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Fever in the ICU

Key sources
The following summarized guidelines for the evaluation and management of fever in the ICU are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA/SCCM 2023).
1

Guidelines

1.Diagnostic investigations

Temperature measurement
Prefer central temperature monitoring methods, including thermistors for pulmonary artery catheters, bladder catheters, or esophageal balloon thermistors, if they are in place or accurate temperature measurements are critical to diagnosis and management.
B
Consider using oral or rectal temperatures over other less reliable temperature measurement methods (such as axillary or tympanic membrane temperatures, noninvasive temporal artery thermometers, or chemical dot thermometers) if central temperature monitoring methods are not in place.
C
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More topics in this section

  • Diagnostic imaging (CXR)

  • Diagnostic imaging (chest ultrasound)

  • Diagnostic imaging (abdominal ultrasound)

  • Diagnostic imaging (CT)

  • Diagnostic imaging (positron emmission tomography)

  • Diagnostic imaging (WBC scan)

  • Microbiological testing (blood culture)

  • Microbiological testing (urine culture)

  • Microbiological testing (viral pathogens)

  • Inflammatory markers

2.Medical management

Antipyretics
Avoid administering routine antipyretic medications solely to reduce the temperature in critically ill patients with fever.
D
Consider administering antipyretics over nonpharmacologic methods to reduce body temperature in critically ill patients with fever valuing comfort by reducing temperature.
C