External Cooling Methods for Treatment of Fever in Adults: a Systematic Review.

Review Objectives: To evaluate the effectiveness and complications of external cooling methods in febrile adults in acute care settings. The following specific research questions were addressed in this review: 1. What is the effectiveness of external cooling method, compared to no cooling in reducing temperature for adults with fever? 2. What is the effectiveness of external cooling method, compared to no cooling in sustaining the reduction in temperature? 3. What are the adverse events or complications with the use of external cooling method compared to no cooling? 4. What are the patients’ accounts of the external cooling methods compared to no cooling? Criteria for considering studies for this review: Types of participants: Participants in this study will include adults who have been admitted to an acute care setting who developed elevated body temperature that requires cooling to normothermia. The authors’ definitions of adult and fever will be utilised. Types of interventions:  This review will consider any external cooling method compared to no intervention. We will exclude trials reporting invasive cooling methods such as the use of endovascular cooling. Trials directly comparing two external cooling methods without a non-intervention group will also be excluded. Furthermore trials involving induced hypothermia for neurotrauma, management of heat stroke, malignant hyperthermia, or severe hypoxemia will not be considered. The studies will be stratified into those where all participants received antipyretic drugs and those where no participants received antipyretic drugs. Types of outcome measures:  The primary outcome of interest is resolution of fever using the authors’ definitions. The secondary outcomes of interest are: 1. Mean drop in temperature after starting treatment 2. Mean time to fever resolution 3. Continued drop in temperature after discontinued treatment 4. Persistent febrile state after starting treatment 5. Complications such as shivering, chills, vomiting, irritability, headache and muscle pain 6. Adverse events defined as those leading to discontinuation of the intervention or defined as ‘adverse events’ using the authors’ definitions 7. Patient’s account of the treatment regimen