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Assessment of New Fever in the Non-neutropenic Intensive Care Unit Patient

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Handbook of Evidence-Based Critical Care

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Abstract

Fever is a common problem in ICU patients. The presence of a fever frequently results in the performance of diagnostic tests and procedures that significantly increase medical costs and expose the patient to unnecessary invasive diagnostic procedures and the inappropriate use of antibiotics. The main diagnostic dilemma is to exclude noninfectious causes of fever and then to determine the site and likely pathogens of those with infections. It should be recalled that antibiotics are not antipyretic agents and that antibiotics should be used only in patients likely to havea bacterial infection. Furthermore, it is important to appreciate that not all patients with infections are febrile. Approximately 10% of septic patients are hypothermic and 35% are normothermic at presentation. Septic patients who fail to develop a temperature have a significantly higher mortality than febrile septic patients.

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Selected References

  1. 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;23:749–752.

    Article  PubMed  CAS  Google Scholar 

  2. Chandrasekar PH, Brown WJ. Clinical issues of blood cultures. Arch Intern Med. 1994;154:841–849.

    Article  PubMed  CAS  Google Scholar 

  3. Cunha BA. Fever in the critical care unit.Crit Care Clin. 1998;14:1–14.

    Article  PubMed  CAS  Google Scholar 

  4. de Kleijn EM, Oyen WJ, Claessens RA, Corstens FH, van der Meer JW. Utility of scintigraphic methods in patients with fever of unknown origin. Arch Intern Med. 1995;155:1989–1994.

    Article  PubMed  Google Scholar 

  5. Engoren M. Lack of association between atelectasis and fever. Chest. 1995; 107:81–84.

    Article  PubMed  CAS  Google Scholar 

  6. Krieger JN, Kaiser DL, Wenzel RP. Urinary tract etiology of bloodstream infections in hospitalized patients. J Infect Dis. 1983;148:57–62.

    Article  PubMed  CAS  Google Scholar 

  7. Lenhardt R, Negishi C, Sessler DI, et al. The effects of physical treatment on induced fever in humans. Am J Med. 1999;106:550–555.

    Article  PubMed  CAS  Google Scholar 

  8. 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: 728–733.

    PubMed  CAS  Google Scholar 

  9. Meduri GU, Mauldin GL, Wunderink RG et al. Causes of fever and pulmonary densities in patients with clinical manifestations of ventilator- associated pneumonia. Chest. 1994;106:221–235.

    Article  PubMed  CAS  Google Scholar 

  10. Metersky ML, Williams A, Rafanan AL. Retrospective analysis: are fever and mental status indications for lumbar puncture in a hospitalized patient who has not undergone neurosurgery. Clin Infect Dis. 1997;25:285–288.

    Article  PubMed  CAS  Google Scholar 

  11. O’Donnel J, Axelrod P, Fisher C, Lorber B. Use of and effectiveness of hypothermia blankets for febrile patients in the intensive care unit. Clin Infect Dis. 1997;24:1208–1213.

    Article  Google Scholar 

  12. O’Grady NP, Barie PS, Bartlett J, et al. Practice parameters for evaluating new fever in critically ill adult patients. Crit Care Med. 1998;26:392–408.

    Article  PubMed  Google Scholar 

  13. Platt R, Polk BF, Murdock B, Rosner B. Mortality associated with nosocomial urinary tract infection. N Engl J Med. 1982;307:637–642.

    Article  PubMed  CAS  Google Scholar 

  14. Styrt B, Sugarman B. Antipyresis and fever. Arch Intern Med. 1990; 150: 1589–1597.

    Article  PubMed  CAS  Google Scholar 

  15. Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1497 catheterized patients. Arch Intern Med. 2000;160:678–82.

    Article  PubMed  CAS  Google Scholar 

  16. Tambyah PA, Maki DG. The relationship between pyuria and infection in patients with indwelling urinary catheters: a prospective study of 761 patients. Arch Intern Med. 2000;160:673–677.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Critical Care Medicine, Mercy Hospital of Pittsburgh, 1400 Locust Street, 15219-5166, Pittsburgh, PA, USA

    Paul Ellis Marik MD, MBBCh, FCP(SA), FRCP(C), FCCP, FCCM

Authors
  1. Paul Ellis Marik MD, MBBCh, FCP(SA), FRCP(C), FCCP, FCCM
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© 2001 Springer-Verlag New York, Inc.

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Marik, P.E. (2001). Assessment of New Fever in the Non-neutropenic Intensive Care Unit Patient. In: Handbook of Evidence-Based Critical Care. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-86943-3_43

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  • DOI: https://doi.org/10.1007/978-3-642-86943-3_43

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-78093-9

  • Online ISBN: 978-3-642-86943-3

  • eBook Packages: Springer Book Archive

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