title: Therapeutic temperature modulation for fever after intracerebral hemorrhage.
abstract: BACKGROUND
  We sought to determine whether therapeutic temperature modulation (TTM) to treat fever after intracerebral hemorrhage (ICH) is associated with improved hospital complications and discharge outcomes.
  
  
  METHODS
  We performed a retrospective case-control study of patients admitted with spontaneous ICH having two consecutive fevers ≥38.3 °C despite acetaminophen administration. Cases were enrolled from a prospective database of patients receiving TTM from 2006 to 2010. All cases received TTM for fever control with goal temperature of 37 °C with a shiver-control protocol. Controls were matched in severity by ICH score and retrospectively obtained from 2001 to 2004, before routine use of TTM for ICH. Primary outcome was discharge-modified Rankin score.
  
  
  RESULTS
  Forty patients were enrolled in each group. Median admission ICH Score, ICH volume, and GCS were similar. TTM was initiated with a median of 3 days after ICH onset and for a median duration of 7 days. Mean daily T max was significantly higher in the control group over the first 12 days (38.1 vs. 38.7 °C, p ≤ 0.001). The TTM group had more days of IV sedation (median 8 vs. 1, p < 0.001) and mechanical ventilation (18 vs. 9, p = 0.003), and more frequently underwent tracheostomy (55 vs. 23 %, p = 0.005). Mean NICU length of stay was longer for TTM patients (15 vs. 11 days, p = 0.007). There was no difference in discharge outcomes between the two groups (overall mortality 33 %, moderate or severe disability 67 %).
  
  
  CONCLUSIONS
  Therapeutic normothermia is associated with increased duration of sedation, mechanical ventilation, and NICU stay, but is not clearly associated with improved discharge outcome.
authors.affiliation: Department of Neurology, New York University, New York, NY, USA, aaron.lord@nyumc.org.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Lord
authors.forename: Sarah
authors.initials: S
authors.lastname: Karinja
authors.forename: Hector
authors.initials: H
authors.lastname: Lantigua
authors.forename: Amanda
authors.initials: A
authors.lastname: Carpenter
authors.forename: J Michael
authors.initials: JM
authors.lastname: Schmidt
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: Sachin
authors.initials: S
authors.lastname: Agarwal
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badjatia
mesh_terms: D000368:Aged; D001831:Body Temperature / Q000502:physiology*; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D015600:Glasgow Coma Scale; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007036:Hypothermia, Induced / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives