Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America.
OBJECTIVE
To update the practice parameters for the evaluation of adult patients who develop a new fever in the intensive care unit, for the purpose of guiding clinical practice.


METHODS
A task force of 11 experts in the disciplines related to critical care medicine and infectious diseases was convened from the membership of the Society of Critical Care Medicine and the Infectious Diseases Society of America. Specialties represented included critical care medicine, surgery, internal medicine, infectious diseases, neurology, and laboratory medicine/microbiology.


METHODS
The task force members provided personal experience and determined the published literature (MEDLINE articles, textbooks, etc.) from which consensus was obtained. Published literature was reviewed and classified into one of four categories, according to study design and scientific value.


METHODS
The task force met twice in person, several times by teleconference, and held multiple e-mail discussions during a 2-yr period to identify the pertinent literature and arrive at consensus recommendations. Consideration was given to the relationship between the weight of scientific evidence and the strength of the recommendation. Draft documents were composed and debated by the task force until consensus was reached by nominal group process.


CONCLUSIONS
The panel concluded that, because fever can have many infectious and noninfectious etiologies, a new fever in a patient in the intensive care unit should trigger a careful clinical assessment rather than automatic orders for laboratory and radiologic tests. A cost-conscious approach to obtaining cultures and imaging studies should be undertaken if indicated after a clinical evaluation. The goal of such an approach is to determine, in a directed manner, whether infection is present so that additional testing can be avoided and therapeutic decisions can be made.
O'Grady
Naomi P
NP
National Institutes of Health, Bethesda, MD, USA. nogrady@mail.cc.nih.gov
Barie
Philip S
PS
Bartlett
John G
JG
Bleck
Thomas
T
Carroll
Karen
K
Kalil
Andre C
AC
Linden
Peter
P
Maki
Dennis G
DG
Nierman
David
D
Pasculle
William
W
Masur
Henry
H
D000328:Adult; D001831:Body Temperature; D003141:Communicable Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D003422:Critical Care / Q000379:methods*; D003428:Cross Infection / Q000175:diagnosis / Q000382:microbiology / Q000503:physiopathology; D005334:Fever / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D007362:Intensive Care Units; D016032:Randomized Controlled Trials as Topic; D012955:Societies, Medical; D014481:United States