TY - JOUR
T1 - Guidelines for evaluation of new fever in critically ill adult patients
T2 - 2008 Update from the American College of Critical Care Medicine and the Infectious Diseases Society of America
AU - O'Grady, Naomi P.
AU - Barie, Philip S.
AU - Bartlett, John G.
AU - Bleck, Thomas
AU - Carroll, Karen
AU - Kalil, Andre C.
AU - Linden, Peter
AU - Maki, Dennis G.
AU - Nierman, David
AU - Pasculle, William
AU - Masur, Henry
PY - 2008/4
Y1 - 2008/4
N2 - OBJECTIVE: To update the practice parameters for the evaluation of adult patients who develop a new fever in the intensive care unit, for the purpose of guiding clinical practice. PARTICIPANTS: A task force of 11 experts in the disciplines related to critical care medicine and infectious diseases was convened from the membership of the Society of Critical Care Medicine and the Infectious Diseases Society of America. Specialties represented included critical care medicine, surgery, internal medicine, infectious diseases, neurology, and laboratory medicine/microbiology. EVIDENCE: The task force members provided personal experience and determined the published literature (MEDLINE articles, textbooks, etc.) from which consensus was obtained. Published literature was reviewed and classified into one of four categories, according to study design and scientific value. CONSENSUS PROCESS: The task force met twice in person, several times by teleconference, and held multiple e-mail discussions during a 2-yr period to identify the pertinent literature and arrive at consensus recommendations. Consideration was given to the relationship between the weight of scientific evidence and the strength of the recommendation. Draft documents were composed and debated by the task force until consensus was reached by nominal group process. CONCLUSIONS: The panel concluded that, because fever can have many infectious and noninfectious etiologies, a new fever in a patient in the intensive care unit should trigger a careful clinical assessment rather than automatic orders for laboratory and radiologic tests. A cost-conscious approach to obtaining cultures and imaging studies should be undertaken if indicated after a clinical evaluation. The goal of such an approach is to determine, in a directed manner, whether infection is present so that additional testing can be avoided and therapeutic decisions can be made.
AB - OBJECTIVE: To update the practice parameters for the evaluation of adult patients who develop a new fever in the intensive care unit, for the purpose of guiding clinical practice. PARTICIPANTS: A task force of 11 experts in the disciplines related to critical care medicine and infectious diseases was convened from the membership of the Society of Critical Care Medicine and the Infectious Diseases Society of America. Specialties represented included critical care medicine, surgery, internal medicine, infectious diseases, neurology, and laboratory medicine/microbiology. EVIDENCE: The task force members provided personal experience and determined the published literature (MEDLINE articles, textbooks, etc.) from which consensus was obtained. Published literature was reviewed and classified into one of four categories, according to study design and scientific value. CONSENSUS PROCESS: The task force met twice in person, several times by teleconference, and held multiple e-mail discussions during a 2-yr period to identify the pertinent literature and arrive at consensus recommendations. Consideration was given to the relationship between the weight of scientific evidence and the strength of the recommendation. Draft documents were composed and debated by the task force until consensus was reached by nominal group process. CONCLUSIONS: The panel concluded that, because fever can have many infectious and noninfectious etiologies, a new fever in a patient in the intensive care unit should trigger a careful clinical assessment rather than automatic orders for laboratory and radiologic tests. A cost-conscious approach to obtaining cultures and imaging studies should be undertaken if indicated after a clinical evaluation. The goal of such an approach is to determine, in a directed manner, whether infection is present so that additional testing can be avoided and therapeutic decisions can be made.
KW - Blood cultures
KW - Catheter infection
KW - Colitis
KW - Critical illness
KW - Fever
KW - Intensive care unit
KW - Nosocomial infection
KW - Pneumonia
KW - Sinusitis
KW - Surgical site infection
KW - Temperature measurement
KW - Urinary tract infection
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U2 - 10.1097/CCM.0b013e318169eda9
DO - 10.1097/CCM.0b013e318169eda9
M3 - Article
C2 - 18379262
AN - SCOPUS:41649099152
SN - 0090-3493
VL - 36
SP - 1330
EP - 1349
JO - Critical care medicine
JF - Critical care medicine
IS - 4
ER -