Abstract
Background: Fever is common in critically ill patients. Antipyretic therapy for fever is routinely performed in intensive care. However, there is not sufficient information on how body temperature should be controlled in non-neurological critically ill patients (ICU patients). Methods: We have conducted a systematic review of the literature to assess the impact of fever and antipyretic therapy on mortality in ICU patients. Results: Our literature search retrieved twenty-seven articles. Review of these articles revealed that 1) fever is associated with increased mortality, 2) among ICU patients with infection, fever may be associated with decreased mortality, 3) there have been no observational studies to assess the relationship between fever and mortality in ICU patients in which information on antipyretic therapy was included, 4) aggressive antipyretic therapy (starting when body temperature is >38.5 degrees Celsius) tends to increase mortality. Conclusions: Data on fever and antipyretic therapy in ICU patients are insufficient to guide a choice of therapy. A randomized controlled trial would be ethically difficult to conduct. Large multicenter observational trials are needed to understand the interaction among fever, antipyretic therapy and outcomes in ICU patients.
