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Should cooling methods such as fanning and tepid sponging be used to manage pyrexia? What do you think?
EXPERT COMMENT
The routine use of physical cooling methods such as tepid sponging and fanning are controversial. If the body’s natural defence mechanism to combat infection is to increase body temperature, why try to reduce it? Physical cooling methods may actually increase body temperature: they can stimulate a compensatory response by resulting in heat-generating activities such as shivering, which can compromise unstable patients by depleting their metabolic reserve.
There is no evidence to support the routine use of tepid sponging in temperate climates such as the UK and it does not produce a sustained drop in temperature. It can cause vasoconstriction, which can result in a further rise in patients’ temperature. If it is performed too quickly, it can cause them to shiver, which will increase metabolic rate and subsequently core body temperature. It is also time-consuming.
However, some authors recommend that physical cooling methods should be used if patients have potentially life threatening hyperpyrexia, heat stroke or malignant hyperthermia.
There is no doubt that a cool fan (not directly on patients) or cool flannel on the face can be very welcome when feeling hot. Reducing the amount of clothing and bedding can also help.
Phil Jevon is resuscitation officer and clinical skills lead at Manor Hospital, Walsall, West Midlands.
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Readers' comments (2)
Anonymous | 26-Oct-2011 9:12 am
I have used tepid spongeing frequently with good effect.
If used with antipyretic medicine it can lead to a very welcome reduction in temperature in the first hour by a degree. The antipyretics then kick in and temp is reduced for a prolonged period...
In the very 'sorry for himself' child a damp tepid cloth over the scalp can be a useful comfort measure, as can regularly wiping the face and neck.
NICE have spoken out against these methods but did not look at them as part of combination therapy.
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Anonymous | 30-Oct-2011 9:01 pm
Sometimes it is very useful to use either method, as when a child is know to prone to febrile convulsions and the alternative is for them to begin to convulse.
I have used this method with my own children whilst awaiting medication to kick in, especially due to the length of time paracetemol takes to be effective. I have also used this with good effect when I had a urine infection but the gp would not prescribe antibiotics until the results of a sample came back from the hospital!! and paracetemol and ibuprofen were not bringing my temperature down.
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