Induced normothermia attenuates cerebral metabolic distress in patients with aneurysmal subarachnoid hemorrhage and refractory Fever.
OBJECTIVE
The purpose of this study was to analyze whether fever control attenuates cerebral metabolic distress after aneurysmal subarachnoid hemorrhage (SAH).


METHODS
Eighteen SAH patients, who underwent intracranial pressure (ICP) and cerebral microdialysis monitoring and were treated with induced normothermia for refractory fever (body temperature >or=38.3 degrees C, despite antipyretics), were studied. Levels of microdialysate lactate/pyruvate ratio (LPR) and episodes of cerebral metabolic crisis (LPR >40) were analyzed during fever and induced normothermia, at normal and high ICP (>20 mm Hg).


RESULTS
Compared to fever, induced normothermia resulted in lower LPR (40+/-24 versus 32+/-9, P<0.01) and a reduced incidence of cerebral metabolic crisis (13% versus 5%, P<0.05) at normal ICP. During episodes of high ICP, induced normothermia was associated with a similar reduction of LPR, fewer episodes of cerebral metabolic crisis (37% versus 8%, P<0.01), and lower ICP (32+/-11 versus 28+/-12 mm Hg, P<0.05).


CONCLUSIONS
Fever control is associated with reduced cerebral metabolic distress in patients with SAH, irrespective of ICP.
Oddo
Mauro
M
Department of Neurosurgery, Clinical Research Division, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. Mauro.Oddo@uphs.upenn.edu
Frangos
Suzanne
S
Milby
Andrew
A
Chen
Isaac
I
Maloney-Wilensky
Eileen
E
Murtrie
Eileen Mac
EM
Stiefel
Michael
M
Kofke
W Andrew
WA
Le Roux
Peter D
PD
Levine
Joshua M
JM
D000328:Adult; D000368:Aged; D015415:Biomarkers; D001831:Body Temperature / Q000502:physiology*; D001923:Brain Chemistry / Q000502:physiology*; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D004351:Drug Resistance; D005260:Female; D005334:Fever / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008659:Metabolic Diseases / Q000628:therapy*; D017551:Microdialysis; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome
D015415:Biomarkers