Fever in ICU Patients

Posted by e-Medical PPT
Fever is a common problem in the ICUCould be due to infectious and non-infectious causes
Objective is to review a rational approach to the management of fever in ICU patients

How to measure temperature in the critically ill patient?
Peripheral temperature measurements
  • Measured in the outer 1.6 mm of skin or mucus membranes
  • Considered unreliable as influenced by environmental temperatures, mouth breathing etc.
  • Examples – oral temperature, axillary, skin temperature
Core temperature measurements
  • Not influenced by external factors
  • More accurately reflects temperature in the internal organs
  • Examples – pulmonary, rectal, esophageal, urinary, tympanic
Optimal site
Pulmonary – but invasive, need equipment

Tympanic – easy but can be off by even 2O
Urinary – good alternative
Rectal – uncomfortable

Approach to fever in the ICU
Acute undifferentiated fever
Fever with thrombocytopenia
  • Malaria (notably falciparum)
  • Dengue
  • Leptospirosis
  • Rickettsial infections
  • Viral fevers
Fever with hepato-renal dysfunction
  • Malaria (falciparum)
  • Leptospirosis
  • Scrub typhus   
  • Fulminant hepatic failure with hepatorenal
Fever with pulmonary renal syndrome
  • Malaria (falciparum)
  • Leptospirosis
  • Scrub typhus   
  • Hantavirus infection
  • Severe legionella / pneumococcal pneumonia
Fever with altered sensorium
  • Malaria – cerebral malaria
  • Encephalitis
  • Meningitis
  • Typhoid fever
  • Septic encephalopathy
  • Brain abscess..

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