Management of febrile critically ill adults: a retrospective assessment of regional practice.
The aim of this study was to report on fever epidemiology and management strategies within a general population of critically ill patients. This was a retrospective cohort study among febrile patients (temperature ≥38.3°C) without acute brain injury admitted to one of four regional adult intensive care units (ICUs). There were 7535 ICU admissions over the 30-month study period. One hundred patients with fever were randomly selected for detailed analysis and represent the study population. The study population had a median age (interquartile range) of 56 (43-69) years and a mean (±standard deviation) Acute Physiology and Chronic Health Evaluation II score of 22 (±9). Septic shock was the most common admission diagnosis (36%), followed by pneumonia (without a shock syndrome; 18%). Fifty-three percent of patients had fever at ICU admission. To investigate the etiology of fever, most patients (89%) had at least one culture sent to the laboratory for analysis and a blood culture (73%) was the most commonly ordered microbiologic investigation. A chest X-ray was ordered in 95% of patients within 48 hours of fever onset. The majority of patients had an infection as the cause of their fever (73%), with pneumonia as the most common diagnosis (70%, 51/73). Prior to the occurrence of fever, 74% of patients were on antibiotics and this increased to 85% within the first 24 hours after documentation of fever. Seventy-nine percent of patients were managed with antipyretic drugs (77%) and/or external cooling (29%); however, only five patients had an order written that specifically guided the use of these temperature-lowering agents. Fever was most commonly infectious in origin. Treatment of patients with fever was a common and nonstandardized practice in this cohort of critically ill patients. This is likely due to lack of evidence in support of a particular temperature management strategy.
1 Department of Critical Care Medicine, University of Calgary , Alberta Health Services, Calgary, Alberta, Canada .
Daniel J
DJ
Niven
Reza
R
Shahpori
Henry T
HT
Stelfox
Kevin B
KB
Laupland