02216nas a2200205   4500000000100000008004100001100001800042700000500060700001800065700001300083700002000096700001300116700001400129245009700143250001500240300001100255490000700266520169600273020004101969       2011                            d1 aTaylor Colman1 a1 aHammond Naomi1 aReade M.1 aBellomo Rinaldo1 aYoung P.1 aM. Saxena00aA survey of fever management for febrile intensive care patients without neurological injury  a2011/12/02  a238-430 v133 a<p>
OBJECTIVE: To determine the attitudes of critical care clinicians in Australia and New Zealand towards fever management for critically ill patients with sepsis but without neurological injury. DESIGN: Online scenario-based survey distributed to members of the Australian and New Zealand Intensive Care Society Clinical Trials Group and their intensive care colleagues. MAIN OUTCOME MEASURES: The choice of intervention and preferred threshold temperature for modification of temperature in clinical practice and in a clinical trial. RESULTS: Most respondents indicated a preference for the use of interventions to lower temperature at or below 39.0 degrees C (80%; 337/423), with first-line preference being a combination of paracetamol and physical cooling. Secondline interventions included the addition of intensive physical cooling. Doctors chose higher temperature thresholds for intervention (32% [43/134] below 38.5 degrees C and 27% [36/134] above 39.5 degrees C) than nurses (78% [226/289] and 7% [19/289], respectively), who, in turn, indicated stronger preferences for the use of physical cooling. There is support (78%) for a clinical trial of fever management, with respondents suggesting randomising patients to a mean intensive control of temperature to 38.0 degrees C versus a permissive approach with a threshold for intervention of between 38.8 degrees xC (SD, 0.6 degrees C) (nurses) and 39.5 degrees C (SD, 0.7 degrees C) (doctors). CONCLUSION: There is considerable variability in attitudes to fever management with a reported tendency to act to reduce fever in febrile patients with sepsis. There was broad support for a clinical trial of fever management.
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