Temperature measurement - Governance

The effect of abnormal body temperatures on patient outcomes differs depending on patient diagnosis. A recent meta-analysis (1) found that the administration of anti-pyretics did not reduce mortality in febrile critically ill patients. Moreover, there is epidemiological evidence to suggest that fever may be protective in critically ill patients with infections (2). Current studies however have not used consistent definitions for fever and were not powered to show other clinically significant outcomes (3).

Recommendations for practice

Section

Recommendation

Grade

11.

To facilitate rapid detection and treatment of abnormal temperatures, ICUs should consider developing standard definitions and interventions for hyperthermia and hypothermia.

Consensus

12.

Fever control including administration of anti-pyretics should not be commenced without consultation with senior Medical Officers.

Consensus

(17, 18)

13.

Staff should receive education on:

  • correct use and calibration of equipment
  • local definitions and standard treatments for abnormal temperatures.

Consensus

14.

Education related to temperature measurement should be included in patient assessment practices.

Consensus

15.

Evaluation of adherence to this guideline should be incorporated into the audit of clinical practices related to patient assessment.

Consensus

The evidence review for these recommendations was current to May 2012. Clinicians are advised to check the literature as research may have been published that change these recommendations

Grading of recommendation taxonomy

Grade of recommendation

Description

A

Body of evidence can be trusted to guide evidence

B

Body of evidence can be trusted to guide practice in most situations

C

Body of evidence provides some support for recommendation/s but care should be taken in its application

D

Body of evidence is weak and recommendation must be applied with caution

Consensus

Consensus was set as a median of ≥ 7

Grades A–D are based on NHMRC grades (4)

References

  • Niven DJ, Stelfox HT, Laupland KB. Antipyretic therapy in febrile critically ill adults: A systematic review and meta-analysis. Journal of Critical Care. in press. Epub 14 November 2012.
  • Young PJ, Saxena M, Beasely R, Bellomo R, Bailey M, Pilcher D, et al. Early peak temperature and mortality in critically ill patients with or without infection. Intensive Care Medicine. 2012;38:437-344. Epub 31 January 2012.
  • Egi M, Morita K. Fever in non-neurological patients: a systematic review of observational studies. Journal of Critical Care. 2012;27(5):428-33.
  • NHMRC. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines:PILOT PROGRAM 2005 - 2007. Australian Government; 2005.

Disclaimer

The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.