Management of Febrile Critically Ill Adults: A Retrospective Assessment of Regional Practice

Niven, Daniel J.; Shahpori, Reza; Stelfox, Henry T.; Laupland, Kevin B.

doi:10.1089/ther.2011.0002

Cited by 14 publications

(15 citation statements)

References 19 publications

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“…Given that bloodstream infection can also be primary or catheter related, the bloodstream is a common site of infection in critically ill patients with pyrexia [3, 5, 19, 36]. Among patients admitted to the ICU owing to a severe bloodstream infection that is community onset, the most common pathogens are E. coli , S. aureus , and S. pneumoniae [37].…”

Section: Aetiology and Incidence Of Hyperthermia And Pyrexiamentioning

confidence: 99%

“…However, this study probably underestimated the incidence of infectious fever because the authors did not systematically evaluate the results of diagnostic tests other than cultures for identifying infection [3]. Another study in the same health region that undertook a detailed chart review to investigate pyrexia management practices in 100 medical and surgical critically ill patients without an acute neurological condition found that infections were responsible for 73 % of pyrexia episodes, with pneumonia the most common infection, occurring in 70 % of infectious fevers [36]. This is consistent with a large, prospective study of infection occurrence in 71 ICUs in Italy, wherein the most common source of infection was pneumonia [30].…”

Section: Aetiology and Incidence Of Hyperthermia And Pyrexiamentioning

confidence: 99%

“…In a multinational survey of temperature management practices in 139 general medical–surgical ICUs, 59 % of respondents indicated that new pyrexia triggers a full septic work-up, mostly via specific physician order, not a standardized protocol [22]. In a study examining management practices among febrile critically ill adults without an acute neurological condition, Niven et al [36] found that 89 % of the population had at least one culture sent to the laboratory for analysis within the first 48 hours of fever onset. The most common culture was a blood culture (73 %), followed by urine culture (62 %) and respiratory secretion culture (61 %).…”

Section: Investigations In Patients With Hyperthermia or Pyrexiamentioning

confidence: 99%

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Pyrexia: aetiology in the ICU

Niven

Laupland

2016

Crit Care

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Elevation in core body temperature is one of the most frequently detected abnormal signs in patients admitted to adult ICUs, and is associated with increased mortality in select populations of critically ill patients. The definition of an elevated body temperature varies considerably by population and thermometer, and is commonly defined by a temperature of 38.0 °C or greater. Terms such as hyperthermia, pyrexia, and fever are often used interchangeably. However, strictly speaking hyperthermia refers to the elevation in body temperature that occurs without an increase in the hypothalamic set point, such as in response to specific environmental (e.g., heat stroke), pharmacologic (e.g., neuroleptic malignant syndrome), or endocrine (e.g., thyrotoxicosis) stimuli. On the other hand, pyrexia and fever refer to the classical increase in body temperature that occurs in response to a vast list of infectious and noninfectious aetiologies in association with an increase in the hypothalamic set point. In this review, we examine the contemporary literature investigating the incidence and aetiology of pyrexia and hyperthermia among medical and surgical patients admitted to adult ICUs with or without an acute neurological condition. A temperature greater than 41.0 °C, although occasionally observed among patients with infectious or noninfectious pyrexia, is more commonly observed in patients with hyperthermia. Most episodes of pyrexia are due to infections, but incidence estimates of infectious and noninfectious aetiologies are limited by studies with small sample size and inconsistent reporting of noninfectious aetiologies. Pyrexia commonly triggers a full septic work-up, but on its own is a poor predictor of culture-positivity. In order to improve culturing practices, and better guide the diagnostic approach to critically ill patients with pyrexia, additional research is required to provide more robust estimates of the incidence of infectious and noninfectious aetiologies, and their relationship to other clinical features (e.g., leukocytosis). In the meantime, using existing literature, we propose an approach to identifying the aetiology of pyrexia in critically ill adults.

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Section: Aetiology and Incidence Of Hyperthermia And Pyrexiamentioning

confidence: 99%

Section: Aetiology and Incidence Of Hyperthermia And Pyrexiamentioning

confidence: 99%

Section: Investigations In Patients With Hyperthermia or Pyrexiamentioning

confidence: 99%

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Pyrexia: aetiology in the ICU

Niven

Laupland

2016

Crit Care

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“…Nonetheless, the use of antipyretic medications and physical cooling interventions to treat fever is widespread in clinical practice. 1-4 …”

mentioning

confidence: 99%

Body Temperature and Mortality in Patients with Acute Respiratory Distress Syndrome

Schell-Chaple

Puntillo

Matthay

et al. 2015

American Journal of Critical Care

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Background Little is known about the relationship between body temperature and outcomes in patients with acute respiratory distress syndrome (ARDS). A better understanding of this relationship may provide evidence for fever suppression or warming interventions, which are commonly applied in practice. Objective To examine the relationship between body temperature and mortality in patients with ARDS. Methods Secondary analysis of body temperature and mortality using data from the ARDS Network Fluid and Catheter Treatment Trial (n =969). Body temperature at baseline and on study day 2, primary cause of ARDS, severity of illness, and 90-day mortality were analyzed by using multiple logistic regression. Results Mean baseline temperature was 37.5°C (SD, 1.1°C; range, 27.2°C-40.7°C). At baseline, fever (≥ 38.3°C) was present in 23% and hypothermia (< 36°C) in 5% of the patients. Body temperature was a significant predictor of 90-day mortality after primary cause of ARDS and score on the Acute Physiology and Chronic Health Evaluation III were adjusted for. Higher temperature was associated with decreased mortality: for every 1°C increase in baseline temperature, the odds of death decreased by 15% (odds ratio, 0.85; 95% CI, 0.73-0.98, P = .03). When patients were divided into 5 temperature groups, mortality was lower with higher temperature (P for trend=.02). Conclusions Early in ARDS, fever is associated with improved survival rates. Fever in the acute phase response to lung injury and its relationship to recovery may be an important factor in determining patients' outcome and warrants further study.

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“…One study from Canada found that among 100 critically ill adults without acute neurological injury, 79 received pharmacologic and/or physical anti-pyretic therapy during an episode of fever [28]. Similarly, another study conducted in Japan and Korea found that more than 50% of patients admitted to ICUs were treated with temperature lowering therapy [5].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and management of temperature abnormality in ICUs: a EUROBACT investigators' survey

et al. 2013

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IntroductionAlthough fever and hypothermia are common abnormal physical signs observed in patients admitted to intensive care units (ICU), little data exist on their optimal management. The objective of this study was to describe contemporary practices and determinants of management of temperature abnormalities among patients admitted to ICUs.MethodsSite leaders of the multi-national EUROBACT study were surveyed regarding diagnosis and management of temperature abnormalities among patients admitted to their ICUs.ResultsOf the 162 ICUs originally included in EUROBACT, responses were received from 139 (86%) centers in 23 countries in Europe (117), South America (8), Asia (5), North America (4), Australia (3) and Africa (2). A total of 117 (84%) respondents reported use of a specific temperature threshold in their ICU to define fever. A total of 14 different discrete levels were reported with a median of 38.2°C (inter-quartile range, IQR, 38.0°C to 38.5°C). The use of thermometers was protocolized in 91 (65%) ICUs and a wide range of methods were reportedly used, with axillary, tympanic and urinary bladder sites as the most common as primary modalities. Only 31 (22%) of respondents indicated that there was a formal written protocol for temperature control among febrile patients in their ICUs. In most or all cases practice was to control temperature, to use acetaminophen, and to perform a full septic workup in febrile patients and that this was usually directed by physician order. While reported practice was to treat nearly all patients with neurological impairment and most patients with acute coronary syndromes and infections, severe sepsis and septic shock, this was not the case for most patients with liver failure and fever.ConclusionsA wide range of definitions and management practices were reported regarding temperature abnormalities in the critically ill. Documenting temperature abnormality management practices, including variability in clinical care, is important to inform planning of future studies designed to optimize infection and temperature management strategies in the critically ill.

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Management of Febrile Critically Ill Adults: A Retrospective Assessment of Regional Practice

Cited by 14 publications

References 19 publications

Pyrexia: aetiology in the ICU

Pyrexia: aetiology in the ICU

Body Temperature and Mortality in Patients with Acute Respiratory Distress Syndrome

Diagnosis and management of temperature abnormality in ICUs: a EUROBACT investigators' survey

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