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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Individualize Fever Definition
Fever cutoff is usually 38.3 Celsius but needs individual adjustment based on patient age and condition.
Fixed fever thresholds can be misleading especially in immunocompromised and elderly ICU patients.
volunteer_activism ADVICE
Consider Non-Infection Fever Causes
Always consider non-infectious causes of fever in ICU such as myocardial infarction, adrenal insufficiency, or pancreatitis.
Identifying the cause correctly is critical as non-infectious fevers require very different treatment approaches.
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.
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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