically ventilated patients at risk for an acute lung injury. We hypothesize that antipyretics will have no effect on clinical outcomes in mechanically ventilated patients with and without sepsis. METHODS/STUDY POPULATION: This is a retrospective study of a “before and after” observational cohort of 1705 patients with acute initiation of mechanical ventilation in the Emergency Department from September 2009 to March 2016. Data were collected retrospectively on the first 72 hours of temperature and antipyretic medication from the EHR. Temperatures measurements were adjusted based on route of measurement. Patients intubated for cardiac arrest or brain injury were excluded from our primary analysis due to the known damage of hyperthermia in these subsets. Cox proportional hazard models and multivariable linear regression analyzed time-to-event and continuous outcomes, respectively. Predetermined patient demographics were entered into each multivariable model using backward and forward stepwise regression. Models were assessed for collinearity and residual plots were used to assure each model met assumptions. RESULTS/ANTICIPATED RESULTS: Antipyretic administration is currently undergoing analysis. Initial temperature results are reported here. In the overall group, presence of hypothermia or fever within 72 hours of intubation compared with normothermia conferred a hazard ratio (HR) of 1.95 (95% CI: 1.48–2.56) and 1.31 (95% CI: 0.97–1.78), respectively. Presence of hypothermia and fever reduced hospital free days by 3.29 (95% CI: 2.15–4.42) and 2.34 (95% CI: 1.21–3.46), respectively. In our subgroup analysis of patients with sepsis, HR for 28-day mortality 2.57 (95% CI: 1.68–3.93) for hypothermia. Fever had no effect on mortality (HR 1.11, 95% CI: 0.694–1.76). Both hypothermia and fever reduced hospital free days by 5.39 (95% CI: 4.33–7.54) and 3.98 (95% CI: 2.46–5.32) days, respectively. DISCUSSION/SIGNIFICANCE OF IMPACT: As expected, both hypothermia and fever increased 28-day mortality and decreased hospital free days. In our sepsis subgroup, hypothermia again resulted in higher mortality and fewer hospital free days, while fever did not have a survival benefit or cost, but reduced hospital free days. Antipyretic administration complicates these findings, as medication may mask fever or exert an effect on survival. Fever may also affect mechanically ventilated septic patients differently than septic patients not on mechanical ventilation. Continued analysis of this data including antipyretic administration, ventilator free days and progression to ARDS will address these questions.

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