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

Abstract

Objective: To determine the attitudes of critical care clinicians in Australia and New Zealand towards fever management for critically ill patients with sepsis but without neurological injury.

Design: Online scenario-based survey distributed to members of the Australian and New Zealand Intensive Care Society Clinical Trials Group and their intensive care colleagues.

Main outcome measures: The choice of intervention and preferred threshold temperature for modification of temperature in clinical practice and in a clinical trial.

Results: Most respondents indicated a preference for the use of interventions to lower temperature at or below 39.0°C (80%; 337/423), with first-line preference being a combination of paracetamol and physical cooling. Secondline interventions included the addition of intensive physical cooling. Doctors chose higher temperature thresholds for intervention (32% [43/134] below 38.5°C and 27% [36/134] above 39.5°C) than nurses (78% [226/289] and 7% [19/289], respectively), who, in turn, indicated stronger preferences for the use of physical cooling. There is support (78%) for a clinical trial of fever management, with respondents suggesting randomising patients to a mean intensive control of temperature to 38.0°C versus a permissive approach with a threshold for intervention of between 38.8°×C (SD, 0.6°C) (nurses) and 39.5°C (SD, 0.7°C) (doctors).

Conclusion: There is considerable variability in attitudes to fever management with a reported tendency to act to reduce fever in febrile patients with sepsis. There was broad support for a clinical trial of fever management.