Great question.

So far its inconclusive. there are 2 reviews that have been published in the past few years which would be a good place to start. 

1. Hammond & Boyle (2011) Pharmacological versus non-pharmacological antipyretic treatments in febrile critically ill adult patients: a systematic review and meta-analysis. Australian Critical Care Vol. 24, issue 1 pp 4-17

2. Jefferies, S., Weatherall, M., Young, P., Eyers, S., Perrin, K. G., Beasley, C. R. (2011) The effect of antipyretic medications on mortality in critically ill patients with infection: a systematic review and meta-analysis in Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine Vol13 issue 2 pp 125-31

Since then there has been some interesting research ongoing and published that may add to those review, the 2 that come immediately to mind is the HEAT trial and the FACE study 

1. the HEAT trial has not published yet but its a multicentred RCT. Young et al. 2012. The HEAT trial: a protocol for a multicentre randomised placebo-controlled trial of IV paracetamol in ICU patients with fever and infection.[Erratum appears in Crit Care Resusc. 2013 Jun;15(2):133] - Critical Care & Resusciation Vol 14 issue 4 pp290-6

2. the Face study - Lee et al. 2012 Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study in Critical Care, vol16 issue 1 pp R33

As far as what is done typically in most ICUs around the world. I think practice reflects the literature, we don't know so there is a huge variety of things occurring, some treat fever aggressively (more-so in brain injury than non-brain injury) and some allow fever unless it gets really high. 

some literature that reflects that in the non-brain injured population is 

1. Hammond et al. (2013) Temperature management of non-elective intensive care patients without neurological abnormalities: a point prevalence study of practice in Australia and New Zealand in Critical Care & Resusciation Vol 15 issue 3 pp228-33

and 

2. Greenberg, Chen & Hasday (2010) Acetaminophen has limited antipyretic activity in critically ill patients. published in Journal of critical care, vol25 issue 2 p363?

There is lots on fever treatment and brain injury out there. the consensus is that fever in brain injury is associated with worse neurologic outcomes. The evidence that outcomes can be improved by aggressive antipyretic therapy is limited but it is what is most recommended.

Hi Vini,

Thank you for your kind response, I will endeavor to read thoroughly the literature you have suggested.

Regards

Jeremy

There is a lot of discussion going on regarding this topic in the filed of Neurology: as you are probably aware, a lot of experimental stroke model studies in animals have showed improved survival, reduced stroke size in induced hypothermia but human attempts at the same have generally not reproduced this. There is a protocol for a new large study ("EuroHYP-1") which involves cooling to target temperatures of 34-35 dgerees within 6 hours after a stroke which may give some answers. More promising are some of the results regarding ICU treatment of post anoxic/post cardiac arrest patients where studies have suggested better outcome subsequent to the introduction of cooling the first 24 h. However, also here some recent studies have questioned this and suggested that the better survival are more related to a generally improved level of care than to this one specific intervention, notably the TTM studies (search for Cronberg T and Fribergh H) find (on a number of parameters) no difference between targeted body temperatures of 33 or 36 degrees regarding neurologic outcome and survival. If one focuses on hyperpyrexia infectious or other causes in stroke patients the picture is also somewhat unclear - most clinical protocols (including ours at our University Hospital stroke department) advocate intervention in the case of hyperpyrexia ie. aiming to keep a normal body temperature. This is especially in cases of seizures.

As for non-neurological ICU cases I leave that to others to answer.

Hi Christofer, for some reason I have just come across your answer.

Many thanks for your kind input.

Your comments are noted.