Abstract
Background
Fever is a beneficial physiologic response to infection and is protective in gram-negative bacteremia and invasive candidiasis. Cooling blankets (CBs) are used in fevers due to a perception of providing symptomatic relief. However, external cooling of septic patients has been shown to be an independent risk factor for adverse effects. Here, we present a retrospective analysis of CB use in our institution and the associations of infections with CB duration.
Methods
We reviewed electronic medical records of patients aged ≥18 years admitted to a tertiary care hospital between 2015–2017 and in whom a CB was used. Study variables included demographics and clinical characteristics such as infection and fever duration (time of CB start to first defervescence). Correlations between continuous variables were assessed using the Spearman's rank correlation test and differences in the distribution of continuous variables by groups were assessed using Mann–Whitney U and Kruskal–Wallis tests.
Results
This analysis included 548 patients who used a total of 575 CBs during their stay (27 patients used ≥1 CB). The median age was 61.9 years and 56.9% were male. The most frequent comorbidities were immunocompromised state (40.3%), diabetes mellitus (33.6%) and coronary artery disease (32.3%). Pneumonia was the most common infection within 5 days of CB start (31.9%). Only 174 CBs had a documented discontinuation during hospitalization; for the remaining CBs, such documentation was absent. The median CB duration for these patients was 33.8 hrs (IQR: 18.0–80.9) while median fever duration was only 21.8 hours (IQR: 6.6–52.2). CB duration was highly correlated with fever duration (rho=.773, p
Conclusion
Clinician documentation of CB use was poor, only 30.2% recorded a stop time. Documented CB duration exceeded fever duration by more than 1.5 times and led to shivering responses in over 2/3 of patients. These findings suggest that CB use is arbitrary, not in keeping with established protocol or rationale, and its adverse effects may outweigh potential benefits. Their role should be re-evaluated and appropriate institutional protocols formulated.
Disclosures
All authors: No reported disclosures.
Session: 37. Bacteremia, CLABSI, and Endovascular Infections
Thursday, October 3, 2019: 12:15 PM