Clinical trial of an air-circulating cooling blanket for fever control in critically ill neurologic patients.
OBJECTIVE
To evaluate the efficacy of an air-circulating cooling blanket for reducing body temperature in febrile neuro-ICU patients treated with acetaminophen.


METHODS
Two-hundred twenty consecutively admitted neuro-ICU patients whose tympanic membrane temperature reached or exceeded 101 degrees F (38.3 degrees C) were randomly assigned to receive acetaminophen (650 mg every 4 hours) alone (n = 107) or acetaminophen plus air blanket therapy (n = 113). After 24 hours of treatment, the authors compared the proportion of subjects who attained treatment success (T < or = 99 degrees F) or treatment failure (T > or = 101 degrees F for 2 consecutive hours) using the chi(2) test and the time to reach these endpoints using Kaplan-Meier survival analysis.


RESULTS
Air blanket therapy resulted in a small increase in the proportion of subjects with treatment success (44% versus 36%, chi(2) p = 0.19, log rank p = 0.10) and a similar small reduction in the proportion of patients with treatment failure (42% versus 53%, chi(2) p = 0.11, log-rank p = 0.21), compared with treatment with acetaminophen alone. Approximately one third of patients in both groups remained febrile after randomization and "failed" after the first 2 hours of treatment. Twelve percent of patients assigned to air blanket therapy refused or were unable to tolerate treatment, compared with 2% of patients treated with acetaminophen alone (p = 0.005).


CONCLUSIONS
Treatment with an air-circulating cooling blanket did not effectively reduce body temperature in febrile neuro-ICU patients treated with acetaminophen. More effective interventions are needed to maintain normothermia in patients at risk for fever-related brain damage.
Mayer
S
S
Division of Critical Care Neurology, Department of Neurology, Columbia University College of Physicians & Surgeons, New York, NY, USA. sam@columbia.edu
Commichau
C
C
Scarmeas
N
N
Presciutti
M
M
Bates
J
J
Copeland
D
D
D000328:Adult; D000368:Aged; D001512:Bedding and Linens; D001831:Body Temperature / Q000502:physiology; D001833:Body Temperature Regulation; D017679:Cryotherapy; D005260:Female; D005334:Fever / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*