Abstract
Fever is a common response to sepsis in critically ill patients. Fever occurs when either exogenous or endogenous pyrogens affect the synthesis of prostaglandin E2 in the pre-optic nucleus. Prostaglandin E2 slows the rate of firing of warm sensitive neurons and results in increased body temperature. The febrile response is well preserved across the animal kingdom, and experimental evidence suggests it may be a beneficial response to infection. Fever, however, is commonly treated in critically ill patients, usually with antipyretics, without good data to support such a practice. Fever induces the production of heat shock proteins (HSPs), a class of proteins critical for cellular survival during stress. HSPs act as molecular chaperones, and new data suggest they may also have an anti-inflammatory role. HSPs and the heat shock response appear to inhibit the activation of NF-kappabeta, thus decreasing the levels of proinflammatory cytokines. The anti-inflammatory effects of HSPs, coupled with improved survival of animal models with fever and infection, call into question the routine practice of treating fever in critically ill patients.
Highlights
IntroductionAdult nonhealthcare workers (i.e. patient family members) have significant misconceptions regarding the perceived detrimental effects of fever [7]
In patients admitted to the intensive care unit (ICU) with severe sepsis, the incidence of fever is more than 90% [2]
Fever in the ICU, and especially in patients with sepsis, is extremely common. It occurs from activity of endogenous pyrogens that enhance prostaglandin E2 production in the pre-optic region of the hypothalamus
Summary
Adult nonhealthcare workers (i.e. patient family members) have significant misconceptions regarding the perceived detrimental effects of fever [7]. In this complicated psychosocial setting, it is easy for the physician to merely treat the fever. The goal of the present review is to question, by critically evaluating the literature, the practice of routinely treating fever in the ICU patient. The pathophysiology of fever will be reviewed, the animal and human data that have evaluated the role and the potential beneficial effects of fever in disease states will be examined, and the hemodynamic and metabolic costs of fever will be summarized
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