Guidelines for Treating Fever

Definition and Measurement of Fever

The Society of Critical Care Medicine and Infectious Diseases Society of America define fever as a single temperature measurement ≥38.3°C 1, 3
Central temperature monitoring methods, such as pulmonary artery catheters, bladder catheters, or esophageal thermistors, are preferred when these devices are in place 1, 4
Oral or rectal temperatures are preferred over less reliable methods like axillary or tympanic measurements when central monitoring is unavailable 1, 3

The Society of Critical Care Medicine recommends that antipyretic medications should not be routinely used for the specific purpose of reducing temperature alone, as this has not been shown to improve mortality outcomes 1, 2
For patients who desire symptomatic relief, antipyretic medications are recommended over non-pharmacologic cooling methods 1, 2

A chest radiograph is recommended for all patients with new fever in the ICU setting 1, 5
Blood cultures should be obtained before initiating antimicrobial therapy, especially if the patient is seriously ill or deteriorating 5
For patients with recent thoracic, abdominal, or pelvic surgery, CT imaging should be considered if an etiology is not readily identified by initial workup 1
In patients with fever and recent abdominal surgery or abdominal symptoms, a formal bedside diagnostic ultrasound of the abdomen is recommended 1

The American Society of Clinical Oncology recommends that for patients with neutropenia and fever, hospitalization and empiric antibacterial therapy with vancomycin plus antipseudomonal antibiotics is recommended 6, 5
In high-risk neutropenic patients with fever, use monotherapy with antipseudomonal β-lactam or carbapenem as empiric therapy 6
Consider discontinuation of empiric antibiotics at 72 hours in low-risk neutropenic patients who have negative blood cultures and have been afebrile for at least 24 hours 6

The Society of Critical Care Medicine advises against treating the number on the thermometer rather than the patient's symptoms and comfort 2
Using unreliable temperature measurement methods, such as tympanic or temporal, in critical decision-making is discouraged 2
Failing to identify and treat the underlying cause of fever can lead to increased mortality 2, 5
Delaying effective antimicrobial therapy when infection is suspected has been associated with increased mortality 5