A survey of fever management for febrile intensive care patients without neurological injury

Manoj K. Saxena, Naomi E. Hammond, Colman Taylor, Paul Young, Michael C. Reade, Rinaldo Bellomo, John Myburgh

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19 Citations (Scopus)

Abstract

Objective: To determine the attitudes of critical care clinicians in Australia and New Zealand towards fever management for critically ill patients with sepsis but without neurological injury. Design: Online scenario-based survey distributed to members of the Australian and New Zealand Intensive Care Society Clinical Trials Group and their intensive care colleagues. Main outcome measures: The choice of intervention and preferred threshold temperature for modification of temperature in clinical practice and in a clinical trial. Results: Most respondents indicated a preference for the use of interventions to lower temperature at or below 39.0°C (80%; 337/423), with first-line preference being a combination of paracetamol and physical cooling. Secondline interventions included the addition of intensive physical cooling. Doctors chose higher temperature thresholds for intervention (32% [43/134] below 38.5°C and 27% [36/134] above 39.5°C) than nurses (78% [226/289] and 7% [19/289], respectively), who, in turn, indicated stronger preferences for the use of physical cooling. There is support (78%) for a clinical trial of fever management, with respondents suggesting randomising patients to a mean intensive control of temperature to 38.0°C versus a permissive approach with a threshold for intervention of between 38.8°×C (SD, 0.6°C) (nurses) and 39.5°C (SD, 0.7°C) (doctors). Conclusion: There is considerable variability in attitudes to fever management with a reported tendency to act to reduce fever in febrile patients with sepsis. There was broad support for a clinical trial of fever management.

Original languageEnglish
Pages (from-to)238-243
Number of pages6
JournalCritical Care and Resuscitation
Volume13
Issue number4
Publication statusPublished - 1 Dec 2011
Externally publishedYes

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