Control of fever by continuous, low-dose diclofenac sodium infusion in acute cerebral damage patients.
OBJECTIVE
The aim of this study was to assess the efficacy and safety of low doses of diclofenac sodium (DCF) in attaining normothermia with minimal major side effects in patients with acute cerebral damage. The study was designed to verify the adequate, prolonged antipyretic action of DCF infusion, to quantify its haemodynamic and cerebral impact and to assess any negative effect on renal and liver function.


METHODS
Retrospective, cohort study on prospectively collected data.


METHODS
Intensive care unit (ICU) of a university hospital.


METHODS
Five patients with subarachnoid haemorrhage and seven severe head-trauma victims with febrile illness of various infectious origin.


METHODS
Continuous i.v. infusion of a low dose (0.04 mg/kg/h) of DCF for 48 h.


RESULTS
Systemic and cerebral haemodynamic data were collected at 4 h intervals for 8 h before diclofenac infusion and 48 h after. Renal and liver functions were monitored. Normothermia, defined as external temperature < 37.5 degrees Celsius (degrees C), was achieved in all cases. Intracranial pressure was significantly lowered and mean arterial pressure was unaffected, so cerebral perfusion pressure rose after DCF. Hepatic and renal function were not altered in the 48 h post DCF. Mean urinary output was preserved at high flow and was not influenced by DCF.


CONCLUSIONS
Continuous infusion of low-dose DCF attained normothermia without any major cerebral or systemic side effects. Renal and liver functions were unaffected. Once normothermia was achieved, intracranial and cerebral perfusion pressure improved.
Anesthesia and Intensive Care, Ospedale Nuovo San Gerardo dei Tintori, Monza (MI), Italy. manuela.cormio@libero.it
M
M
Cormio
G
G
Citerio
S
S
Spear
R
R
Fumagalli
A
A
Pesenti
D000208:Acute Disease; D000328:Adult; D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006259:Craniocerebral Trauma / Q000150:complications*; D004008:Diclofenac / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000150:complications / Q000188:drug therapy*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007427:Intracranial Pressure / Q000187:drug effects; D007677:Kidney Function Tests; D008111:Liver Function Tests; D008297:Male; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac