Management of Severe Infections: A Time to Keep a Cool Head or a Hot Topic for Clinical Trials?

We believe that the study by Mourvillier et al (6) is an important addition to the infectious diseases literature and serves to guide our management of patients with severe meningitis. Based on this study and others, it is evident that hypothermia is a pathological state and prompt resuscitation to normothermia is warranted in patients with severe infections. In contrast, fever is an adaptive host response to infection and its presence is associated with improved outcome in neurologically intact, infected patients admitted to ICUs. While it may appear ridiculous to the many clinicians who insist on treating all fevers in infected patients, it is our contention that therapeutic hyperthermia requires (re-)exploration as an adjunctive therapy for selected patients with infection (25).