CURRENT Essentials of Critical Care.pdf

Chapter 10 Infectious Disease 139■■■Fever in the ICUEssentials of Diagnosis• Temperature 38.3°C orally or rectally; axillary temperaturemeasurements not accurate• In critically ill, both noninfectious and infectious etiologies mustbe considered, including drug reactions• Evaluate based on underlying medical conditions, symptomsand signs, recent infections, current or recent antibiotics, reviewof medication record, laboratory findingsDifferential Diagnosis• Infectious causes: sepsis, pneumonia, urinary tract infection (especiallyif indwelling urinary catheter), intravenous catheter infection(with or without signs of inflammation at insertion site),Clostridium difficile colitis, infected decubitus ulcer, sinusitis(especially with nasotracheal or nasogastric tube), intra-abdominalinfections, endocarditis• Noninfectious causes of fever include drugs or allergic reactions,deep venous thrombosis, central nervous system fever, intraventricularhemorrhage, tissue necrosis, malignancy, hyperthyroidism,neuroleptic-malignant syndromeTreatment• Specific treatment determined by etiology of fever• Empiric antibiotic therapy if high suspicion for infection; obtaincultures prior to initiating antibiotics• Administer antipyretics; consider physical cooling (ice packs,cooling blanket, cool fluids, intravenously or via peritoneum,cold hemodialysis) if severe hyperthermia■ PearlAntibiotic treatment of colonized sites unnecessary, and likely to selectfor resistant organisms.ReferenceCunha BA: Fever in the intensive care unit. Intensive Care Med 1999;25:648.[PMID:10470566]