• Hildy M Schell-Chaple, Kathleen A Puntillo, Michael A Matthay, Kathleen D Liu, and National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network.
• Hildy M. Schell-Chaple is a clinical nurse specialist and PhD candidate at the University of California, San Francisco (UCSF) School of Nursing. Kathleen A. Puntillo is a professor emerita at the UCSF School of Nursing. Michael A. Matthay is a professor of medicine and anesthesia and Kathleen D. Liu is an associate professor at the UCSF School of Medicine. hildy.schell@ucsfmedctr.org.
• Am. J. Crit. Care. 2015 Jan 1; 24 (1): 15-23.

BackgroundLittle is known about the relationship between body temperature and outcomes in patients with acute respiratory distress syndrome (ARDS). A better understanding of this relationship may provide evidence for fever suppression or warming interventions, which are commonly applied in practice.ObjectiveTo examine the relationship between body temperature and mortality in patients with ARDS.MethodsSecondary analysis of body temperature and mortality using data from the ARDS Network Fluid and Catheter Treatment Trial (n = 969). Body temperature at baseline and on study day 2, primary cause of ARDS, severity of illness, and 90-day mortality were analyzed by using multiple logistic regression.ResultsMean baseline temperature was 37.5°C (SD, 1.1°C; range, 27.2°C-40.7°C). At baseline, fever (≥ 38.3°C) was present in 23% and hypothermia (< 36°C) in 5% of the patients. Body temperature was a significant predictor of 90-day mortality after primary cause of ARDS and score on the Acute Physiology and Chronic Health Evaluation III were adjusted for. Higher temperature was associated with decreased mortality: for every 1°C increase in baseline temperature, the odds of death decreased by 15% (odds ratio, 0.85; 95% CI, 0.73-0.98, P = .03). When patients were divided into 5 temperature groups, mortality was lower with higher temperature (P for trend = .02).ConclusionsEarly in ARDS, fever is associated with improved survival rates. Fever in the acute phase response to lung injury and its relationship to recovery may be an important factor in determining patients' outcome and warrants further study.©2015 American Association of Critical-Care Nurses.

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