Rob Orman, MD and Mel Herbert, MD MBBS FAAEM

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Should we treat febrile patients in whom we suspect infection? The HEAT trial, just published in NEJM, studied 700 ICU patients with fever (and either infection or suspected infection). Half got acetaminophen and half placebo. Primary outcome was ICU free days and there was no significant difference in this outcome between the two groups. So should we treat fever, should we not? Swami sums it up like this: Fever need not always be treated in patients with suspected infectious causes. It appears reasonable to give acetaminophen to patients in whom the fever is causing distress but it is similarly reasonable to withhold it in patients who are not distressed.


Young, Paul, et al. “Acetaminophen for Fever in Critically Ill Patients with Suspected Infection.” New England Journal of Medicine (2015). PMID: 26436473