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Fever in the ICU^*

^* From the Department of Internal Medicine, Section of Critical Care, Washington Hospital Center, Washington, DC.

Correspondence to: Paul E. Marik, MD, Department of Internal Medicine, Washington Hospital Center, 110 Irving St NW, Washington, DC 20010-2975; e-mail: pem4{at}mhg.edu

Fever is a common problem in ICU patients. The presence of fever frequently results in the performance of diagnostic tests and procedures that significantly increase medical costs and expose the patient to unnecessary invasive diagnostic procedures and the inappropriate use of antibiotics. ICU patients frequently have multiple infectious and noninfectious causes of fever, necessitating a systematic and comprehensive diagnostic approach. Pneumonia, sinusitis, and blood stream infection are the most common infectious causes of fever. The urinary tract is unimportant in most ICU patients as a primary source of infection. Fever is a basic evolutionary response to infection, is an important host defense mechanism and, in the majority of patients, does not require treatment in itself. This article reviews the common infectious and noninfectious causes of fever in ICU patients and outlines a rational approach to the management of this problem.

Key Words: cytokines • fever • ICU • sinusitis • urinary tract infection • ventilator-associated pneumonia

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