Fever in a critically ill patient
From IDWiki
Revision as of 03:04, 23 November 2023 by Aidan (talk | contribs) (Created page with "== Etiologies == * Non-infectious ** Acalculous cholecystitis ** Acute myocardial infarction ** Adrenal insufficiency ** Atelectasis ** Blood product transfusion ** Cytokine release syndrome ** Dressler syndrome ** Drug fever ** Fat emboli ** Fibroproliferative phase of acute respiratory distress syndrome ** Gout ** Heterotopic ossification ** Immune reconstitution inflammatory syndrome ** Intracran...")
Etiologies
- Non-infectious
- Acalculous cholecystitis
- Acute myocardial infarction
- Adrenal insufficiency
- Atelectasis
- Blood product transfusion
- Cytokine release syndrome
- Dressler syndrome
- Drug fever
- Fat emboli
- Fibroproliferative phase of acute respiratory distress syndrome
- Gout
- Heterotopic ossification
- Immune reconstitution inflammatory syndrome
- Intracranial hemorrhage
- Jarisch-Herxheimer reaction
- Malignant hyperthermia
- Neuroleptic malignant syndrome
- Nonconvulsive status epilepticus
- Pancreatitis
- Pulmonary embolism
- Pneumonitis without infection
- Serotonin syndrome
- Stroke
- Thyroid storm
- Transplant rejection
- Tumour lysis syndrome
- Venous thrombosis
- Withdrawal from certain substances including alcohol, opiates, barbiturates, benzodiazepines
Investigations
- Invasive central temperature measurement, if possible, or else oral or rectal preferred over axillary or tympanic
- Routine chest x-ray
- If abnormal, bedside chest ultrasound for pleural effusion, parenchymal disease, or interstitial lung disease
- Routine COVID testing, when transmission is high
- If recent abdominal, pelvic, or thoracic surgery, CT of surgical site
- If recent abdominal surgery or if localizing abdominal signs or symptoms, ultrasound of the abdomen
- If still undiagnosed after routine investigations, consider PET/CT if stable enough
- If central line, simultaneous CVC (at least 2 lumens) and peripheral blood cultures
- If suspected respiratory source, multiplex PCR for respiratory pathogens
- If pyuria and suspected UTI, replace catheter and get fresh urine culture
- If low suspicion of bacterial infection and no clear focus of infection, consider procalcitonin and C-reactive protein
Management
- Avoid routine use of antipyretics for temperature alone (can continue to use for comfort)
Further Reading
- SCCM and IDSA Guidelines for Evaluating New Fever in Adult Patients in the ICU. Crit Care Med. 2023;51(11):1570-1586. doi 10.1097/CCM.0000000000006022
