How do I approach fever in the intensive care unit and should fever be treated?

Fever is common in critically ill patients, and antipyretic therapies, including pharmacological and physical methods, are frequently administered. Fever potentially benefits infected patients by modulating the immune response and directly inhibiting the pathogen growth. However, fever may adversely affect cardiopulmonary and neurological functions through its effects on metabolism, oxygen consumption, and inflammation. In neurologically injured patients, fever has consistently been associated with poor outcomes; therefore international guidelines recommend treatment of fever in such patients. In patients without neurological injury, particularly in patients with sepsis, evidence supporting routine treatment of fever is lacking. Several observational studies have demonstrated that fever may be associated with improved survival in patients with sepsis. Moreover, large randomized trials have failed to show improvement in clinical outcomes with antipyretic therapy. Thus we recommend against routine treatment of fever in patients without neurological injury. The decision to control fever in these patients should be individualized and based on various patient factors, such as comorbidities, cardiovascular reserve, degree of discomfort due to fever, and potential adverse effects of antipyretic therapy.