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.
AD - The George Institute for Global Health, Sydney, NSW, Australia. m.saxena@unsw.edu.au AN - 22129285 BT - Critical Care and Resuscitation ET - 2011/12/02 LA - eng M1 - 4 N1 - Saxena, Manoj KHammond, Naomi ETaylor, ColmanYoung, PaulReade, Michael CBellomo, RinaldoMyburgh, JohnAustraliaCritical care and resuscitation : journal of the Australasian Academy of Critical Care MedicineCrit Care Resusc. 2011 Dec;13(4):238-43. N2 -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.
PY - 2011 SN - 1441-2772 (Print)1441-2772 (Linking) SP - 238 EP - 43 T2 - Critical Care and Resuscitation TI - A survey of fever management for febrile intensive care patients without neurological injury VL - 13 ER -