title: Induced normothermia attenuates cerebral metabolic distress in patients with aneurysmal subarachnoid hemorrhage and refractory Fever.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Clinical Research Division, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. Mauro.Oddo@uphs.upenn.edu
authors.forename: Mauro
authors.initials: M
authors.lastname: Oddo
authors.forename: Suzanne
authors.initials: S
authors.lastname: Frangos
authors.forename: Andrew
authors.initials: A
authors.lastname: Milby
authors.forename: Isaac
authors.initials: I
authors.lastname: Chen
authors.forename: Eileen
authors.initials: E
authors.lastname: Maloney-Wilensky
authors.forename: Eileen Mac
authors.initials: EM
authors.lastname: Murtrie
authors.forename: Michael
authors.initials: M
authors.lastname: Stiefel
authors.forename: W Andrew
authors.initials: WA
authors.lastname: Kofke
authors.forename: Peter D
authors.initials: PD
authors.lastname: Le Roux
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Levine
mesh_terms: 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
chemical_list: D015415:Biomarkers