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Richard Fagley - One of the best experts on this subject based on the ideXlab platform.
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early Antipyretic exposure does not increase mortality in patients with gram negative severe sepsis a retrospective cohort study
Internal and Emergency Medicine, 2012Co-Authors: Nicholas M Mohr, Brian M Fuller, Lee P Skrupky, Robert Alunday, Scott T Micek, Michael Wallendorf, Richard FagleyAbstract:Existing data suggest that Antipyretic medications may have deleterious effects on immune function and may increase mortality in human infection. This study was designed to evaluate the impact of Antipyretic therapy on 28-day in-hospital mortality when administered early in the course of gram-negative severe sepsis or septic shock. This study was a single-center retrospective cohort study at a 1,111-bed academic medical center of all febrile patients with gram-negative bacteremia hospitalized with severe sepsis or septic shock (n = 278) between Jan 2002 and Feb 2008. Although the raw mortality was lower in the group that received an early Antipyretic medication (22 vs. 35 %, p = 0.01), patients in the early Antipyretic group had higher mean arterial pressure (58.0 vs. 52.7, p = 0.01) and higher 24-h T max (39.3 vs. 39.0, p < 0.01). Early Antipyretic therapy was not significantly associated with 28-day in-hospital mortality (adjusted OR 0.55, 0.29–1.03) in a multivariable logistic regression model controlling for APACHE-II score, hypotension, pneumonia, surgery during hospitalization, persistent fever, and in-hospital dialysis. In conclusion, early Antipyretic therapy is not associated with increased mortality.
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clinical and demographic factors associated with Antipyretic use in gram negative severe sepsis and septic shock
Annals of Pharmacotherapy, 2011Co-Authors: Nicholas M Mohr, Brian M Fuller, Lee P Skrupky, Robert Alunday, Scott T Micek, Richard FagleyAbstract:Background:Antipyretic therapy is commonly prescribed for patients with Infection, but studies of its impact on clinical outcomes have yielded mixed results. No data exist to characterize the use of Antipyretic medications in patients with severe sepsis or septic shock.Objective:To identify clinical and demographic factors associated with Antipyretic medication administration in severe sepsis and septic shock.Methods:This single-center, retrospective, cohort study assessed febrile patients [temperature ≥38.3°C) with gram-negative severe sepsis or septic shock at an 1111-bed academic medical center between January 2002 and February 2008, Patients were excluded if they had liver disease, acute brain injury, or allergy to acetaminophen. Generalized estimating equations were used to estimate the effect of clinical factors on treatment of patients with Antipyretic medications,Results:Although 76% of patients in this febrile cohort (n = 241) were prescribed an Antipyretic agent, only 42% received Antipyretic th...
Brian M Fuller - One of the best experts on this subject based on the ideXlab platform.
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the association of fever and Antipyretic medication with outcomes in mechanically ventilated patients a cohort study
Shock, 2019Co-Authors: Emily Evans, Brian M Fuller, Rebecca J Doctor, Brian F Gage, Richard S Hotchkiss, Anne M DrewryAbstract:BACKGROUND Fever is common in mechanically ventilated patients and may be uniquely detrimental in those with lung injury because of its injurious effects on pulmonary vascular permeability and alveolar epithelium. We evaluated the association of fever and Antipyretic medication with mortality in mechanically ventilated emergency department (ED) patients. METHODS This is a retrospective cohort study of 1,264 patients requiring mechanical ventilation initiated in the ED with subsequent admission to an intensive care unit. Maximum body temperature was recorded for the first 24 h after ED admission and categorized into four categories: <37°C, 37°C to 38.2°C, 38.3°C to 39.4°C, and ≥39.5°C. The primary outcome was 28-day mortality. We conducted a planned subgroup analysis of patients with sepsis at the time of intubation. Multivariable Cox proportional hazard ratios (HRs) were used to assess the relationship between temperature, Antipyretics, and mortality. RESULTS Multivariable Cox proportional HRs demonstrated that a maximum temperature ≥39.5°C was associated with increased mortality (adjusted hazard ratio [aHR] 1.59 [95% confidence interval, CI, 1.05-2.39]). In the subgroup of patients with sepsis, a maximum temperature of 38.3°C to 39.4°C was associated with survival (aHR 0.61 [95% CI, 0.39-0.99]). There was no difference in 28-day mortality between patients who did and did not receive Antipyretic medication in either the overall cohort or the septic subgroup. CONCLUSION High fever (≥39.5°C) was associated with increased risk for mortality in mechanically ventilated patients. However, in patients with sepsis, moderate fever (38.3°C-39.4°C) was protective. Antipyretic medication was not associated with changes in outcome. This suggests that fever may have different implications in septic versus nonseptic mechanically ventilated patients.
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early Antipyretic exposure does not increase mortality in patients with gram negative severe sepsis a retrospective cohort study
Internal and Emergency Medicine, 2012Co-Authors: Nicholas M Mohr, Brian M Fuller, Lee P Skrupky, Robert Alunday, Scott T Micek, Michael Wallendorf, Richard FagleyAbstract:Existing data suggest that Antipyretic medications may have deleterious effects on immune function and may increase mortality in human infection. This study was designed to evaluate the impact of Antipyretic therapy on 28-day in-hospital mortality when administered early in the course of gram-negative severe sepsis or septic shock. This study was a single-center retrospective cohort study at a 1,111-bed academic medical center of all febrile patients with gram-negative bacteremia hospitalized with severe sepsis or septic shock (n = 278) between Jan 2002 and Feb 2008. Although the raw mortality was lower in the group that received an early Antipyretic medication (22 vs. 35 %, p = 0.01), patients in the early Antipyretic group had higher mean arterial pressure (58.0 vs. 52.7, p = 0.01) and higher 24-h T max (39.3 vs. 39.0, p < 0.01). Early Antipyretic therapy was not significantly associated with 28-day in-hospital mortality (adjusted OR 0.55, 0.29–1.03) in a multivariable logistic regression model controlling for APACHE-II score, hypotension, pneumonia, surgery during hospitalization, persistent fever, and in-hospital dialysis. In conclusion, early Antipyretic therapy is not associated with increased mortality.
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clinical and demographic factors associated with Antipyretic use in gram negative severe sepsis and septic shock
Annals of Pharmacotherapy, 2011Co-Authors: Nicholas M Mohr, Brian M Fuller, Lee P Skrupky, Robert Alunday, Scott T Micek, Richard FagleyAbstract:Background:Antipyretic therapy is commonly prescribed for patients with Infection, but studies of its impact on clinical outcomes have yielded mixed results. No data exist to characterize the use of Antipyretic medications in patients with severe sepsis or septic shock.Objective:To identify clinical and demographic factors associated with Antipyretic medication administration in severe sepsis and septic shock.Methods:This single-center, retrospective, cohort study assessed febrile patients [temperature ≥38.3°C) with gram-negative severe sepsis or septic shock at an 1111-bed academic medical center between January 2002 and February 2008, Patients were excluded if they had liver disease, acute brain injury, or allergy to acetaminophen. Generalized estimating equations were used to estimate the effect of clinical factors on treatment of patients with Antipyretic medications,Results:Although 76% of patients in this febrile cohort (n = 241) were prescribed an Antipyretic agent, only 42% received Antipyretic th...
Nicholas M Mohr - One of the best experts on this subject based on the ideXlab platform.
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early Antipyretic exposure does not increase mortality in patients with gram negative severe sepsis a retrospective cohort study
Internal and Emergency Medicine, 2012Co-Authors: Nicholas M Mohr, Brian M Fuller, Lee P Skrupky, Robert Alunday, Scott T Micek, Michael Wallendorf, Richard FagleyAbstract:Existing data suggest that Antipyretic medications may have deleterious effects on immune function and may increase mortality in human infection. This study was designed to evaluate the impact of Antipyretic therapy on 28-day in-hospital mortality when administered early in the course of gram-negative severe sepsis or septic shock. This study was a single-center retrospective cohort study at a 1,111-bed academic medical center of all febrile patients with gram-negative bacteremia hospitalized with severe sepsis or septic shock (n = 278) between Jan 2002 and Feb 2008. Although the raw mortality was lower in the group that received an early Antipyretic medication (22 vs. 35 %, p = 0.01), patients in the early Antipyretic group had higher mean arterial pressure (58.0 vs. 52.7, p = 0.01) and higher 24-h T max (39.3 vs. 39.0, p < 0.01). Early Antipyretic therapy was not significantly associated with 28-day in-hospital mortality (adjusted OR 0.55, 0.29–1.03) in a multivariable logistic regression model controlling for APACHE-II score, hypotension, pneumonia, surgery during hospitalization, persistent fever, and in-hospital dialysis. In conclusion, early Antipyretic therapy is not associated with increased mortality.
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clinical and demographic factors associated with Antipyretic use in gram negative severe sepsis and septic shock
Annals of Pharmacotherapy, 2011Co-Authors: Nicholas M Mohr, Brian M Fuller, Lee P Skrupky, Robert Alunday, Scott T Micek, Richard FagleyAbstract:Background:Antipyretic therapy is commonly prescribed for patients with Infection, but studies of its impact on clinical outcomes have yielded mixed results. No data exist to characterize the use of Antipyretic medications in patients with severe sepsis or septic shock.Objective:To identify clinical and demographic factors associated with Antipyretic medication administration in severe sepsis and septic shock.Methods:This single-center, retrospective, cohort study assessed febrile patients [temperature ≥38.3°C) with gram-negative severe sepsis or septic shock at an 1111-bed academic medical center between January 2002 and February 2008, Patients were excluded if they had liver disease, acute brain injury, or allergy to acetaminophen. Generalized estimating equations were used to estimate the effect of clinical factors on treatment of patients with Antipyretic medications,Results:Although 76% of patients in this febrile cohort (n = 241) were prescribed an Antipyretic agent, only 42% received Antipyretic th...
Zdeněk Kořistek - One of the best experts on this subject based on the ideXlab platform.
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symptomatic intravenous Antipyretic therapy efficacy of metamizol diclofenac and propacetamol
Journal of Pain and Symptom Management, 2002Co-Authors: Andrea Obořilova, Jiři Mayer, Zdeněk Pospisil, Zdeněk KořistekAbstract:Abstract Fever is a common symptom in cancer patients. The most frequent causes of fever are infections, malignancy itself, various medications, transfusions, and allergy. Although it is necessary to treat the cause of fever, if possible, symptomatic fever management is also important. Surprisingly, little attention is paid to this topic in the medical literature, despite the fact that it is a very frequent problem. In order to support symptomatic fever therapy, we wanted to study the patients' discomfort accompanying fever and the beneficial effects of the symptomatic fever management. To the best of our knowledge, there is an absence of studies in this area, despite the fever discomfort can be an important reason for the Antipyretic treatment, mainly in cancer patients. In this non-randomized open label pilot study, three intravenous Antipyretics were tested in five groups of patients: diclofenac (75 mg, brief intravenous [IV] infusion) vs. metamizol (2500 mg or 1000 mg, brief IV infusion) vs. propacetamol (2000 mg or 1000 mg, slow IV injection or brief IV infusion). The study included 254 febrile episodes mainly in hemato-oncological patients with axillary temperature at least 38°C. The main study endpoints were: changes in axillary temperature, improvement in patient comfort, and number and nature of adverse events. To support justification for symptomatic fever management in febrile patients, we asked the first 45 study subjects to fill in a questionnaire concerning their opinions about fever, fever-associated discomfort, and relief upon Antipyretic therapy. All study medications had a significant Antipyretic effect. However, metamizol at the dose 2500 mg was considered as the most effective, while propacetamol at the dose 1000 mg showed the lowest Antipyretic efficacy. Concerning tolerability and adverse events, there were significant differences among the treatment groups. Diclofenac and metamizol (both 2500 mg and 1000 mg) were tolerated at best. All tested Antipyretics significantly improved comfort in febrile patients. Overall, 87% of patients declared improvement in their comfort after administration of Antipyretics. Based on the results of the present study, the choice of the Antipyretic drug should depend on the clinical status of patient, contraindications, and potential adverse events and risks of the selected agent. It is advisable to use proparacetamol at the higher dosage and to administer it as a brief IV infusion in order to avoid injection-related adverse events. The symptomatic Antipyretic treatment in febrile cancer patients is supported by patients themselves and has a significant role in the complex supportive care. Discomfort of patients during fever episodes may be greater than previously thought.
Eric Woode - One of the best experts on this subject based on the ideXlab platform.
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Antipyretic activity of polyalthia longifolia benth hook f var pendula annonaceae on lipopolysaccharide induced fever in rats
Journal of Medical and Biomedical Sciences, 2013Co-Authors: Kofi Annan, Kwame Sarpong, C Asare, K I Amponsah, R.a. Dickson, Eric WoodeAbstract:Fever is a complex physiological response triggered by infectious or aseptic stimuli. The present investigation was carried out to study the Antipyretic activity of Polyalthia longifolia extracts in Wistar rats against Lipopolysaccharide (LPS) -induced pyrexia. P. longifolia Benth. & Hook. f. var. Pendula (Annonaceae) is an evergreen tropical tree well known for its numerous medicinal properties. Methanol extracts of the leaves, stem bark and root of the plant were tested for their Antipyretic activities at doses of 30, 100 and 300 mg kg-1 body weight using LPS-induced Antipyretic activity model. All extracts showed significant (p < 0.001) dose-dependent Antipyretic activity. At 300 mg kg-1, all extracts exhibited activities higher than that of Acetylsalicyclic acid (Aspirin) whose percentage inhibition of pyrexia was 86%. The root extract was the most active with a percentage inhibition of 127.5%, followed by the leaf extract (123.0%) and the stem bark extract (99.2%). This study proves P. longifolia as an effective Antipyretic agent and could be used as an adjunct in the treatment of other ailments. Journal of Medical and Biomedical Sciences (2013) 2(1), 8-12
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Antipyretic activity of Polyalthia longifolia Benth. & Hook. F. var. pendula (Annonaceae), on lipopolysaccharide-induced fever in rats
2013Co-Authors: Kofi Annan, Kwame Sarpong, C Asare, K I Amponsah, R.a. Dickson, Eric WoodeAbstract:Fever is a complex physiological response triggered by infectious or aseptic stimuli. The present investigation was carried out to study the Antipyretic activity of Polyalthia longifolia extracts in Wistar rats against Lipopolysaccharide (LPS) -induced pyrexia. P. longifolia Benth. & Hook. f. var. Pendula (Annonaceae) is an evergreen tropical tree well known for its numerous medicinal properties. Methanol extracts of the leaves, stem bark and root of the plant were tested for their Antipyretic activities at doses of 30, 100 and 300 mg kg-1 body weight using LPS-induced Antipyretic activity model. All extracts showed significant (p < 0.001) dose-dependent Antipyretic activity. At 300 mg kg-1, all extracts exhibited activities higher than that of Acetylsalicyclic acid (Aspirin) whose percentage inhibition of pyrexia was 86%. The root extract was the most active with a percentage inhibition of 127.5%, followed by the leaf extract (123.0%) and the stem bark extract (99.2%). This study proves P. longifolia as an effective Antipyretic agent and could be used as an adjunct in the treatment of other ailments. Journal of Medical and Biomedical Sciences (2013) 2(1), 8-12
