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. 2019 Mar;114(2):173-184.
doi: 10.1007/s00063-018-0507-x. Epub 2018 Nov 28.

[Fever in the critically ill : To treat or not to treat]

[Article in German]
W Druml  1
Affiliations

[Fever in the critically ill : To treat or not to treat]

[Article in German]
W Druml. Med Klin Intensivmed Notfmed. 2019 Mar.

Abstract
in English, German

Fever, arbitrarily defined as a core body temperature >38.3 °C, is present in 20-70 % of intensive care unit patients. Fever caused by infections is a physiologic reset of the thermostatic set-point and is associated with beneficial consequences, but may have negative sequelae with temperatures >39.5 °C. Fever of non-infectious and neurologic origin affects about 50 % of patients with elevated body temperature, presents as a pathologic loss of thermoregulation, and may be associated with untoward side effects at temperatures above 38.5-39.0 °C. Cooling can be achieved by physical and pharmacologic means. Evidence-based recommendations are not available. The indication for a cooling therapy can only be based on the physiologic reserve and the neurologic, hemodynamic, and respiratory state. The temperature should be lowered to the normothermic range. Hyperthermia syndromes require immediate physical cooling (and dantrolen when indicated).

Fieber, arbiträr als zentrale Körpertemperatur von >38,3 °C definiert, tritt bei 20–70 % der Intensivpatienten auf. Bei Infektionen ist es eine physiologische Umstellung der Temperaturregulation mit günstigen Effekten, kann aber bei Temperaturen >39,5 °C negative Auswirkungen haben. Fieber nichtinfektiöser oder neurologischer Ursache betrifft etwa 50 % der Patienten mit erhöhter Körpertemperatur, ist ein pathologischer Verlust der Thermoregulation und kann bei Temperaturen über 38,5–39,0 °C zu negativen Effekten führen. Fiebersenkung kann physikalisch oder pharmakologisch erfolgen. Evidenzbasierte Empfehlungen sind nicht möglich. Die Indikation zur Kühlungstherapie wird individuell unter Berücksichtigung der Ursache, der physiologischen Reserve sowie der neurologischen, hämodynamischen bzw. respiratorischen Situation gestellt. Die Temperatur sollte nur bis in den normothermen Bereich abgesenkt werden. Hypertherme Syndrome erfordern sofortige physikalische Kühlung (und ggf. Gabe von Dantrolen).

Keywords: Cooling; Infectious fever; Non-infectious fever; Pyrexia; Temperature management.

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