Diagnosis and management of temperature abnormality in ICUs: a EUROBACT investigators' survey

Critical Care

Jean-Francois Timsit⁶  Jan de Waele⁵  George Dimopoulos³  Despoina Koulenti³  Jordi Rello¹  Aurélien Vesin⁶  Alexis Tabah²  Kevin B Laupland⁶  Daniel J Niven⁴ 

[1] CIBERES, Universitat Autonoma de Barcelona, Barcelona 08035, Spain;Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Butterfield Street, Brisbane, QLD 4029, Australia;Department of Critical Care, University Hospital ATTIKON, Medical School University of Athens, 1 Rimini Street, Athens 14569, Greece;Critical Care Medicine, Peter Lougheed Centre and University of Calgary, 3500 26th Street NE, Calgary, AB T1Y 6J4, Canada;Ghent University Hospital, 185 De Pintelaan, Ghent 9000, Belgium;Albert Bonniot Institute, Team 11: Outcome of Mechanically Ventilated Patients and Respiratory Cancers, Université Grenoble 1, U 823, Rond-point de la Chantourne, Grenoble 38042, France

关键词: bacteremia;    septic shock;    sepsis;    intensive care unit;    hypothermia;    Fever;   

Others  :  813828
DOI  :  10.1186/cc13153

 received in 2013-02-07, accepted in 2013-12-10,  发布年份 2013

【 摘 要 】

Introduction

Although fever and hypothermia are common abnormal physical signs observed in patients admitted to intensive care units (ICU), little data exist on their optimal management. The objective of this study was to describe contemporary practices and determinants of management of temperature abnormalities among patients admitted to ICUs.

Methods

Site leaders of the multi-national EUROBACT study were surveyed regarding diagnosis and management of temperature abnormalities among patients admitted to their ICUs.

Results

Of the 162 ICUs originally included in EUROBACT, responses were received from 139 (86%) centers in 23 countries in Europe (117), South America (8), Asia (5), North America (4), Australia (3) and Africa (2). A total of 117 (84%) respondents reported use of a specific temperature threshold in their ICU to define fever. A total of 14 different discrete levels were reported with a median of 38.2°C (inter-quartile range, IQR, 38.0°C to 38.5°C). The use of thermometers was protocolized in 91 (65%) ICUs and a wide range of methods were reportedly used, with axillary, tympanic and urinary bladder sites as the most common as primary modalities. Only 31 (22%) of respondents indicated that there was a formal written protocol for temperature control among febrile patients in their ICUs. In most or all cases practice was to control temperature, to use acetaminophen, and to perform a full septic workup in febrile patients and that this was usually directed by physician order. While reported practice was to treat nearly all patients with neurological impairment and most patients with acute coronary syndromes and infections, severe sepsis and septic shock, this was not the case for most patients with liver failure and fever.

Conclusions

A wide range of definitions and management practices were reported regarding temperature abnormalities in the critically ill. Documenting temperature abnormality management practices, including variability in clinical care, is important to inform planning of future studies designed to optimize infection and temperature management strategies in the critically ill.

【 授权许可】

   
2013 Niven et al., licensee BioMed Central Ltd.

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