No, do not use cooled normal saline infusion for routine fever management in hemodynamically stable adults with high pyrexia.
Based on the highest quality guideline evidence, cold saline infusion is specifically NOT recommended for fever control, even in the specialized context of post-cardiac arrest targeted temperature management where it has been most studied 1.
Key Evidence Against Routine Use
The 2018 French expert panel guidelines on targeted temperature management explicitly state: "We do not suggest initiating TTM with infusion of large volumes of cold saline solution" (Grade 2- recommendation) 1. This recommendation stems from multiple randomized trials showing:
- No improvement in outcomes with pre-hospital cold fluid infusion
- Increased risk of re-arrest after return of spontaneous circulation
- Increased occurrence of pulmonary edema 1
Context-Specific Considerations
Where Cold Saline Has Limited Evidence:
Neurological injury patients: Small studies show cold saline can reduce fever burden in refractory cases 2, but these involved only 9-12 patients with brain injury already failing conventional antipyretics 2, 3. This is not generalizable to routine fever management.
Exercise-induced hyperthermia: A 2023 randomized trial found cold IV saline produced minimal cooling (0.039°C/min vs 0.028°C/min passive cooling) - a clinically insignificant difference that "casts significant doubt for the use of cold-IV saline infusion for whole-body cooling" 4.
The Cardiac Arrest Exception (Not Applicable to Your Question):
Cold saline infusion has been studied for rapid hypothermia induction post-cardiac arrest 5, 6, but this is therapeutic hypothermia (target 32-34°C), not fever management. Even in this specialized context, guidelines recommend against it during transport 1.
Why This Matters Clinically
Common pitfalls to avoid:
- Volume overload risk: Studies used 2-2.3L of cold fluid rapidly 5, 6 - dangerous in patients with any cardiac or renal compromise
- Hemodynamic instability: Blood pressure increases of 15 mmHg occurred even in selected populations 5
- False sense of efficacy: Temperature drops are modest and transient without sustained benefit 4
What to Do Instead
For hemodynamically stable adults with fever ≥39°C:
- Standard antipyretics (acetaminophen, NSAIDs if not contraindicated)
- External cooling methods (fans, cooling blankets, tepid sponging)
- Treat underlying cause of fever
- Monitor for deterioration requiring ICU-level interventions
Cold saline infusion should be reserved exclusively for specialized protocols in ICU settings (e.g., post-cardiac arrest therapeutic hypothermia under strict monitoring), not routine fever management 1.