Cunha B A, Shea K W
Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, USA.
Infect Dis Clin North Am. 1996 Mar;10(1):185-209. doi: 10.1016/s0891-5520(05)70294-4.
In the ICU, fever can be expected to accompany an extensive number of conditions of both infectious and noninfectious etiologies. It is crucial to identify the precise cause of fever, because certain conditions in either category may be life-threatening, whereas others require no treatment at all. It is important to rule out the most common infections that may be present based on historical and physical signs and symptoms and epidemiologic factors. The extent of evaluation should be based on the likelihood of the disease process being present and is highly variable for each individual patient. Therefore, "routine fever work-up" should not be advocated. If overt infection is not found upon initial evaluation, antibiotics should be withheld if possible. Alternatively, in the unstable patient, empiric therapy may be started, and if no infection is evident, it may be stopped within a reasonable time frame. In no case should prolonged antibiotics be given for presumed but unproven infection. Thorough knowledge of the more common infectious and noninfectious conditions, as well as the awareness of less frequent ones and their predisposing risk factors, is essential for adequate evaluation of the febrile ICU patient. Likewise, familiarity with the techniques used for diagnosis of these infections and their appropriate interpretation and limitations in specific instances is immensely helpful to the clinician providing appropriate care for the critically ill patient.
在重症监护病房（ICU），发热可能伴随大量感染性和非感染性病因的病症。明确发热的确切原因至关重要，因为这两类病症中的某些情况可能危及生命，而其他一些情况可能根本无需治疗。根据病史、体征和症状以及流行病学因素排除可能存在的最常见感染很重要。评估的范围应基于疾病过程存在的可能性，且因每个患者而异。因此，不应提倡“常规发热检查”。如果初步评估未发现明显感染，应尽可能停用抗生素。或者，对于不稳定的患者，可开始经验性治疗，如果未发现感染迹象，可在合理时间内停药。在任何情况下，都不应因推测但未经证实的感染而长期使用抗生素。全面了解更常见的感染性和非感染性病症，以及认识到较罕见的病症及其易感风险因素，对于充分评估发热的ICU患者至关重要。同样，熟悉用于诊断这些感染的技术及其在特定情况下的正确解读和局限性，对为重症患者提供适当护理的临床医生非常有帮助。
