6/28/23, 12:03 AM CASS Pathway Feedback Search Clinical Topics Home Studies CASS CASS Disease Sepsis and septic shock Trial question What is the role of induced hypothermia among patients with septic shock and ventilator- dependent respiratory failure? Study design Multi-center Open label RCT Population Characteristics of study participants 40.4% female N = 436 59.6% male 436 patients (173 female, 259 male) Inclusion criteria: patients with at least 50 years of age admitted to the ICU for at least 24 hours with severe sepsis or septic shock who were on mechanical ventilation Key exclusion criteria: uncontrolled bleeding, clinically important bleeding disorder, recent open surgery, pregnancy or breastfeeding, or involuntary psychiatric admission Interventions N=217 induced hypothermia (a target temperature of 32-34 degree Celsius for 24 hours and subsequent normothermia) N=215 control (routine thermal management) Primary outcome Rate of death from all causes by day 30 44.2 % 44.2 https://web.pathway.md/studies/recWcq6McvaiMH4C2 1/2 6/28/23, 12:03 AM CASS Pathway 35.8 33.2 % 22.1 % 11.1 % Borderline significant increase 0.0 % Induced hypothermia Control Borderline significant increase in the rate of death from all causes by day 30 (44.2% vs. 35.8%; RR 1.2, 95% CI 1 to 1.6) Secondary outcomes No significant difference in death at day 180 (56.2% vs. 50.7%; RR 1.1, 95% CI 0.9 to 1.3) Safety outcomes No significant differences in delirium, need for blood transfusion and surgery. Significant differences in Sequential Organ Failure Assessment score at 72 hours (11 vs. 9), > 30% decrease in CRP (33.3% vs. 50.3%). Conclusion In patients with at least 50 years of age admitted to the ICU for at least 24 hours with severe sepsis or septic shock who were on mechanical ventilation, induced hypothermia was inferior to control with respect to the rate of death from all causes by day 30. Reference Theis Skovsgaard Itenov, Maria Egede Johansen, Morten Bestle et al. Induced hypothermia in patients with septic shock and respiratory failure (CASS): a randomised, controlled, open-label trial. Lancet Respir Med. 2018 Mar;6(3):183-192. Open reference URL https://web.pathway.md/studies/recWcq6McvaiMH4C2 2/2