What is the recommended blanket use for patients with fever?

Blanket Use for Patients with Fever

For patients with fever, antipyretic medications are recommended over nonpharmacologic methods like cooling blankets when temperature reduction is desired for comfort, as cooling blankets can cause discomfort and temperature fluctuations without providing superior fever reduction. 1

Temperature Monitoring and Management Principles

• Central temperature monitoring methods (pulmonary artery catheters, bladder catheters, esophageal thermistors) are preferred when available for accurate temperature measurement 1
• When central monitoring is unavailable, oral or rectal temperatures are recommended over less reliable methods like axillary or tympanic measurements 1
• Routine use of antipyretic medications solely for temperature reduction is not recommended in critically ill patients, as fever is a protective physiological response 1
• For patients who desire symptomatic relief from fever, antipyretic medications are recommended over nonpharmacologic cooling methods 1

Evidence Against Routine Cooling Blanket Use

• Cooling blankets are not more effective than other cooling measures and are associated with more temperature fluctuations (56% vs 18%) and episodes of rebound hypothermia (18% vs 0%) 2
• Febrile patients treated with external cooling methods (like tepid-water sponging) plus antipyretics are more uncomfortable than those treated with antipyretic drugs alone 3
• Hypothermia blanket therapy was found to have the same mean cooling rate (0.028°F/h) as conventional methods in one study, but with more "zigzag" temperature fluctuations 2
• Tepid sponging alone may result in immediate temperature decrease, but this response is short-duration compared to antipyretics or antipyretics plus sponging 4

When Blankets May Be Appropriate

• If blankets are used for comfort during fever, warmer blanket temperatures (23.9°C) provide similar cooling rates as colder temperatures (7.2°C) but are perceived as more comfortable by patients 5
• Warmer blanket temperatures show a trend toward less shivering compared to colder temperatures 5
• Preventing shivering is important as it can increase oxygen consumption by 5-6 times resting levels, which may be detrimental in patients with limited physiological reserves 6
• Even when managing fever, preventing hypothermia remains a priority, especially in vulnerable patients 6

Special Considerations

• In neurological patients with fever, more aggressive temperature management may be warranted as uncontrolled fever can precipitate secondary brain injury 7
• For patients with acute neurological conditions and fever, catheter-based cooling systems added to conventional management (including antipyretics) have shown superior fever reduction compared to conventional management alone 8
• In trauma patients, preventing hypothermia is critical, and warm blankets may be part of standard care even when managing fever 6

Practical Approach

• Use antipyretics as first-line therapy when temperature reduction is desired for patient comfort 1
• If blankets are used, opt for warmer blanket temperatures (around 23.9°C) rather than colder ones to improve comfort while achieving similar cooling rates 5
• Protect extremities when using cooling blankets to reduce discomfort 5
• Monitor for shivering, which increases metabolic demand and may worsen outcomes in critically ill patients 6, 2
• Be vigilant for rebound hypothermia when using cooling blankets 2