Congress Abstracts 2006

6

TO COOL OR NOT TO COOL: WHAT'S THE EVIDENCE FOR EXTERNALLY COOLING FEBRILE PATIENTS? Tina Mason, ARNP, MSN, AOCN^®, and Lorna P. Baker, MSN, ARNP, CCRN, OCN^®, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.

In the oncology patient population, there are numerous etiologies for an elevated core temperature including infection, neoplasms, blood transfusion, side effects of medications (e.g., chemotherapy, growth factors, steroids), and radiation therapy. The Infectious Diseases Society of America (IDSA) algorithm outlines use of antimicrobial agents in neutropenic patients and differentiates between high and low risk patients. Use of external cooling, such as cooling blankets or ice packs, for fever management has traditionally been a nursing action. A question was posed to our Nursing Research Committee of whether benefits of externally cooling outweigh the risks. The evidence was identified and critically appraised.

The purpose of this abstract is to review the evidence-based literature on use of external cooling methods for febrile patients.

The history of the concept of fever and thermometry including the 37.0oC /98.6oF average temperature will be outlined. Fever, hyperthermia, and hyperpyrexia will be defined and their management listed. Research on use of external cooling methods will be summarized. Benefits versus harmful effects on the use of physical cooling will be illustrated. The IDSA algorithm will be reviewed.

Whether or not to treat fever and at what temperature to initiate therapy in critically ill patients remains unanswered. Although external cooling is a commonly used therapy, the use of cooling blankets or ice packs has limited research support. Evidence-based literature does not support the use of external cooling for fever management except in cases of hyperpyrexia in conjunction with antipyretic therapy such as acetaminophen. Harmful effects such as increased cardiovascular demands, increased oxygen consumption, and hyperventilation outweigh the benefits.

Accurate assessment for etiology of elevated core temperature leads to correct treatment. Collaboration with Infectious Disease Department and Pharmacy is essential for the selection of institutional antimicrobial therapy. It is imperative that evidence-based findings guide nursing actions. Disseminating these findings will provide the foundation for astute nursing care.