文档介绍：Fever in the ICU
J V Peter MD, DNB (Med), FRACP, Medical ICU
Christian Medical College & Hospital
Introduction
Fever is mon problem in the ICU
Could be due to infectious and non-infectious causes
Objective is to review a rational approach to the management of fever in ICU patients
Introduction
Fever is a co-ordinated neuro endocrine, autonomic and behavioral response that is adaptive, and an essential part of the acute-phase response to immune stimulus or tissue injury
Co-ordinated by the hypothalamus
Neural input from peripheral thermoreceptors
Humoral cues from inflammation or infection
What is fever?
Enhances parameters of immune function
Improves antibody production
Activates T-cells
Produces cytokines
Enhances neutrophil and macrophage function
Benefits of fever
Hot baths for malaria fever for treatment of syphilis
Positive correlation between maximum temperature on the day of bacteremia and survival
Temperature > 38 °C improved survival in patients with SBP
In children with chicken pox, treatment with acetaminophen increased time to crusting of skin lesions
Benefits of fever - translated?
Increased cardiac output
Increased oxygen consumption
Increased carbon-di-oxide production
Increased basal metabolic rate
The downside of fever
Poorer neurological es in patients with stroke and traumatic brain injury who manifest temperature
Fever poorly tolerated in patients with reduced cardio-respiratory reserve
Maternal fever cause of fetal malformations as well as spontaneous abortions
The downside of fever-translated
How to measure temperature in the critically ill patient?
With a thermometer of course !