Evaluation of the Febrile Patient

  • Ellen Riccobene
  • Richard Gleckman


The presence of fever in patients in the surgical intensive care unit (SICU) demands prompt attention because infection, often heralded by an elevation in core body temperature, is the leading cause of death in this patient population (1). Fever is defined as “a state of elevated core temperature,” and is present when the oral temperature is higher than 99°F (>37.3°C) in the early morning or higher than 100°F (>37.8°C) at any time during the day. This frame of reference is obviously of limited value when applied to seriously ill patients in the SICU, some of whom may exhibit an absent or blunt response to infection and others who are not candidates for oral temperature measurements. Most authorities consider the thermistor of a pulmonary artery catheter to be the most accurate device for measuring core temperature. However, when pulmonary artery catheters are not in place, most believe that electronic probes, placed in the rectum or external auditory canal, are acceptable alternatives. Measurements from the axilla are unreliable and should not be used (2).


Surgical Site Infection Pulmonary Artery Catheter Surgical Intensive Care Unit Toxic Shock Syndrome Febrile Patient 
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  1. 1.
    Price J, Ekleberry A, Grover A, Melendy S, Baddam K, McMahon J, Villalba M, Johnson M, Zervos MJ. Evaluation of clinical practice guidelines on outcome of infection in patients in the surgical intensive care unit. Crit Care Med 1999; 27: 2118–24.PubMedCrossRefGoogle Scholar
  2. 2.
    Schmitz T, Bair N, Falk M, Levine C. A comparison of five methods of temperature measurement in febrile intensive care patients. Am J Crit Care 1995; 4: 286–92.PubMedGoogle Scholar
  3. 3.
    Sehdev PS, Mackowiak PA. Fever in the ICU patient. In: Pankey GA, ed. Serious Hospital Infections 1999; 11: 1–8.Google Scholar
  4. 4.
    Clarke DE, Kimelman J, Raffin TA. The evaluation of fever in the intensive care unit. Chest 1991; 100: 213–20.PubMedCrossRefGoogle Scholar
  5. 5.
    Mackowiak PA, LeMaistre CF. Drug fever: a critical appraisal of conventional concepts. An analysis of 51 episodes in two Dallas hospitals and 97 episodes reported in the English literature. Ann Intern Med 1987; 106: 728–33.PubMedGoogle Scholar
  6. 6.
    O’Grady NP, Barie PS, Bartlett JG, Bleck T, Gaevey G, Jacobi J, Linden P, Maki DG, Nam M, Pasculle W, Pasquale MD, Tribett DL, Masur H. 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: 1042–59.PubMedCrossRefGoogle Scholar
  7. 7.
    Hilton E, Lerner CW, Lowy FD, Tapper ML. “Culture-negative” prosthetic valve endocarditis. Hazards of postoperative steroid therapy for unexplained fever. Arch Intern Med 1984; 144: 2083–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Knowles SR, Gupta AK, Shear NH, Sauder D. Azathioprine hypersensitivity-like reactions-a case report and a review of the literature. Clin Exp Dermatol 1995; 20: 353–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Povoa P, Almeida E, Moreira P, Fernandes A, Meath R, Aragao A, Sabino H. C-reactive protein as an indicator of sepsis. Intensive Care Med 1998; 24: 1052–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Fassbender K, Pargger H, Muller W, Zimmerli W. Interleukin-6 and acute-phase protein concentrations in surgical intensive care unit patients: diagnostic signs in nosocomial infection. Crit Care Med 1993; 21: 1175–80.PubMedCrossRefGoogle Scholar
  11. 11.
    Kuse ER, Langefeld I, Jaeger K, Kulpmann WR. Procalcitonin in fever of unknown origin after liver transplantation: a variable to differentiate acute rejection from infection Crit Care Med 2000; 28: 555–9.Google Scholar
  12. 12.
    Cunha BA. Intravenous line infections Crit Care Clin 1998; 14: 339–46.CrossRefGoogle Scholar
  13. 13.
    Marquette CH, Georges H, Wallet F, Ramon P, Saulnier F, Neviere R, Mathieu D, Rime A, Tonne! AB. Diagnostic efficiency of endotracheal aspirates with quantitative bacterial cultures in intubated patients with suspected pneumonia. Comparison with the protected specimen brush. Am Rev Respir Dis 1993; 148: 138–44.Google Scholar
  14. 14.
    Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. Arch Intern Med 2000; 160: 678–82.PubMedCrossRefGoogle Scholar
  15. 15.
    Mirvis SE, Tobin KD, Kostrubiak I, Belzberg H. Thoracic CT in detecting occult disease in critically ill patients. AJR Am J Roentgenol 1987; 148: 685–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Rouby JJ, Laurent P, Gosnach M, Cambau E, Lamas G, Zouaoui A, Leguillou JL, Bodin L, Khac TD, Marsault C, Poete P, Nicolas MH, Jarlier V, Viars P. Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill. Am J Respir Crit Care Med 1994; 150: 776–83.PubMedCrossRefGoogle Scholar
  17. 17.
    Borman KR, Brown PM, Mezera KK, Jhaveri H. Occult fever in surgical intensive care unit patients is seldom caused by sinusitis. Am J Surg 1992; 164: 412–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Sessions SC, Scoma RS, Sheikh FA, McGeehin WH, Smink RD Jr. Acute acalculous cholecystitis following open heart surgery. Am Surg 1993; 59: 74–7.PubMedGoogle Scholar
  19. 19.
    Cunha BA, Shea KW. Fever in the intensive care unit. Infect Dis Clin North Am 1996; 10: 185209.Google Scholar
  20. 20.
    Marik PE, Andrews L, Maini B. The incidence of deep venous thrombosis in ICU patients. Chest 1997; 111: 661–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Adelson-Mitty J, Fink MP, Lisbon A. The value of lumbar puncture in the evaluation of critically ill, non-immunosuppressed, surgical patients: a retrospective analysis of 70 cases. Intensive Care Med 1997; 23: 749–52.PubMedCrossRefGoogle Scholar
  22. 22.
    Circiumaru B, Baldock G, Cohen J. A prospective study of fever in the intensive care unit. Intensive Care Med 1999; 25: 668–73.PubMedCrossRefGoogle Scholar
  23. 23.
    Meduri GU, Mauldin GL, Wunderink RG, Leeper KV Jr, Jones CB, Tolley E, Mayhall G. Causes of fever and pulmonary densities in patients with clinical manifestations of ventilator-associated pneumonia. Chest 1994; 106: 221–35.PubMedCrossRefGoogle Scholar
  24. 24.
    Brun-Buisson C. Nosocomial pneumonia during mechanical ventilation: problems with diagnostic criteria. Thorax 1995; 50: 1128–30.PubMedCrossRefGoogle Scholar
  25. 25.
    Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, American Thoracic Society, November 1995. Am J Respir Crit Care Med 1996;153:1711–25.Google Scholar
  26. 26.
    Ramadan HH, Owens RM Tiu C, Wax MK. Role of antral puncture in the treatment of sinusitis in the intensive care unit Otolaryngol Head Neck Surg 1998; 119: 381–4.Google Scholar
  27. 27.
    Patel CV, Powell L, Wilson SE. Surgical wound infections. Cuff Treatment Options Infect Dis 2000; 2: 147–53.Google Scholar
  28. 28.
    Vincent JL, Anaissie E, Bruining H., Demajo W, el-Ebiary M, Haber J, Hiramatsu Y, Nitenberg G, Nystrom PO, Pittet D, Rogers T, SandvenP, Sganga G, Schaller MD, Solomkin J. Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care. Intensive Care Med 1998; 24: 206–16.Google Scholar
  29. 29.
    Walsh TJ, Chanock Si. Diagnosis of invasive fungal infections: advances in nonculture systems. Cuff Clin Top Infect Dis 1998; 18: 101–53.Google Scholar
  30. 30.
    Mackowiak PA, Plaisance KI. Benefits and risks of antipyretic therapy. Ann NY Acad Sci 1998; 856: 214–23.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Ellen Riccobene
    • 1
  • Richard Gleckman
    • 1
  1. 1.St. Joseph’s Hospital & Medical CenterPattersonUSA

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