J Korean Med Sci.  2016 Dec;31(12):2033-2041. 10.3346/jkms.2016.31.12.2033.

The Association of Fever with Total Mechanical Ventilation Time in Critically Ill Patients

Affiliations
  • 1Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
  • 2Department of Anesthesiology, Kobe University Hospital, Kobe, Japan.
  • 3Department of Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan.
  • 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 5Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 6Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. yskoh@amc.seoul.kr
  • 7Department of Pulmonary and Critical Care Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
  • 8Department of Anesthesiology and Intensive Care Medicine, Hiroshima City Hospital, Hiroshima, Japan.
  • 9Division of Intensive Care Unit, New Tokyo Hospital, Tokyo, Japan.
  • 10Division of Intensive and Coronary Care Unit, Nippon Medical School Hospital, Tokyo, Japan.
  • 11Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi, Japan.
  • 12Intensive Care Unit, Department of Anesthesiology, Teine Keijinkai Hospital, Sapporo, Japan.
  • 13Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Abstract

This research aims to investigate the impact of fever on total mechanical ventilation time (TVT) in critically ill patients. Subgroup analysis was conducted using a previous prospective, multicenter observational study. We included mechanically ventilated patients for more than 24 hours from 10 Korean and 15 Japanese intensive care units (ICU), and recorded maximal body temperature under the support of mechanical ventilation (MAX(MV)). To assess the independent association of MAX(MV) with TVT, we used propensity-matched analysis in a total of 769 survived patients with medical or surgical admission, separately. Together with multiple linear regression analysis to evaluate the association between the severity of fever and TVT, the effect of MAX(MV) on ventilator-free days was also observed by quantile regression analysis in all subjects including non-survivors. After propensity score matching, a MAX(MV) ≥ 37.5℃ was significantly associated with longer mean TVT by 5.4 days in medical admission, and by 1.2 days in surgical admission, compared to those with MAX(MV) of 36.5℃ to 37.4℃. In multivariate linear regression analysis, patients with three categories of fever (MAX(MV) of 37.5℃ to 38.4℃, 38.5℃ to 39.4℃, and ≥ 39.5℃) sustained a significantly longer duration of TVT than those with normal range of MAX(MV) in both categories of ICU admission. A significant association between MAX(MV) and mechanical ventilator-free days was also observed in all enrolled subjects. Fever may be a detrimental factor to prolong TVT in mechanically ventilated patients. These findings suggest that fever in mechanically ventilated patients might be associated with worse mechanical ventilation outcome.

Keyword

Body Temperature; Intensive Care Units; Mechanical Ventilation; Fever

MeSH Terms

Asian Continental Ancestry Group
Body Temperature
Critical Illness*
Fever*
Humans
Intensive Care Units
Linear Models
Observational Study
Propensity Score
Prospective Studies
Reference Values
Respiration, Artificial*

Figure

  • Fig. 1 Study design in survived subjects. MV = mechanical ventilation, MAXMV = maximum body temperature during MV.


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