Prophylactic, endovascularly based, long-term normothermia in ICU patients with severe cerebrovascular disease: bicenter prospective, randomized trial.
OBJECTIVE
We sought to study the effectiveness and safety of endovascular cooling to maintain prophylactic normothermia in comparison with standardized, stepwise, escalating fever management to reduce fever burden in patients with severe cerebrovascular disease.


METHODS
This study was a prospective, randomized, controlled trial with a blinded neurologic outcome evaluation comparison between prophylactic, catheter-based normothermia (CoolGard; ie, body core temperature 36.5 degrees C) and conventional, stepwise fever management with anti-inflammatory drugs and surface cooling. Patients admitted to 1 of the 2 neurointensive care units were eligible for study inclusion when they had a (1) spontaneous subarachnoid hemorrhage with Hunt & Hess grade between 3 and 5, (2) spontaneous intracerebral hemorrhage with a Glasgow Coma Scale score <or=10, or (3) complicated cerebral infarction requiring intensive care unit treatment with a National Institutes of Health Stroke Scale score >or=15.


RESULTS
A total of 102 patients (56 female) were enrolled during a 3.5-year period. Fifty percent had a spontaneous subarachnoid hemorrhage, 40% had a spontaneous intracerebral hemorrhage, and 10% had a complicated cerebral infarction. Overall median total fever burden during the course of treatment was 0.0 degrees C hour and 4.3 degrees C hours in the catheter and conventional groups, respectively (P<0.0001). Prophylactic normothermia did not lead to an increase in the number of patients who experienced a major adverse event. No significant difference was found in mortality and neurologic long-term follow-up.


CONCLUSIONS
Long-term, catheter-based, prophylactic normothermia significantly reduces fever burden in neurointensive care unit patients with severe cerebrovascular disease and is not associated with increased major adverse events.
Broessner
Gregor
G
Department of Neurology, Neurologic Intensive Care Unit, Innsbruck Medical University, Innsbruck, Austria. gregor.broessner@i-med.ac.at
Beer
Ronny
R
Lackner
Peter
P
Helbok
Raimund
R
Fischer
Marlene
M
Pfausler
Bettina
B
Rhorer
Janelle
J
Küppers-Tiedt
Lea
L
Schneider
Dietmar
D
Schmutzhard
Erich
E
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001833:Body Temperature Regulation / Q000502:physiology*; D002404:Catheterization; D002543:Cerebral Hemorrhage / Q000150:complications; D002544:Cerebral Infarction / Q000150:complications; D002561:Cerebrovascular Disorders / Q000150:complications*; D002985:Clinical Protocols; D004864:Equipment and Supplies; D005260:Female; D005334:Fever / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D016037:Single-Blind Method; D013345:Subarachnoid Hemorrhage / Q000150:complications; D013997:Time Factors; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents