Pyrexia - PACT - ESICM

Task 1. Assessing and measuring fever in ICU
Approach to
the febrile
patient in the
ICU
Dimopoulos G, Falagas ME. Approach to the febrile patient in the ICU. Infect Dis Clin
North Am 2009; 23(3): 471–484. PMID 19665078
This figure, and a number of the figures used below, are slides in the
recommended ESICM Flash Conference: George Dimopoulos. Late fever in an
ICU patient, Barcelona, 2010.
Fever – notable features and measurement
Prior to assessment, you will wish to confirm the presence of fever and
determine its severity. Response to fever varies with age. Elderly patients are
unable to regulate their body temperature to the same degree as young adults,
making them susceptible to extremes of temperature – older patients with
serious infections have a substantial prevalence of apyrexia (20% to 30%) and a
lower febrile response than younger patients. A lack of fever may contribute to
lower resistance to infection, delayed recovery, and suboptimal outcome while
lower febrile responses to infection are associated with a higher mortality rate
and poorer prognosis. In children between the ages of six months and six years,
febrile convulsions may occur.
Core temperature measurement is, of course, the gold standard and several
methods may be used in the ICU, involving the placement of a thermistor or
similar device in the pulmonary (or femoral) artery, the bladder or the
oesophagus. In practice, however, surrogate site (rectal, oral or axillary)
temperature measurement is often used (Table below).
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