Fever Management of Critically Ill Patients with COVID-19 Infection: Less is More?

Although physicians usually intervene to treat fever in critically ill patients, the relationship between body dysthermia (both hypothermia or hyperthermia) and these patients' outcomes are not well understood (1, 2). Fever is practically the most prevalent clinical feature at the onset of an illness during the hospitalization of patients with SARS-CoV-2 infection (3). Some studies report that fever management in critically-ill patients can increase infection risk without a decrease in mortality (4). For example, a recent meta-analysis on forty-two studies has suggested that the mortality rate is lower in septic patients with fever (5). Another study described no significant difference in critically ill patients' mortality rates between the patients with more-active fever management and less-active fever management (6). Compatibly, the results of a recently published meta-analysis show that the use of antipyretic drugs and external cooling is associated with higher risk mortality in septic ICU patients who require mechanical ventilation (7).