Temperature management in patients with acute neurological lesions: an Australian and New Zealand point prevalence study.
BACKGROUND
Given the scientific uncertainty of the efficacy and safety of normothermia (36.0°C to 37.5°C) on disability and death after acute neurological lesions, we sought to understand how temperature is managed in usual clinical care for this patient population in Australia and New Zealand.


OBJECTIVE
To describe temperature management in patients with acute neurological lesions.


METHODS
Prospective, observational, multicentre, single-day point-prevalence study.


METHODS
Observational data of usual practice were recorded for all patients with an intensive care admission diagnosis of acute neurological lesions and who were present in 33 intensive care units at 10:00 on the study day. Data were collected prospectively for the ensuing 24-hour period.


METHODS
Achieved temperature, interventions used to modify temperature and target temperature.


RESULTS
There were 106 patients with acute neurological lesions (61% with either stroke or traumatic brain injury) with a mean APACHE (Acute Physiology and Chronic Health Evaluation) II score of 19.3 ± 7.4, age of 53.5 ± 19.0 years and median time from intensive care admission to data capture of 3 days (interquartile range, 1-9). A target temperature was specified in 24% of patients. Although paracetamol was commonly used (56%), it was infrequently used at the maximum licensed dose and there was no use recorded of non-steroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors. Physical cooling was used in 25% of patients and core temperature was measured in 32%. Measured temperature often exceeded 37.0°C (62% of readings), 37.5°C (43%) and 38.0°C (22%).


CONCLUSIONS
Temperature readings above 37.5°C are common. Further cohort studies are required to validate these preliminary, exploratory findings.
Department of Intensive Care Medicine, St George Hospital, Sydney, NSW, Australia. m.saxena@unsw.edu.au
Manoj K
MK
Saxena
Colman B
CB
Taylor
Naomi E
NE
Hammond
Paul J
PJ
Young
Ian M
IM
Seppelt
Parisa
P
Glass
John A
JA
Myburgh
D000082:Acetaminophen / Q000008:administration & dosage*; D058633:Antipyretics / Q000008:administration & dosage; D001315:Australia / Q000453:epidemiology; D001831:Body Temperature; D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome
D058633:Antipyretics; D000082:Acetaminophen