clinical review fever in intensive care unit patients重症监护病房患者的临床评估发热.pdfVIP

Available online /content/7/3/221 Review Clinical review: Fever in intensive care unit patients Michael Ryan1 and Mitchell M Levy2 1Fellow, Brown Medical School/Rhode Island Hospital, Pulmonary/Critical Care Division, Providence, Rhode Island, USA 2Associate Professor, Brown Medical School/Rhode Island Hospital and Medical Director of MICU, Rhode Island Hospital, Pulmonary/Critical Care Division, Providence, Rhode Island, USA Correspondence: Mitchell M Levy, mitchell.levy@ Published online: 8 March 2003 Critical Care 2003, 7:221-225 (DOI 10.1186/cc1879) This article is online at /content/7/3/221 © 2003 BioMed Central Ltd (Print ISSN 1364-8535; Online ISSN 1466-609X) Abstract Fever is a common response to sepsis in critically ill patients. Fever occurs when either exogenous or endogenous pyrogens affect the synthesis of prostaglandin E2 in the pre-optic nucleus. Prostaglandin E2 slows the rate of firing of warm sensitive neurons and results in increased body temperature. The febrile response is well preserved across the animal kingdom, and experimental evidence suggests it may be a beneficial response to infection. Fever, however, is commonly treated in critically ill patients, usually with antipyretics, without good data to support such a practice. Fever induces the production of heat shock proteins (HSPs), a class of proteins critical for cellular survival during stress. HSPs act as molecular chaperones, and new data suggest they may also have an anti-inflammatory role. HSPs and the heat shock response appear to inhibit the activation of NF-κβ, thus decreasing the levels of proinflammatory cytokines. Th