Standardized antipyretic treatment in stroke: a pilot study.
BACKGROUND
Fever after acute cerebral injury is associated with unfavorable functional outcome and increased mortality, but there is controversy about the optimal antipyretic treatment. This study investigated an institutional standard operating procedure (SOP) for fever treatment in stroke patients including a sequence of pharmacologic and physical interventions.


METHODS
A 4-step antipyretic SOP was established for patients with acute cerebral ischemia or hemorrhage and a body temperature ≥37.5°C within the first 6 days after admission. Data on the course of body temperature, duration of fever and achievement of normothermia were recorded. Results were compared to a historic control group that underwent conventional treatment.


RESULTS
A total of 77 patients (mean age 70.4 ± 14.2 years) received 331 antipyretic interventions. Sequential administration of paracetamol (n = 219), metamizole (n = 71) and calf packing (n = 24) resulted in a significant drop in body temperature after 60 min in each instance. In 5 of 9 cases which were refractory to previous attempts, normothermia followed the infusion of ice-cooled saline. In more than 90% of cases treated per protocol, normothermia was achieved within 120 min. Compared to conventional treatment, fever burden was significantly lower within the first 4 days after admission (p < 0.001).


CONCLUSIONS
This SOP may help to optimize antipyretic treatment for stroke patients.
Department of Neurology, University Medical Center Erlangen-Nuremberg, Germany. bernd.kallmuenzer@uk-erlangen.de
Bernd
B
Kallmünzer
Christiane
C
Krause
Elisabeth
E
Pauli
Alexander
A
Beck
Lorenz
L
Breuer
Martin
M
Köhrmann
Rainer
R
Kollmar
D000082:Acetaminophen / Q000008:administration & dosage; D000368:Aged; D000369:Aged, 80 and over; D058633:Antipyretics / Q000008:administration & dosage* / Q000009:adverse effects; D001833:Body Temperature Regulation / Q000187:drug effects*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D019091:Critical Pathways / Q000592:standards*; D004177:Dipyrone / Q000008:administration & dosage; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005858:Germany; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000592:standards*; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015397:Program Evaluation; D012965:Sodium Chloride / Q000008:administration & dosage; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
D058633:Antipyretics; D000082:Acetaminophen; D012965:Sodium Chloride; D004177:Dipyrone