UCSF

Fever in critically ill adults: monitoring, management, and outcomes

Fever is a common occurrence in intensive care unit (ICU) patients and is routinely treated with antipyretic therapies. Evidence to inform guidelines for fever management in ICUs is limited due to the low level of evaluable data. The introduction (Chapter 1) provides the background and significance of fever management in ICU patients. The question of whether fever should be suppressed based on its impact on outcomes in all ICU patients or in specific subpopulations, such as sepsis, neurological injury, and acute respiratory distress syndrome (ARDS), remains unanswered. To describe the impact of fever on outcomes of ICU patients with ARDS, a secondary analysis was completed and found that early in the ARDS trajectory, fever is associated with improved survival rates (Chapter 2).

A common limitation of studies investigating body temperature alterations in ICU patients is the lack of standard measurement of core body temperature. To address this limitation for the primary clinical trial of this dissertation and to evaluate a prospective continuous core temperature monitoring device for use in ICU patients, a method-comparison study was completed (Chapter 3). This method-comparison study tested the agreement and precision of a novel technology for continuous thermometry with standard thermometry methods in febrile ICU patients.

Fever suppression remains widespread and acetaminophen is the most common first line therapy used by ICU clinicians. There is a lack of high-grade evidence about the antipyretic efficacy and the acute hemodynamic effects of the more recently available intravenous (IV) formulation of acetaminophen in ICU patients. To better understand the therapy response and potential acute adverse effects of this commonly administered medication in febrile critically ill patients, a randomized, double blind, placebo-controlled trial to evaluate the effect of IV acetaminophen on body temperature and hemodynamic responses was conducted (Chapter 4).