Matt Stanton

🔥⚠️We are fighting fever… when we should be using it 🤓 Every day in ICU...Paracetamol, Cooling blankets, Aggressive temperature control But what if fever is not the problem 🤔 *Fever is not a failure of physiology It is an adaptive response Driven by cytokines and Controlled by the hypothalamus 🫀 Clinical implication Fever is not noise...It is a signal *Heat boosts immunity At 38–41°C: • ↑ Neutrophil activation • ↑ NK cell activity • ↑ Antigen presentation • ↑ T-cell interaction 🫀 Clinical implication You are suppressing immune function when you suppress fever *Bacteria don’t like heat Most pathogens: • Optimal growth ~37°C • Growth impairment near 40°C Even more interesting β-lactams work better at higher temperatures 🫀 Clinical implication Fever may act as a natural antibiotic enhancer *The paradox: treating fever may worsen outcomes Observational data show: • Higher fever → lower mortality • Hypothermia → worse outcomes And even more concerning Antipyretics in sepsis → ↑ mortality 🫀 Clinical implication We may be harming patients with “routine care” *The myth of temperature control Antipyretics reduce temperature by 0.3–0.5°C No mortality benefit Sometimes harm 🫀 Clinical implication We are treating a number, not a patient *The real strategy: permissive hyperthermia Target: ~38–40°C Not normothermia Not aggressive cooling 🫀 Clinical implication Fever should be tolerated, not eliminated *When should we treat fever? ✔ Extreme hyperthermia (>40°C) ✔ Patient discomfort ✔ Cardiovascular stress ❌ Routine suppression in sepsis 🫀 Clinical implication Treat symptoms, not physiology *The uncomfortable truth We were trained that fever is dangerous, but evidence suggests that Fever is PROTECTIVE and its suppression may be HARMFUL 🫨 🤓Final reflection In sepsis, the goal is not comfort alone. The goal is survival, and sometimes survival requires heat😎🔥 📚 Tilanus A, Villamil W. Open Forum Infectious Diseases, 2025 “Fever in Sepsis Revisited: Is a Little Heat What We Need?” doi.org/10.1093/ofid/ofaf608