Fever is a common symptom in intensive care unit (ICU) patients and is caused by a wide variety of infectious and noninfectious disorders. The presence of fever often results in the act of diagnostic tests and procedures that considerably increase medical costs and expose the patient to inappropriate use of antibiotics which eventually results in antibiotic resistance. Thus, evaluation of the febrile patient in the ICU requires a meticulous and attentive approach. Currently, managing ICU patients with fever should be towards a more restrictive approach than simply starting antibiotic therapy. This review summarizes the common causes of fever in ICU patients and outlines a clinical approach to the management of these patients.