Dr. Andre Kalil discusses the evaluation of fever in adult ICU patients, highlighting the importance of determining underlying causes. Topics include defining fever considering age, comorbidities, and medications, administering antimicrobials promptly, importance of blood cultures, culturing blood in ICU patients, testing for viral pathogens, and accepting uncertainty in patient care.
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volunteer_activism ADVICE
Reliable Temperature Measurement Tips
Use bladder or esophageal probes for the most accurate temperature measurement in ICU when possible.
If unavailable, use oral or rectal measurements consistently; avoid tympanic or skin probes due to variability.
volunteer_activism ADVICE
Cautiously Use Antipyretics in ICU
Do not routinely treat fever with antipyretics unless temperature or patient condition threatens hemodynamics.
Fever often helps fight infection, so indiscriminate use of antipyretics usually offers no benefit and might be harmful.
volunteer_activism ADVICE
Start Early Antibiotics If Infection Suspected
Start empiric antimicrobials quickly when infection is suspected in ICU fever patients.
Stop antibiotics within 24 hours if suspicion turns out incorrect to minimize unnecessary treatment.
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In this episode, we discuss the evaluation of fever in the adult ICU patient. We discuss updates from the recently published Society of Critical Care Medicine and Infectious Diseases Society of America clinical guidelines. My guest is Dr. Andre Kalil, a critical care and infectious disease physician. Dr. Kalil is a Professor in the Division of Infectious Disease and Director of Transplant Infectious Disease at the University of Nebraska Medical Center (UNMC). A renowned clinician, educator, and researcher, Dr. Kalil has received many distinctions, including the 2021 Scientist Laureate Award at UNMC. Dr. Kalil is an author of the 2023 Society of Critical Care Medicine and The Infectious Disease Society of America Guidelines for Evaluating New Fever in Adult Patients in the ICU.
Additional Resources:
Society of Critical Care Medicine and the Infectious Diseases Society of America guidelines for Evaluation New Fever in Adult Patients in the ICU. Crit Care Medicine 2023.
https://pubmed.ncbi.nlm.nih.gov/37902340/
Executive Summary: Guidelines for Evaluating New Fever in Adult Patients in the ICU. Crit Care Medicine 2023.
https://pubmed.ncbi.nlm.nih.gov/37902339/
Guidelines for the evaluation of new fever in critically ill adult patients: 2008 Update. Crit Care Medicine 2008/
https://pubmed.ncbi.nlm.nih.gov/18379262/
Books mentioned in this episode:
Splendid Solution: Jonas Salk and the Conquest of Polio. By Jeffrey Kluger
https://www.amazon.com/Splendid-Solution-Jonas-Conquest-Polio/dp/0425205703/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1702571365&sr=8-2
Critical Matters