Background
What is pyrexia?
Pathophysiology
Grading and measurement
Should we treat pyrexia?
The cost of pyrexia
Pyrexia treatment in specific situations
Sepsis
Out of hospital cardiac arrest
Acute brain injury
Organ donation
General ICU patients
Overall guidance
Study | Patients | Number | Temperature criteria at inclusion | Baseline temperature in the treatment group | Antipyretic method | Duration of treatment | Primary end point | Main results | |
---|---|---|---|---|---|---|---|---|---|
SIRS and Sepsis | Gozolli et al. [41] | SIRS | 38 | ≥38.5 °C | 39 (SD 0.3) | Surface cooling | Up to fever resolution (≤37.5 °C) | Temperature difference | Similar temperature and comfort evolution |
Bernard et al. [15] | Severe sepsis | 455 | Nonea
| 37.9 (SE 0.2) | NSAID: IV ibuprofen 10 mg/kg/6 h | 48 h | 30-day mortality | Lower temperature in the treatment group | |
No difference in mortality | |||||||||
Memis et al. [50] | Severe sepsis | 40 | Nonea
| 37.8 (SD 0.75) | NSAID: IV lornoxicam 8 mg/12 h | 72 h | Anti-inflammatory effects | Similar temperature evolution | |
Schortgen et al. [27] | Septic shock | 200 | ≥38.3 °C | 38.8 (IQR 38.6–39.2) | TTM 36.5–37 °C with surface cooling | 48 h | Dose of vasopressor | Less vasopressor requirement and 14-day mortality in the treatment group | |
Janz [48] | Severe sepsis | 40 | Nonea
| 37.7 (IQR 37–38.5) | IV paracetamol 1 g/6 h | 3 days | Antioxidant effect | Lower maximal temperature in the treatment group | |
Young et al. [29] | Suspected infection | 700 | ≥38 °C | 38.5 (SD 0.5) | IV paracetamol 1 g/ 6 h | Up to fever resolution (<37.5 °C, 24 h) or day 28 | ICU-free days up to day 28. | Lower temperature in the treatment group | |
No difference in ICU-free days | |||||||||
Acute brain injury | den Hertog et al. [35] | Stroke | 1400 | Between 36 and 39 °C | 36.9 (SD 0.6) | Enteral paracetamol 1 g/4 h | 72 h | Modified Rankin scale at 3 months | Lower temperature in the treatment group |
No difference in neurological outcome | |||||||||
Saxena et al. [46] | TBI | 41 | Between 36 and 39 °C | 37.3 (SD 0.8) | IV paracetamol 1 g/4 h | 72 h | Temperature difference | No difference in temperature |
Management of pyrexia
Temperature target
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Control of pyrexia when it occurs: treatment administered when temperature exceeds a predefined threshold
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Strict avoidance of pyrexia: temperature maintained below fever threshold
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Strict maintenance of normothermia: TTM with a predefined normothermia range, e.g., 36–37 °C.
Efficacy and risks of antipyretic methods
Antipyretic agents | Physical cooling |
---|---|
• Non sedated patients • Concomitant need for analgesia | • Hypothalamic dysfunction • Need for rapid induction • Need for strict temperature control • Patients with hemodynamic instability • Failure of antipyretic agents |