title: Persistent fever in the ICU.
abstract: Disorders of elevated body temperature may be classified as either fever or hyperthermia. Fever is caused by a pyrogen-mediated upward adjustment of the hypothalamic thermostat; hyperthermia results from a loss of physiologic control of temperature regulation. Fever in the ICU can be due to infectious or noninfectious causes. The initial approach to a febrile, critically ill patient should involve a thoughtful review of the clinical data to elicit the likely source of fever prior to the ordering of cultures, imaging studies, and broad-spectrum antibiotics. Both high fever and prolonged fever have been associated with increased mortality; however, a causal role for fever as a mediator of adverse outcomes during non-neurologic critical illness has not been established. Outside the realm of acute brain injury, the practice of treating fever remains controversial. To generate high-quality, evidence-based guidelines for the management of fever, large, prospective, multicenter trials are needed.
authors.affiliation: Section of Pulmonary & Critical Care Medicine, Department of Medicine, LSU Health Sciences Center, New Orleans, LA.
authors.forename: Tayyab
authors.initials: T
authors.lastname: Rehman
authors.affiliation: Section of Pulmonary & Critical Care Medicine, Department of Medicine, LSU Health Sciences Center, New Orleans, LA. Electronic address: bdeboi@lsuhsc.edu.
authors.forename: Bennett P
authors.initials: BP
authors.lastname: deBoisblanc
mesh_terms: D042101:Acalculous Cholecystitis / Q000150:complications / Q000601:surgery; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy; D055499:Catheter-Related Infections / Q000150:complications / Q000188:drug therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003428:Cross Infection / Q000150:complications / Q000188:drug therapy; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000188:drug therapy; D005334:Fever / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007362:Intensive Care Units; D008305:Malignant Hyperthermia / Q000150:complications / Q000628:therapy; D009459:Neuroleptic Malignant Syndrome / Q000150:complications / Q000628:therapy; D053717:Pneumonia, Ventilator-Associated / Q000150:complications / Q000188:drug therapy; D020230:Serotonin Syndrome / Q000150:complications / Q000628:therapy; D012852:Sinusitis / Q000150:complications / Q000188:drug therapy; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy; D054556:Venous Thromboembolism / Q000150:complications / Q000628:therapy