Hyperthermia and fever control in brain injury.
Fever in the neurocritical care setting is common and has a negative impact on outcome of all disease types. Meta-analyses have demonstrated that fever at onset and in the acute setting after ischemic brain injury, intracerebral hemorrhage, and cardiac arrest has a negative impact on morbidity and mortality. Data support that the impact of fever is sustained for longer durations after subarachnoid hemorrhage and traumatic brain injury. Recent advances have made eliminating fever and maintaining normothermia feasible. However, there are no prospective randomized trials demonstrating the benefit of fever control in these patient populations, and important questions regarding indications and timing remain. The purpose of this review is to analyze the data surrounding the impact of fever across a range of neurologic injuries to better understand the optimal timing and duration of fever control. Prospective randomized trials are needed to determine whether the beneficial impact of secondary injury prevention is outweighed by the potential risks of prolonged fever control.
Badjatia
Neeraj
N
Neurological Institute of New York, Columbia University College of Physicians and Surgeons, New York, NY, USA. Nb2217@columbia.edu
D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D001833:Body Temperature Regulation / Q000187:drug effects / Q000502:physiology; D001930:Brain Injuries / Q000150:complications*; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D019317:Evidence-Based Medicine; D005334:Fever / Q000209:etiology / Q000628:therapy*; D006323:Heart Arrest / Q000150:complications; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017053:Infection Control; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012768:Shivering / Q000187:drug effects / Q000502:physiology; D013119:Spinal Cord Injuries / Q000150:complications; D020521:Stroke / Q000150:complications; D013345:Subarachnoid Hemorrhage / Q000150:complications; D013997:Time Factors; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000187:drug effects / Q000502:physiology
D018712:Analgesics, Non-Narcotic