Fever is a highly conserved response to infection in animal species. The presence of fever implies immune competence, and although some postulate the ability to mount fever portends survival advantages, the magnitude of fever has been associated with higher mortality in sepsis.1 Unfortunately, the pathophysiologic derangements accompanying septic shock overcome the protective value of fever, and in some cases fever contributes to a cycle of vasodilatory shock, myocardial dysfunction, and organ failure that precedes death. Critical care physicians should strongly consider external cooling to minimize the harmful effects of fever, especially among the most seriously ill patients. We base this position upon the following arguments:
1. A physiologic rationale exists to support fever therapy;
2. Contradictory conclusions in the literature result primarily from heterogeneity of studies (eg, severity of illness, methods of cooling, and timing of interventions); and
3. The strongest clinical trial supports fever treatment.