Should we treat pyrexia? And how do we do it?

Abstract

The concept of pyrexia as a protective physiological response to aid in host defence has been challenged with the awareness of the severe metabolic stress induced by pyrexia. The host response to pyrexia varies, however, according to the disease profile and severity and, as such, the management of pyrexia should differ; for example, temperature control is safe and effective in septic shock but remains controversial in sepsis. From the reported findings discussed in this review, treating pyrexia appears to be beneficial in septic shock, out of hospital cardiac arrest and acute brain injury.Multiple therapeutic options are available for managing pyrexia, with precise targeted temperature management now possible. Notably, the use of pharmacotherapy versus surface cooling has not been shown to be advantageous. The importance of avoiding hypothermia in any treatment strategy is not to be understated.Whilst a great deal of progress has been made regarding optimal temperature management in recent years, further studies will be needed to determine which patients would benefit the most from control of pyrexia and by which means this should be implemented. This narrative review is part of a series on the pathophysiology and management of pyrexia.

Targeted temperature management in patients with intracerebral haemorrhage, subarachnoid haemorrhage, or acute ischaemic stroke: consensus recommendations

“…A 4 g day À1 dose is often administered as standard, but reports suggest this is frequently ineffective for fever control in patients with brain injury. 1 Other studies using a higher dose (6 g day À1 ) have shown small but important reductions in temperature. 1,18,19 Many of these studies administered paracetamol to all patients, not only those with fever, so it is difficult to draw firm conclusions on its use in fever.…”

“…TTM has been used in several clinical situations, such as out-of-hospital cardiac arrest, traumatic brain injury (TBI), and cerebral vascular accidents, in an attempt to reduce neurological damage and enhance functional outcomes. 1 The evidence base for TTM use in patients with intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH), or acute ischaemic stroke (AIS) is limited and difficult to interpret given the range of TTM methods used, the different target temperatures used, the heterogeneity of the patient groups, and the presence or absence of neurogenic or infectious fever. A similar amount of heterogeneity exists in the limited number of clinical guidelines published in France and the USA.…”

Pyrexia in juvenile dogs: a review of 140 referred cases

“…Pyrexia, or fever, in contrast to hyperthermia, is defined as an elevated body temperature that occurs due to alteration of the thermoregulatory set point in the anterior hypothalamus in response to endogenous or exogenous pyrogens (Doyle & Schortgen ). Pyrexia is a highly conserved physiological adaptive response that, in the short term, confers an evolutionary advantage, particularly when combating infectious disease (Kluger et al .…”

Antibiotic Stewardship – From Bench to Bedside

“…Dabei ist bekannt, dass eine erhöhte Körpertemperatur bei bakteriellen Infektionen mit einem verbesserten Überleben einhergeht [17][18][19]. Dahingegen bleibt es unklar, ob die alleinige Senkung der Temperatur nicht auch gefährlich ist [20,21].…”