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The guidelines appear in the current issue of Critical Care Medicine, the leading medical journal for health professionals in the critical care setting.
Dr. Kalil was among a group of specialists invited to help develop the new guidelines. The other specialists came from such prestigious institutions as Johns Hopkins University, National Institutes of Health, Northwestern University, University of Pittsburgh Medical Center, University of Wisconsin Medical School and Mount Sinai Hospital.
They represented a wide variety of specialties including critical care medicine, surgery, internal medicine, infectious diseases, neurology, and laboratory medicine/microbiology.
The task force met twice in person, several times by teleconference and held multiple e-mail discussions over a two-year period to identify pertinent literature and arrive at consensus recommendations. Consideration was given to the relationship between the weight of scientific evidence and the strength of the recommendation.
The task force concluded that because fever can have many infectious and noninfectious etiologies, a new fever in a patient in the intensive care unit (ICU) should trigger a careful clinical assessment rather than automatic orders for laboratory and radiologic tests.
The experts said a cost-conscious approach to obtaining cultures and imaging studies should be undertaken if indicated after a clinical evaluation. The goal of such an approach is to determine whether infection is present so that additional testing can be avoided and therapeutic decisions can be made.
“It was a great honor for me to be invited to be a part of this panel,” Dr. Kalil said. “The other members of the panel represent some of the top research institutions in the country, so I was thrilled to be a part of this effort.
“Whenever a person in the ICU develops a new fever, it does raise a lot of questions and necessitates important medical decisions that can truly impact the patient’s life. The panel really looked at the issue from every possible angle and then developed thoughtful recommendations that are in the patient’s best interests.”
The final report was broken into 13 sections with each section looking at a different component that could be relative when an ICU patient develops a new fever. Some of these sections included measuring body temperature and defining fever, blood cultures, intravascular devices, pulmonary infections and ICU-acquired pneumonia, stool evaluation, urinary tract infection, sinusitis, postoperative fever, surgical site infections, central nervous system infection, and non-infectious causes of fever.
Dr. Kalil played a key role in contributing to three of the sections – blood cultures and intravascular devices, pulmonary infections and ICU-acquired pneumonia, and new fever. He also was involved in the incorporation of the recent developments in the fever assessment of critically ill patients who are immunocompromised in all sections of the report.
For a complete copy of this article, go to http://www.ccmjournal.com.