Induced Normothermia Attenuates Intracranial Hypertension and Reduces Fever Burden after Severe Traumatic Brain Injury

• Published in: Neurocritical care 2009-08, Vol.11 (1), p.82-87
• Main Authors: Puccio, Ava M., Fischer, Michael R., Jankowitz, Brian T., Yonas, Howard, Darby, Joseph M., Okonkwo, David O.
• Format: Article
• Language: English
• Subjects: Adult; Body Temperature; Brain Injuries - therapy; Case-Control Studies; Catheters; Cooling; Critical Care - methods; Critical Care Medicine; Female; Fever; Fever - therapy; Gender; Glasgow Coma Scale; Hemorrhage; Humans; Hypertension; Hyperthermia; Hypothermia, Induced - methods; Intensive; Intensive care; Internal Medicine; Intracranial Hypertension - therapy; Kinases; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Original Article; Patients; Severity of Illness Index; Temperature; Traumatic brain injury; Treatment Outcome; Young Adult
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-009-9213-0

Introduction Hyperthermia following a severe traumatic brain injury (TBI) is common, potentiates secondary injury, and worsens neurological outcome. Conventional fever treatment is often ineffective. An induced normothermia protocol, utilizing intravascular cooling, was used to assess the impact on fever incidence and intracranial pressure (ICP) in patients with severe TBI. Methods A comparative cohort study of 21 adult patients with severe TBI (GCS ≤ 8) treated with induced normothermia [36–36.5°C rectal probe setting; intravascular cooling catheter (CoolLine ® , Alsius Corporation, Irvine, CA)] were matched by age, gender, and severity of injury to 21 historical control severe TBI patients treated with conventional fever control methods. ICP was measured via an external ventricular catheter and time duration for ICP > 25 mmHg was calculated for the initial 72-h monitoring period. Non-parametric rank tests were performed. Results Mean (±SD) or median [range] demographics did not differ between groups [total N  = 42 (6 female, 36 male, age 36.4 ± 14.8 years and initial GCS 7 [ 3 – 8 ], median and range]. Fever burden in the first 3 days (time >38°C) in the induced normothermia versus control group was significantly less at 1.6% versus 10.6%, respectively ( P  = 0.03). Mean ICP for patients with induced normothermia versus control was 12.74 ± 4.0 and 16.37 ± 6.9 mmHg, respectively. Furthermore, percentage of time with ICP > 25 mmHg was significantly less in the induced normothermia group ( P  = 0.03). Conclusion Induced normothermia (fever prophylaxis via intravascular cooling catheter) is effective in reducing fever burden and may offer a means to attenuate secondary injury, as evidenced by a reduction in the intracranial hypertension burden.