Clinical trial of a novel surface cooling system for fever control in neurocritical care patients.
OBJECTIVE
To compare the efficacy of a novel water-circulating surface cooling system with conventional measures for treating fever in neuro-intensive care unit patients.


METHODS
Prospective, unblinded, randomized controlled trial.


METHODS
Neurologic intensive care unit in an urban teaching hospital.


METHODS
Forty-seven patients, the majority of whom were mechanically ventilated and sedated, with fever > or =38.3 degrees C for >2 consecutive hours after receiving 650 mg of acetaminophen.


METHODS
Subjects were randomly assigned to 24 hrs of treatment with a conventional water-circulating cooling blanket placed over the patient (Cincinnati SubZero, Cincinnati OH) or the Arctic Sun Temperature Management System (Medivance, Louisville CO), which employs hydrogel-coated water-circulating energy transfer pads applied directly to the trunk and thighs.


RESULTS
Diagnoses included subarachnoid hemorrhage (60%), cerebral infarction (23%), intracerebral hemorrhage (11%), and traumatic brain injury (4%). The groups were matched in terms of baseline variables, although mean temperature was slightly higher at baseline in the Arctic Sun group (38.8 vs. 38.3 degrees C, p = .046). Compared with patients treated with the SubZero blanket (n = 24), Arctic Sun-treated patients (n = 23) experienced a 75% reduction in fever burden (median 4.1 vs. 16.1 C degrees -hrs, p = .001). Arctic Sun-treated patients also spent less percent time febrile (T > or =38.3 degrees C, 8% vs. 42%, p < .001), spent more percent time normothermic (T < or =37.2 degrees C, 59% vs. 3%, p < .001), and attained normothermia faster than the SubZero group median (2.4 vs. 8.9 hrs, p = .008). Shivering occurred more frequently in the Arctic Sun group (39% vs. 8%, p = .013).


CONCLUSIONS
The Arctic Sun Temperature Management System is superior to conventional cooling-blanket therapy for controlling fever in critically ill neurologic patients.
Mayer
Stephan A
SA
Neurological Intensive Care Unit, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. sam@columbia.edu
Kowalski
Robert G
RG
Presciutti
Mary
M
Ostapkovich
Noeleen D
ND
McGann
Elaine
E
Fitzsimmons
Brian-Fred
BF
Yavagal
Dileep R
DR
Du
Y Evelyn
YE
Naidech
Andrew M
AM
Janjua
Nazli A
NA
Claassen
Jan
J
Kreiter
Kurt T
KT
Parra
Augusto
A
Commichau
Christopher
C
D000328:Adult; D000368:Aged; D001833:Body Temperature Regulation / Q000502:physiology; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis; D016009:Chi-Square Distribution; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005334:Fever / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation* / Q000379:methods; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D016896:Treatment Outcome