Persistent fever in the ICU

Chest. 2014 Jan;145(1):158-165. doi: 10.1378/chest.12-2843.


Disorders of elevated body temperature may be classified as either fever or hyperthermia. Fever is caused by a pyrogen-mediated upward adjustment of the hypothalamic thermostat; hyperthermia results from a loss of physiologic control of temperature regulation. Fever in the ICU can be due to infectious or noninfectious causes. The initial approach to a febrile, critically ill patient should involve a thoughtful review of the clinical data to elicit the likely source of fever prior to the ordering of cultures, imaging studies, and broad-spectrum antibiotics. Both high fever and prolonged fever have been associated with increased mortality; however, a causal role for fever as a mediator of adverse outcomes during non-neurologic critical illness has not been established. Outside the realm of acute brain injury, the practice of treating fever remains controversial. To generate high-quality, evidence-based guidelines for the management of fever, large, prospective, multicenter trials are needed.

Publication types

  • Review

MeSH terms

  • Acalculous Cholecystitis / complications
  • Acalculous Cholecystitis / surgery
  • Bacteremia / complications
  • Bacteremia / drug therapy
  • Catheter-Related Infections / complications
  • Catheter-Related Infections / drug therapy
  • Catheterization, Central Venous / adverse effects
  • Cross Infection / complications
  • Cross Infection / drug therapy
  • Enterocolitis, Pseudomembranous / complications
  • Enterocolitis, Pseudomembranous / drug therapy
  • Fever / etiology*
  • Fever / therapy
  • Humans
  • Intensive Care Units*
  • Malignant Hyperthermia / complications
  • Malignant Hyperthermia / therapy
  • Neuroleptic Malignant Syndrome / complications
  • Neuroleptic Malignant Syndrome / therapy
  • Pneumonia, Ventilator-Associated / complications
  • Pneumonia, Ventilator-Associated / drug therapy
  • Serotonin Syndrome / complications
  • Serotonin Syndrome / therapy
  • Sinusitis / complications
  • Sinusitis / drug therapy
  • Urinary Tract Infections / complications
  • Urinary Tract Infections / drug therapy
  • Venous Thromboembolism / complications
  • Venous Thromboembolism / therapy