In 2008, ACCM and IDSA created a set of guidelines for evaluation of new onset fever in the critically ill patient. Although these guidelines also apply to hypothermia, we hypothesized that hypothermic patients would receive less comprehensive infection evaluation and management than febrile patients. In this study, we describe the epidemiology of and assess differences in evaluation and management of new onset hypothermia compared to fever.
143 Patients were enrolled in a prospective non-interventional cohort study from 8 different ICUs, including medical and surgical units at 2 hospitals in Detroit from May-November 2013. Medical records were reviewed to analyze various parameters pertaining to fever evaluation and management.
Of the 143 patients enrolled, 46 patients (32.2%) met the criteria for new onset hypothermia (≤36 °C) and 97 patients (67.8 %) for fever (≥38 °C).
35.6% of hypothermic patients had blood cultures obtained within 24 hours compared to 54.6% of febrile patients (OR 0.44, 95% CI 0.21-0.92, p=0.03). Although similar proportions of hypothermic and febrile patients were mechanically ventilated at the time of enrollment(p=0.82), hypothermic patients had fewer respiratory cultures obtained than febrile patients (26.1% and 49.48% respectively, OR 0.21, 95% CI 0.09-0.51, p=0.0002).
Fewer hypothermic patients (76.9%) received antibiotics within 24 hours of enrollment compared to febrile patients (86%) with OR of 0.49, 95% CI 0.20-1.20. Among patients who did receive antibiotics, the delay in initiation of antibiotics was similar in the two groups (p=0.71), but hypothermic patients received fewer antibiotics over 7 days than did febrile patients (hypothermia median 1, IQR 0-2 vs fever median 2, IQR 1-3; p=0.02)
Compared to febrile patients, hypothermic patients were less likely to have blood and respiratory cultures obtained. Clinicians should be made aware of the indications and need for appropriate evaluation and management of hypothermic patients in the ICU.
C. Leonard, None
H. Shaikh, None
M. Salim, None
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