Intensive Care Medicine

, Volume 30, Issue 5, pp 811–816 | Cite as

Body temperature alterations in the critically ill

  • Daliana Peres Bota
  • Flavio Lopes Ferreira
  • Christian Mélot
  • Jean Louis Vincent
Original

Abstract

Objective

To determine the incidence of body temperature (BT) alterations in critically ill patients, and their relationship with infection and outcome.

Design

Prospective, observational study.

Setting

Thirty-one bed, medico-surgical department of intensive care.

Patients

Adult patients admitted consecutively to the ICU for at least 24 h, during 6 summer months.

Interventions

None.

Results

Fever (BT≥38.3°C) occurred in 139 (28.2%) patients and hypothermia (BT≤36°C) in 45 (9.1%) patients, at some time during the ICU stay. Fever was present in 52 of 100 (52.0%) infected patients without septic shock, and in 24 of 38 (63.2%) patients with septic shock. Hypothermia occurred in 5 of 100 (5.0%) infected patients without septic shock and in 5 of 38 (13.1%) patients with septic shock. Patients with hypothermia and fever had higher Sequential Organ Failure Assessment (SOFA) scores on admission (6.3±3.7 and 6.4±3.3 vs 4.6±3.2; p<0.01), maximum SOFA scores during ICU stay (7.6±5.2 and 8.2±4.7 vs 5.4±3.8; p<0.01) and mortality rates (33.3 and 35.3% vs 10.3%; p<0.01). The length of stay (LOS) was longer in febrile patients than in hypothermic and normothermic (36°C<BT<38.3°C) patients [median 6 (1–57) vs 5 (2–28) and 3 (1–33) days, p=0.02 and p=0.01, respectively). Among the septic patients hypothermic patients were older than febrile patients (69±9 vs 54±7 years, p=0.01). Patients with septic shock had a higher mortality if they were hypothermic than if they were febrile (80 vs 50%, p<0.01).

Conclusions

Both hypothermia and fever are associated with increased morbidity and mortality rates. Patients with hypothermia have a worse prognosis than those with fever.

Keywords

Hypothermia Normothermia Fever Infection Septic shock Organ failure Length of stay 

References

  1. 1.
    Kramer MR, Vandijk J, Rosin AJ (1989) Mortality in elderly patients with thermoregulatory failure. Arch Intern Med 149:1521–1523CrossRefPubMedGoogle Scholar
  2. 2.
    Reuler JB (1978) Hypothermia: pathophysiology, clinical settings, and management. Ann Intern Med 89:519–527PubMedGoogle Scholar
  3. 3.
    Circiumaru B, Baldock G, Cohen J (1999) A prospective study of fever in the intensive care unit. Intensive Care Med 25:668–673PubMedGoogle Scholar
  4. 4.
    Bryant RE, Hood AF, Hood CE, Koenig MG (1971) Factors affecting mortality of gram-negative rod bacteremia. Arch Intern Med 127:120–128CrossRefPubMedGoogle Scholar
  5. 5.
    Hodgin UG, Sanford JP (1965) Gram-negative rod bacteremia. An analysis of 100 patients. Am J Med 39:952–960PubMedGoogle Scholar
  6. 6.
    Kreger BE, Craven DE, McCabe WR (1980) Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med 68:344–355PubMedGoogle Scholar
  7. 7.
    Clemmer TP, Fisher CJ, Bone RC, Slotman GJ, Metz GA, Thomas FO (1992) Hypothermia in the sepsis syndrome and clinical outcome. Crit Care Med 20:1395–1401PubMedGoogle Scholar
  8. 8.
    Arons MM, Wheeler AP, Bernard GR, Christman BW, Russell JA, Schein R, Summer WR, Steinberg KP, Fulkerson W, Wright P, Dupont WD, Swindell BB (1999) Effects of ibuprofen on the physiology and survival of hypothermic sepsis. Ibuprofen in Sepsis Study Group. Crit Care Med 27:699–707CrossRefPubMedGoogle Scholar
  9. 9.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedGoogle Scholar
  10. 10.
    Vincent JL, Moreno R, Takala J, Willatts S, de Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar
  11. 11.
    Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16:128–140PubMedGoogle Scholar
  12. 12.
    ACCP-SCCM Consensus Conference (1992) Definitions of sepsis and multiple organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874PubMedGoogle Scholar
  13. 13.
    McGowan JE, Jr., Rose RC, Jacobs NF, Schaberg DR, Haley RW (1987) Fever in hospitalized patients. With special reference to the medical service. Am J Med 82:580–586PubMedGoogle Scholar
  14. 14.
    Filice GA, Weiler MD, Hughes RA, Gerding DN (1989) Nosocomial febrile illnesses in patients on an internal medicine service. Arch Intern Med 149:319–324CrossRefPubMedGoogle Scholar
  15. 15.
    Commichau C, Scarmeas N, Mayer SA (2003) Risk factors for fever in the neurologic intensive care unit. Neurology 60:837–841PubMedGoogle Scholar
  16. 16.
    Georgilis K, Plomaritoglou A, Dafni U, Bassiakos Y, Vemmos K (1999) Aetiology of fever in patients with acute stroke. J Intern Med 246:203–209Google Scholar
  17. 17.
    Doherty NE, Fung P, Lefkowitz M, Ellrodt AG (1985) Hypothermia and sepsis. Ann Intern Med 103:308Google Scholar
  18. 18.
    Megarbane B, Axler O, Chary I, Pompier R, Brivet FG (2000) Hypothermia with indoor occurrence is associated with a worse outcome. Intensive Care Med 26:1843–1849CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Daliana Peres Bota
    • 1
  • Flavio Lopes Ferreira
    • 1
  • Christian Mélot
    • 1
  • Jean Louis Vincent
    • 1
  1. 1.Department of Intensive CareErasme University Hospital, Free University of BrusselsBrusselsBelgium

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