Volume 15 Supplement 3

Sepsis 2011

Open Access

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

  • MK Saxena1, 2, 3,
  • NE Hammond1,
  • C Taylor1, 4,
  • P Young5,
  • MC Reade6,
  • R Bellomo6 and
  • J Myburgh1, 2, 3
Critical Care201115(Suppl 3):P18

DOI: 10.1186/cc10387

Published: 27 October 2011


Fever is a common observation during critical illness [1, 2] and may be due to many possible causes such as infection, sterile inflammation and neurological injury. Clinical trials of fever management lack sufficient methodological quality to answer the question of whether attempts at reduction in temperature improves patient-centred outcomes in patients with sepsis, inflammation or neurological injury [37]. We undertook a survey to describe the attitudes of critical care clinicians in Australia and New Zealand towards fever management in critically ill patients without neurological injury or hyperthermic syndromes.


An online scenario-based questionnaire survey was distributed to medical and nursing members of the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS-CTG) and their intensive care colleagues. Main outcome measures: the choice of drug and preferred threshold temperature for intervention with antipyretics in clinical practice and in a clinical trial.


There were 588 email invitations distributed through the ANZICS-CTG and Research Coordinator mailing list. Four hundred and forty-seven responses were received from 308 nurses (69%), 137 doctors (31%), and two others (0.5%). The majority of respondents having more than 8 years of experience (62%) worked in mixed medical and surgical units (84%) in a metropolitan or tertiary hospital setting (77%). The primary findings of our survey suggest that fever management is highly variable. Most clinicians administer an intervention to reduce temperature at or below 39°C (Figure 1); and initially use a combination of both pharmacological and physical interventions, with an increase in intensity of physical interventions for persistent fever (Figure 2). There were differences between the professions, with doctors choosing higher temperature thresholds for intervention and nurses generally using more physical cooling (Figure 1 and Table 1); fourthly, temperature thresholds for a clinical trial were 39.0°C (SD = 0.7°C) for a permissive strategy and 38.0°C (SD = 0.75°C) for an intensive strategy; finally, there was broad support for a clinical trial of fever management.
Figure 1

Thresholds for initiation of antipyretic interventions between professions. Nurse/other (n = 289); doctor (n = 134) (P < 0.0001).

Figure 2

First-line and second-line treatment preferences for fever management ( n = 458).

Table 1

Preference of first-line and second-line interventional category of antipyretic by profession


First line (n= 418)

Second line (n= 409)


Nurse (%)

Doctor (%)

P value

Nurse (%)

Doctor (%)

P value

Pharmacological only







Physical only







Pharmacological and physical








This survey suggests there is considerable clinical variability in fever management in patients with sepsis and without neurological injury or hyperthermic syndromes. At present, no particular management strategy is known to be superior to any other and it remains possible that current practice may be harming substantial numbers of patients. A temperature threshold of up to 40°C may be acceptable to clinicians for the design of a future randomized controlled trial. Further observational data may be informative for the design of such clinical trials.

Authors’ Affiliations

The George Institute for Global Health
St George Hospital
St George Clinical School, University of New South Wales
Sydney Medical School, University of Sydney
Medical Research Institute of New Zealand
Austin Hospital &, University of Melbourne


  1. Laupland KB, Shahpori R, Kirkpatrick AW, Ross T, Gregson DB, Stelfox HT: Occurrence and outcome of fever in critically ill adults. Crit Care Med 2008, 36: 1531-1535. 10.1097/CCM.0b013e318170efd3View ArticlePubMedGoogle Scholar
  2. Ryan M, Levy M: Clinical review: fever in intensive care unit patients. Crit Care 2003, 7: 221-225. 10.1186/cc1879PubMed CentralView ArticlePubMedGoogle Scholar
  3. Bernard GR, Wheeler AP, Russell JA, et al.: The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group. N Engl J Med 1997, 336: 912-918. 10.1056/NEJM199703273361303View ArticlePubMedGoogle Scholar
  4. Hammond NE, Boyle M: Pharmacological versus non-pharmacological antipyretic treatments in febrile critically ill patients: a systematic review and meta-analysis. Aust Crit Care 2011, 24: 4-17. 10.1016/j.aucc.2010.11.002View ArticlePubMedGoogle Scholar
  5. Schulman CI, Namias N, Doherty J, et al.: The effect of antipyre tic therapy upon outcomes in critically ill patients: a randomized, prospective study. Surg Infect 2005, 6: 369-375. 10.1089/sur.2005.6.369View ArticleGoogle Scholar
  6. Saxena M, Andrews P, Cheng A: Modest cooling therapies (35°C to 37.5°C) for traumatic brain injury. Cochrane Database Syst Rev 2008, 3: CD006811.PubMedGoogle Scholar
  7. Jefferies S, Weatherall M, Young P, et al.: The effect of antipyretic medications on mortality in critically ill patients with infection: a systematic review and meta-analysis. Crit Care Resusc 2011, 13: 125-131.PubMedGoogle Scholar


© Saxena et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.