Managing Fever in Critical Care

Abstract

Fever; is one of the most common abnormal symptoms in patients admitted to adult intensive care units (ICUs) and is associated with increased mortality in critically ill populations. Fever in the critical care unit affects important diagnosis and treatment decisions. It usually occurs early, is often non-infective, and is usually benign. Fever in the intensive care unit can be caused by infectious and non-infectious causes. The cornerstone of treatment is to treat the underlying cause of the fever. There is a need for the clinician to determine the best evidence-based approach for the identification and treatment of fever by paying attention to appropriate body temperature measurement, diagnostic evaluation, replacement of indwelling catheters, administration of antipyretic drugs, antibiotic therapy in critical patient follow-up in the intensive care unit, through literature analysis.

Keywords

• fever
• critical care
• infectious
• non-infectious

Yoğun Bakımda Ateşin Yönetilmesi

Abstract

Ateş; yetişkin yoğun bakım ünitelerine (YBÜ) kabul edilen hastalarda en sık saptanan anormal belirtilerden biridir ve kritik hasta popülasyonlarında artan mortalite ile ilişkilidir. Yoğun bakım ünitesinde ateş, önemli tanı ve tedavi kararlarını etkilemektedir. Genellikle erken döneminde ortaya çıkar, sıklıkla enfektif değildir ve genellikle iyi huyludur. Yoğun bakım ünitesindeki ateş enfeksiyöz ve enföksiyöz olmayan nedenlerden kaynaklı olabilir. Tedavinin temel taşı, ateşin altında yatan nedeni tedavi etmektir. Klinisyenin yoğun bakımda kritik hasta takibinde uygun vücut ısısı ölçümüne, tanısal değerlendirmeye, kalıcı kateterlerin değiştirilmesine, ateş düşürücü ilaçların uygulanmasına ve antibiyotik tedavisine, değişikliğe dikkat edilerek ateşin tanımlanması ve tedavisine yönelik en iyi kanıta dayalı yaklaşımın literatür analizi yoluyla belirlenmesine ihtiyaç vardır.

Keywords

• ateş
• yoğun bakım
• enfeksiyöz
• non-enfeksiyöz

References

1. Hasday JD, Thompson C, Singh IS. Fever, immunity, and molecular adaptations. Compr Physiol. 2014;4(1):109-48.
2. O’Grady NP, Barie PS, Bartlett JG, Bleck T, Garvey G, Jacobi J, et al. Practice guidelines for evaluating new fever in critically ill adult patients. Task Force of the Society of Critical Care Medicine and the Infectious Diseases Society of America. Clin Infect Dis. 1998;26(5):1042-1059.
3. Mackowiak PA, Wasserman SS, Levine MM. A critical appraisal of 98.6 degrees F, the upper limit of the normal body temperature, and other legacies of Carl Reinhold August Wunderlich. JAMA. 1992;268(12):1578-1580.
4. Niven DJ, Léger C, Stelfox HT, Laupland KB. Fever in the critically ill: a review of epidemiology, immunology, and management. J Intensive Care Med. 2012;27(5):290-297.
5. Niven DJ, Laupland KB. Pyrexia: aetiology in the ICU. Crit Care. 2016;20(1):247.
6. Cevıker SA, Yılmaz M, Yıldız E, Alıravcı ID, Demıray EKD. Serotonin Syndrome Dueto Linezolid in a Patient Receiving Escitalopram Treatment. Osmangazi Journal of Medicine. 2021;43(1):82-85
7. Singh IS, Hasday JD. Fever, hyperthermia and the heat shock response. Int J Hyperthermia. 2013;29(5):423-435.
8. Young PJ, Saxena M. Fever management in intensive care patients with infections. Critical Care. 2014;18(2):206.

9. Terekci M. Yoğun bakım ünitesinde ateş (İnternet). Available at:https://www.gunceltipdernegi.org/pdf/Murat-Terekeci.pdf. Accessed September 5, 2021.
10. O’Grady NP, Barie PS, Bartlett JG, Bleck T, Carroll K, Kalil AC, et al; American College of Critical Care Medicine; Infectious Diseases Society of America. Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med. 2008 Apr;36(4):1330-1349.
11. Laupland KB, Shahpori R, Kirkpatrick AW, Ross T, Gregson DB, Stelfox HT. Occurrence and outcome of fever in critically ill adults. Crit Care Med. 2008;36(5):1531-1535.
12. Karasu D, Yilmaz C, Durmus G, Ozer D, Cağlayan U, Karaduman I, et al. Evaluation of Healthcare-Associated Infections in Critically Ill Patients Receiving Long-Term Treatment in the Intensive Care Unit. Klimik Dergisi. 2016;29(2):72-77.
13. Circiumaru B, Baldock G, Cohen J. A prospective study of fever in the intensive care unit. Intensive Care Med. 1999;25(7):668-73.
14. Niven DJ, Stelfox HT, Shahpori R, Laupland KB. Fever in adult ICUs: an interrupted time series analysis*. Crit Care Med. 2013;41(8):1863-9.
15. McLaws ML, Berry G. Nonuniform risk of bloodstream infection with increasing central venous catheter-days. Infect Control Hosp Epidemiol. 2005;26(8):715-719.
16. MacLaren G, Spelman D. Fever in the intensive care unit (Internet). Available at: https://www.uptodate.com/contents/fever-in-the-intensive-care-unit. Accessed September 8, 2021.
17. Sivrikaya SK, Erdem G. Kronik hastalıklarda yara bakımı. Balıkesir Sağlık Bil. Derg. 2019;8(2):99-104.
18. Young P, Saxena M, Eastwood GM, Bellomo R, Beasley R. Fever and fever management among intensive care patients with known or suspected infection: a multicentre prospective cohort study. Crit Care Resusc. 2011;13(2):97-102.
19. Selladurai S, Eastwood GM, Bailey M, Bellomo R. Paracetamol therapy for septic critically ill patients: a retrospective observational study. Crit Care Resusc. 2011;13(3):181-186.
20. Lee BH, Inui D, Suh GY, Kim JY, Kwon JY, Park J, et al. Fever and Antipyretic in Critically ill patients Evaluation (FACE) Study Group. Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study. Crit Care. 2012;16(1):R33.
21. Laupland KB, Zahar JR, Adrie C, Schwebel C, Goldgran-Toledano D, Azoulay E, et al. Determinants of temperature abnormalities and influence on outcome of critical illness. Crit Care Med. 2012;40(1):145-51.
22. Young PJ, Saxena M, Beasley R, Bellomo R, Bailey M, Pilcher D, et al. Early peak temperature and mortality in critically ill patients with or without infection. Intensive Care Med. Published online January 31, 2012. doi:10.1007/s00134-012-2478-3
23. Azap DA. Sağlık Bakımıyla İlişkili İnfeksiyonların Epidemiyolojisinde Temel Tanımlar (İnternet). Erişim adresi: https://www.klimik.org.tr/wp-content/uploads/2014/03/ALPAY-AZAP.pdf. Erişim tarihi:08/08/2021.
24. Munro N. Fever in acute and critical care: a diagnostic approach. AACN Adv Crit Care. 2014;25(3):237-48; quiz 249-50.
25. Pile JC. Evaluating postoperative fever: a focused approach. Cleve Clin J Med. 2006;73:62-66.
26. Aliravci İD, Akinci E, Çevi̇ker SA. Ateş nedeniyle enfeksiyon hastalıkları kliniğine yatırılarak takip ve tedavi edilen hastaların retrospektif değerlendirilmesi. Pamukkale Tıp Dergisi. 2020;13(2):276-283.
27. Abrams-Downey A, Erna Milunka K. Fever of Undetermined Origin (Internet). Available at: https://www.clinicalkey.com/#!/content/derived_clinical_overview/76-s2.0-B9780323755702003544?scrollTo=%23result-1. Accessed September 7, 2021.
28. Jones PA, Andrews PJ, Midgley S, Anderson SI, Piper IR, Tocher JL, et al. Measuring the burden of secondary insults in head-injured patients during intensive care. J Neurosurg Anesthesiol. 1994;6(1):4-14.
29. Ferguson A. Evaluation and treatment of fever in intensive care unit patients. Crit Care Nurs Q. 2007;30(4):347-363.