Techniques for evaluating fever in the ICU. A stepwise approach for detecting infectious and noninfectious causes.
The initial work-up of a critically ill patient with fever begins with a hunt for an infectious cause. A positive urine culture, or the presence of dysuria or suprapubic tenderness, suggests urinary tract infection. Diagnosing pneumonia in ventilated patients is particularly difficult; CT may be helpful when chest films are hard to interpret. Blood cultures can rule out septicemia. Other common causes of fever in the ICU include abdominal abscesses and catheter-related infections; atelectasis has not been shown to cause fever. If the initial work-up fails to establish a cause of postoperative fever, and the fever resolves within 4 days, no further work-up is required.
Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, California, USA.
R J
RJ
Green
D E
DE
Clarke
R S
RS
Fishman
T A
TA
Raffin
D002404:Catheterization / Q000009:adverse effects; D003422:Critical Care; D003937:Diagnosis, Differential; D005335:Fever of Unknown Origin / Q000209:etiology*; D006801:Humans; D007239:Infections / Q000150:complications / Q000175:diagnosis; D011183:Postoperative Complications