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

Introduction

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.

Methods

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.

Results

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.
https://static-content.springer.com/image/art%3A10.1186%2Fcc10387/MediaObjects/13054_2011_Article_9677_Fig1_HTML.jpg
Figure 1

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

https://static-content.springer.com/image/art%3A10.1186%2Fcc10387/MediaObjects/13054_2011_Article_9677_Fig2_HTML.jpg
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

23

40

0.0002

5

5

0.87

Physical only

13

5

0.0087

58

62

0.36

Pharmacological and physical

64

55

0.077

38

33

0.39

Conclusion

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

(1)
The George Institute for Global Health
(2)
St George Hospital
(3)
St George Clinical School, University of New South Wales
(4)
Sydney Medical School, University of Sydney
(5)
Medical Research Institute of New Zealand
(6)
Austin Hospital &, University of Melbourne

References

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Copyright

© 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.

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