DOI: https://doi.org/10.22141/2224-0586.4.91.2018.137856

Pyrexia and antipyretic therapy in critically ill patients

L.O. Maltseva, M.F. Mosentsev, V.M. Lisnycha, I.V. Kozachenko

Abstract


Elevation of core body temperature is one of the most common abnormal signs in patients admitted to the intensive care unit (ICU) and is associated with increased mortality among some groups of critically ill patients. Elevated body temperature is detected in approximately 50 % of adult patients admitted to the ICU. Elevated body temperature is classified as pyrexia, or hyperthermia. Pyrexia, also referred to as fever, is an adaptive response to a physiologic stress that is regulated through endo­genous pyrogenic and antipyretic pathways and is associated with an increase in the hypothalamic set-point. The hyperthermia syndromes include: environmental hyperthermia, and heatstroke as well, drug-induced hyperthermia, neuroleptic malignant syndrome, serotonin syndrome and endocrine causes, in particular thyrotoxicosis, pheochromocytoma and adrenal crisis. Many epi­sodes of pyrexia are due to infections. The most common sources of infection are lower respiratory, intra-abdominal, urinary tract infections and other that include the skin and soft tissue, bone/joints, central nervous system and ethmoid and maxillary sinu­ses. Pyrexia due to non-infectious origin is also common cause of fever in ICU patients. Antipyretic agents, mainly paracetamol and non-steroidal anti-inflammatory drugs, and physical coo­ling methods can be used to control pyrexia. Treatment with antipyretic therapies is common in the ICU. Studies of antipyretic therapy that included both septic and non-septic patients did not reveal any significant improvement of 28-day hospital mortality in adult critically ill patients with and without sepsis. Additional studies will improve understanding of pyrexia pathophysiology and will contribute to the development of this direction.

Keywords


pyrexia; fever; hyperthermia; antipyretic therapy; review

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