Fever effects and treatment in critical care: literature review

Considering that the incidence of fever may reach up to 75% among critically ill adults, healthcare professionals employed in the Intensive Care Unit (ICU) are called to evaluate and manage patient temperature elevation on a daily basis. This literature review synthesizes the evidence about the effects of fever and antipyretic treatment in ICU patients. Although the febrile response acts protectively against infections, noxious effects are possible for patients with cerebral damage, neuropsychiatric disorders or limited cardiorespiratory reserve. Observational studies on ICU populations have reported associations between fever magnitude and patient mortality. Especially recent findings indicated that infected patients may significantly benefit from temperature elevation, while high fever may be maladaptive for non-infected ones. Aggressive antipyretic treatment of ICU patients has not been followed by decreased mortality in randomized trials. However, fever suppression and return to normothermia improved outcomes of septic shock patients. Antipyretic treatment should begin with drug administration and proceed with external cooling in case of refractory fever, but adverse effects of both antipyretic methods should always be considered. This article concludes by providing implications for antipyretic treatment of critically ill adults and suggesting areas for future research.