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The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group.

Publication ,  Journal Article
Bernard, GR; Wheeler, AP; Russell, JA; Schein, R; Summer, WR; Steinberg, KP; Fulkerson, WJ; Wright, PE; Christman, BW; Dupont, WD; Higgins, SB ...
Published in: N Engl J Med
March 27, 1997

BACKGROUND: In patients with sepsis the production of arachidonic acid metabolites by cyclooxygenase increases, but the pathophysiologic role of these prostaglandins is unclear. In animal models, inhibition of cyclooxygenase by treatment with ibuprofen before the onset of sepsis reduces physiologic abnormalities and improves survival. In pilot studies of patients with sepsis, treatment with ibuprofen led to improvements in gas exchange and airway mechanics. METHODS: From October 1989 to March 1995, we conducted a randomized, double-blind, placebo-controlled trial of intravenous ibuprofen (10 mg per kilogram of body weight [maximal dose, 800 mg], given every six hours for eight doses) in 455 patients who had sepsis, defined as fever, tachycardia, tachypnea, and acute failure of at least one organ system. RESULTS: In the ibuprofen group, but not the placebo group, there were significant declines in urinary levels of prostacyclin and thromboxane, temperature, heart rate, oxygen consumption, and lactic acidosis. With ibuprofen therapy there was no increased incidence of renal dysfunction, gastrointestinal bleeding, or other adverse events. However, treatment with ibuprofen did not reduce the incidence or duration of shock or the acute respiratory distress syndrome and did not significantly improve the rate of survival at 30 days (mortality, 37 percent with ibuprofen vs 40 percent with placebo). CONCLUSIONS: In patients with sepsis, treatment with ibuprofen reduces levels of prostacyclin and thromboxane and decreases fever, tachycardia, oxygen consumption, and lactic acidosis, but it does not prevent the development of shock or the acute respiratory distress syndrome and does not improve survival.

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Published In

N Engl J Med

DOI

ISSN

0028-4793

Publication Date

March 27, 1997

Volume

336

Issue

13

Start / End Page

912 / 918

Location

United States

Related Subject Headings

  • Thromboxanes
  • Survival Rate
  • Shock
  • Sepsis
  • Respiratory Distress Syndrome
  • Oxygen Consumption
  • Middle Aged
  • Male
  • Ibuprofen
  • Humans
 

Citation

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Bernard, G. R., Wheeler, A. P., Russell, J. A., Schein, R., Summer, W. R., Steinberg, K. P., … Swindell, B. B. (1997). The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group. N Engl J Med, 336(13), 912–918. https://doi.org/10.1056/NEJM199703273361303
Bernard, G. R., A. P. Wheeler, J. A. Russell, R. Schein, W. R. Summer, K. P. Steinberg, W. J. Fulkerson, et al. “The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group.N Engl J Med 336, no. 13 (March 27, 1997): 912–18. https://doi.org/10.1056/NEJM199703273361303.
Bernard GR, Wheeler AP, Russell JA, Schein R, Summer WR, Steinberg KP, et al. The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group. N Engl J Med. 1997 Mar 27;336(13):912–8.
Bernard, G. R., et al. “The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group.N Engl J Med, vol. 336, no. 13, Mar. 1997, pp. 912–18. Pubmed, doi:10.1056/NEJM199703273361303.
Bernard GR, Wheeler AP, Russell JA, Schein R, Summer WR, Steinberg KP, Fulkerson WJ, Wright PE, Christman BW, Dupont WD, Higgins SB, Swindell BB. The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group. N Engl J Med. 1997 Mar 27;336(13):912–918.
Journal cover image

Published In

N Engl J Med

DOI

ISSN

0028-4793

Publication Date

March 27, 1997

Volume

336

Issue

13

Start / End Page

912 / 918

Location

United States

Related Subject Headings

  • Thromboxanes
  • Survival Rate
  • Shock
  • Sepsis
  • Respiratory Distress Syndrome
  • Oxygen Consumption
  • Middle Aged
  • Male
  • Ibuprofen
  • Humans