Why should fever, an adaptive response, be treated in a hospital setting?

From the Guidelines

Fever should be treated in a hospital setting when it becomes excessive or occurs in vulnerable patients, as it is associated with poor neurological outcomes and increased risk of morbidity and mortality, as seen in patients with acute ischemic stroke 1. In the context of acute ischemic stroke, increased body temperature is associated with poor neurological outcome, possibly due to increased metabolic demands, enhanced release of neurotransmitters, and increased free radical production 1.

• The source of any fever should be ascertained, as it may be secondary to a cause of stroke or a complication such as pneumonia.
• Measures to lower an acutely elevated body temperature may include antipyretic medications and cooling devices.
• However, recent guidelines suggest that routine use of antipyretic medications to reduce fever in critically ill patients may not be necessary, unless the patient values comfort by reducing temperature 1.
• In patients with intracerebral hemorrhage, fever is associated with death and disability, and early treatment of fever with antipyretics may be considered in clinical practice, although preventive treatment of fever is not recommended outside of clinical trials 1.
• The goal of treating fever is not to eliminate it entirely, but to prevent complications like dehydration, metabolic stress, and neurological issues, while still allowing the body's natural defenses to function.
• Common antipyretics include acetaminophen and ibuprofen, and in hospital settings, more aggressive cooling measures may be implemented for severe hyperthermia, including cooling blankets, ice packs, or intravenous antipyretics.
• It is essential to note that treating fever addresses symptoms but does not cure the underlying cause, which requires appropriate diagnosis and targeted therapy.

From the Research

Reasons for Treating Fever in a Hospital Setting

• Fever can be a symptom of a serious underlying condition, such as meningitis, septicemia, or pneumonia, which requires immediate medical attention 2
• In critically ill patients, fever is associated with an increased risk of death, and its management is crucial to improve patient outcomes 3
• Although fever is an adaptive response to infection, its suppression may be necessary in certain cases, such as in patients with neurologic impairment or marked hyperpyrexia 3
• The use of antipyretics, such as paracetamol or ibuprofen, can help reduce fever and improve patient comfort, but their administration should be guided by a healthcare professional to avoid potential harm 4, 2, 5, 6

Considerations for Fever Management

• The decision to treat fever should be based on the underlying cause and the patient's clinical condition, rather than solely on the presence of fever 4, 3
• Non-pharmacological interventions, such as maintenance of hydration and rest, can be effective in managing fever in children, but their use should be individualized and guided by a healthcare professional 5
• The administration of antipyretics should be minimized and used selectively, especially in children, to avoid potential risks and side effects 2, 5, 6

Hospital Setting

• A hospital setting provides the necessary resources and expertise to manage fever and its underlying causes, especially in critically ill patients or those with complex medical conditions 4, 3
• Healthcare professionals in a hospital setting can monitor patients closely and adjust treatment plans as needed to ensure optimal outcomes 4, 3