title: Fever is associated with delayed ventilator liberation in acute lung injury.
abstract: BACKGROUND
  Acute lung injury (ALI) is characterized by inflammation, leukocyte activation, neutrophil recruitment, endothelial dysfunction, and epithelial injury, which are all affected by fever. Fever is common in the intensive care unit, but the relationship between fever and outcomes in ALI has not yet been studied. We evaluated the association of temperature dysregulation with time to ventilator liberation, ventilator-free days, and in-hospital mortality.
  
  
  METHODS
  Analysis of a prospective cohort study, which recruited consecutive patients with ALI from 13 intensive care units at four hospitals in Baltimore, Maryland. The relationship of fever and hypothermia with ventilator liberation was assessed with a Cox proportional hazards model. We evaluated the association of temperature during the first 3 days after ALI with ventilator-free days, using multivariable linear regression models, and the association with mortality was evaluated by robust Poisson regression.
  
  
  RESULTS
  Of 450 patients, only 12% were normothermic during the first 3 days after ALI onset. During the first week post-ALI, each additional day of fever resulted in a 33% reduction in the likelihood of successful ventilator liberation (95% confidence interval [CI] for adjusted hazard ratio, 0.57 to 0.78; P < 0.001). Hypothermia was independently associated with decreased ventilator-free days (hypothermia during each of the first 3 d: reduction of 5.58 d, 95% CI: -9.04 to -2.13; P = 0.002) and increased mortality (hypothermia during each of the first 3 d: relative risk, 1.68; 95% CI, 1.06 to 2.66; P = 0.03).
  
  
  CONCLUSIONS
  Fever and hypothermia are associated with worse clinical outcomes in ALI, with fever being independently associated with delayed ventilator liberation.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine and.
authors.forename: Giora
authors.initials: G
authors.lastname: Netzer
authors.forename: David W
authors.initials: DW
authors.lastname: Dowdy
authors.forename: Thelma
authors.initials: T
authors.lastname: Harrington
authors.forename: Satish
authors.initials: S
authors.lastname: Chandolu
authors.forename: Victor D
authors.initials: VD
authors.lastname: Dinglas
authors.forename: Nirav G
authors.initials: NG
authors.lastname: Shah
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Mendez-Tellez
authors.forename: Carl
authors.initials: C
authors.lastname: Shanholtz
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Hasday
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D055371:Acute Lung Injury / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000150:complications*; D017052:Hospital Mortality; D006801:Humans; D007035:Hypothermia / Q000150:complications*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D015300:Ventilator Weaning
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