Pyrexia in head-injured patients admitted to intensive care.
OBJECTIVE
(a) To quantify the occurrence of pyrexia during the first week after head injury; (b) to elucidate the relationships between pyrexia and neurological severity, length of stay in the ICU, intracranial hypertension, and cerebral perfusion pressure (CPP); and (c) to describe the effects of antipyretic therapy on temperature, intracranial pressure (ICP) and CPP.


METHODS
Multicenter retrospective observational study in three ICUs in the Milan area.


METHODS
110 patients with traumatic brain injury.


RESULTS
Eighty patients suffered pyrexia, defined as an external temperature higher than 38 degrees C or internal temperature higher than 38.4 degrees C. Occurrence and duration of pyrexia were associated with the degree of neurological impairment and with prolonged ICU stay. In patients with normal perimesencephalic cisterns the episodes of increased ICP were more frequent in febrile cases. Various antipyretic therapies were used in 66 patients. Pharmacological treatment was slightly effective (mean temperature reduction 0.58+/-0.7 degrees C) but caused a significant drop in CPP (6.5+/-12.5 mmHg).


CONCLUSIONS
Pyrexia is extremely frequent in the acute phase after head injury. Its incidence is higher in more severe cases and is correlated with a longer ICU stay. It may affect ICP, but its contribution is difficult to assess when other major causes of increased intracranial volume are present. Antipyretic therapy is poorly effective for controlling body temperature and may be deleterious for CPP.
Stocchetti
Nino
N
Terapia Intensiva Neuroscienze, Ospedale Maggiore, Policlinico IRCCS, Via S Sforza, 3520 122 Milan, Italy.
Rossi
Sandra
S
Zanier
Elisa Roncati
ER
Colombo
Angelo
A
Beretta
Luigi
L
Citerio
Giuseppe
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D006259:Craniocerebral Trauma / Q000150:complications*; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007427:Intracranial Pressure; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric
D018712:Analgesics, Non-Narcotic