title: Impact of induced normothermia on outcome after subarachnoid hemorrhage: a case-control study.
abstract: OBJECTIVE
  Fever during the first week after subarachnoid hemorrhage (SAH) is associated with poor outcome; however, eliminating fever has not been shown to improve outcome. We sought to explore the potential impact of induced normothermia using advanced fever control (AFC) methods on outcome after SAH.
  
  
  METHODS
  We identified 40 consecutive febrile patients enrolled in the Columbia University SAH Outcomes Project between 2003 and 2005 who underwent AFC (37 degrees C) with a surface cooling device during the first 14 days after SAH and randomly matched by age, Hunt and Hess grade, and SAH sum score to 80 SAH patients who underwent conventional fever control between 1996 and 2004. Average daily fever burden was calculated as the time and extent (degrees C x hours) above 37 degrees C. Poor outcome was defined as death or moderate to severe disability (modified Rankin Scale score of 4 or higher). A multivariate analysis was performed to identify factors associated with poor outcome 12 months after SAH.
  
  
  RESULTS
  The fever burden was lower over 14 days in the AFC patients as compared with the patients receiving conventional fever control (P < .001). AFC patients had higher rates of hyperglycemia (P < .01) and arrhythmias (P = .02). Higher admission Hunt and Hess grade on admission and the development of pneumonia (P = .02) were associated with an increased risk for poor outcome at 12 months (P = .04), whereas AFC was associated with a reduced risk (P = .004) after adjusting for age, arrhythmia, and anemia.
  
  
  CONCLUSIONS
  Elimination of fever with AFC may be associated with improved outcome after SAH. A prospective randomized trial of AFC vs conventional fever control is warranted.
authors.affiliation: Department of Neurology, Division of Neurocritical Care, Columbia University College of Physicians and Surgeons, New York, New York, USA. nbadjatia@neuro.columbia.edu
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badjatia
authors.forename: Luis
authors.initials: L
authors.lastname: Fernandez
authors.forename: J Michael
authors.initials: JM
authors.lastname: Schmidt
authors.forename: Kiwon
authors.initials: K
authors.lastname: Lee
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
mesh_terms: D000328:Adult; D000368:Aged; D001831:Body Temperature / Q000502:physiology*; D001833:Body Temperature Regulation; D016022:Case-Control Studies; D005260:Female; D005334:Fever / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000503:physiopathology* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome