Fiebre y terapia antipirética en el paciente con sepsis en la unidad de cuidados intensivos: actualización

Abstract

Fever is a very common sign to observe in critically ill children during their intensive care unit stay. This should be understood as an evolutionary biological response, of normal adaptive character, from the host to the physiological stress. It is the result of a complex response to pyrogenic stimuli, resulting in the generation of cytokines and prostaglandins. The molecular mechanisms involved in the onset of fever are not yet fully specified, thus creating difficulties in the knowledge of the exact pathophysiological processes involved and, therefore, necessary to elaborate an adequate and specific therapeutic strategy. Experimental studies conclude that fever and inflammation are beneficial to the host. However, antipyretic therapy is commonly employed and human studies on the presence of fever and its treatment for the prognosis of critically ill septic patients are inconclusive. Up-to-date information on the physiology of human thermoregulation, the effect of temperature on febrile range over multiple biological processes involved in host defense, and thermoregulatory interventions in the septic patient are essential to know by the critical care physician.

Long-term health effects of antipyretic drug use in the ageing population: protocol for a systematic review

“…Lack of fever and leukocytosis led to increased mortality in community acquired pneumonia in the elderly, and another study has demonstrated that introducing acetaminophen, the common drug for fever, did not help reduce the intensive care unit admission days in the elderly with infection 20,21 . On the other hand, there is evidence showing the benefit of reducing fever, such as averting febrile convulsion in children, which may result in brain injuries and neuropsychiatric alterations 22,23 and also in the elderly where the extra metabolic cost and the danger of organic damage from fever exists due to debilitating co-morbidities 22,24,25 . Thus, while there is logic behind suppressing fever as it can be detrimental, it is not entirely clear in what way the presence of fever is beneficial or in which situation harmful to the body 26,27 .…”