A survey of fever management for febrile intensive care patients without neurological injury.

OBJECTIVE

To determine the attitudes of critical care clinicians in Australia and New Zealand towards fever management for critically ill patients with sepsis but without neurological injury.

DESIGN

Online scenario-based survey distributed to members of the Australian and New Zealand Intensive Care Society Clinical Trials Group and their intensive care colleagues.

MAIN OUTCOME MEASURES

The choice of intervention and preferred threshold temperature for modification of temperature in clinical practice and in a clinical trial.

RESULTS

Most respondents indicated a preference for the use of interventions to lower temperature at or below 39.0°C (80%; 337/423), with first-line preference being a combination of paracetamol and physical cooling. Secondline interventions included the addition of intensive physical cooling. Doctors chose higher temperature thresholds for intervention (32% [43/134] below 38.5°C and 27% [36/134] above 39.5°C) than nurses (78% [226/289] and 7% [19/289], respectively), who, in turn, indicated stronger preferences for the use of physical cooling. There is support (78%) for a clinical trial of fever management, with respondents suggesting randomising patients to a mean intensive control of temperature to 38.0°C versus a permissive approach with a threshold for intervention of between 38.8°×C (SD, 0.6°C) (nurses) and 39.5°C (SD, 0.7°C) (doctors).

CONCLUSION

There is considerable variability in attitudes to fever management with a reported tendency to act to reduce fever in febrile patients with sepsis. There was broad support for a clinical trial of fever management.