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Chest. 2014 Jan;145(1):158-165. doi: 10.1378/chest.12-2843.

Persistent fever in the ICU.

Author information

1
Section of Pulmonary & Critical Care Medicine, Department of Medicine, LSU Health Sciences Center, New Orleans, LA.
2
Section of Pulmonary & Critical Care Medicine, Department of Medicine, LSU Health Sciences Center, New Orleans, LA. Electronic address: bdeboi@lsuhsc.edu.

Abstract

Disorders of elevated body temperature may be classified as either fever or hyperthermia. Fever is caused by a pyrogen-mediated upward adjustment of the hypothalamic thermostat; hyperthermia results from a loss of physiologic control of temperature regulation. Fever in the ICU can be due to infectious or noninfectious causes. The initial approach to a febrile, critically ill patient should involve a thoughtful review of the clinical data to elicit the likely source of fever prior to the ordering of cultures, imaging studies, and broad-spectrum antibiotics. Both high fever and prolonged fever have been associated with increased mortality; however, a causal role for fever as a mediator of adverse outcomes during non-neurologic critical illness has not been established. Outside the realm of acute brain injury, the practice of treating fever remains controversial. To generate high-quality, evidence-based guidelines for the management of fever, large, prospective, multicenter trials are needed.

PMID:
24394828
DOI:
10.1378/chest.12-2843
[Indexed for MEDLINE]
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