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Postgraduate Education Corner: Contemporary Reviews in Critical Care Medicine |

Persistent Fever in the ICUPersistent Fever in the ICU

Tayyab Rehman, MD; Bennett P. deBoisblanc, MD
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From the Section of Pulmonary & Critical Care Medicine (Drs Rehman and deBoisblanc), Department of Medicine, LSU Health Sciences Center, New Orleans, LA.

Correspondence to: Bennett P. deBoisblanc, MD, Section of Pulmonary & Critical Care Medicine, Department of Medicine, LSU Health Sciences Center, 1901 Perdido St, MEB, Ste 3205, New Orleans, LA 70112; e-mail: bdeboi@lsuhsc.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(1):158-165. doi:10.1378/chest.12-2843
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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.


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