BACKGROUND AND PURPOSE: We analyzed the impact of long-term endovascularly based prophylactic normothermia versus conventional temperature management on inflammatory parameters in patients with severe cerebrovascular disease. METHODS: This was a prospective, randomized, controlled trial comparing the course of inflammatory parameters between the 2 treatment arms: (1) prophylactically endovascular long-term normothermia; and (2) conventional, stepwise fever management with antiinflammatory drugs and surface cooling. Inclusion criteria were (1) spontaneous subarachnoid hemorrhage with Hunt-Hess grade between 3 and 5; (2) spontaneous intracerebral hemorrhage with a Glasgow Coma Scale score of ≤ 10; or (3) complicated cerebral infarction requiring intensive care unit treatment with a NIH Stroke Scale score of ≥ 15. Treatment period was 336 hours in subarachnoid hemorrhage patients and 168 hours in patients with complicated stroke or intracerebral hemorrhage patients. RESULTS: A total of 102 patients (56 female) were enrolled during a 3.5-year period. Overall median total fever burden during the course of treatment was 0.0°C hour and 4.3°C hours in the catheter and conventional group, respectively (P < 0.0001). C-reactive protein and interleukin-6 were significantly elevated in the endovascular group (P < 0.05). Nonsteroidal antiinflammatory drugs, used as additional treatment of fever, significantly reduced mean C-reactive protein in endovascular treated patients (P < 0.01). CONCLUSIONS: The proinflammatory cytokines C-reactive protein and interleukin-6 were significantly elevated in patients receiving prophylactic endovascularly based long-term normothermia. Nonsteroidal antiinflammatory drugs significantly affected the course of proinflammatory parameters; thus, future trials should investigate the role of nonsteroidal antiinflammatory drugs in severe cerebrovascular disease patients and their interaction with temperature management. Clinical Trial Registration-Trial not registered; enrollment began before July 2005.
RCT Entities:
BACKGROUND AND PURPOSE: We analyzed the impact of long-term endovascularly based prophylactic normothermia versus conventional temperature management on inflammatory parameters in patients with severe cerebrovascular disease. METHODS: This was a prospective, randomized, controlled trial comparing the course of inflammatory parameters between the 2 treatment arms: (1) prophylactically endovascular long-term normothermia; and (2) conventional, stepwise fever management with antiinflammatory drugs and surface cooling. Inclusion criteria were (1) spontaneous subarachnoid hemorrhage with Hunt-Hess grade between 3 and 5; (2) spontaneous intracerebral hemorrhage with a Glasgow Coma Scale score of ≤ 10; or (3) complicated cerebral infarction requiring intensive care unit treatment with a NIH Stroke Scale score of ≥ 15. Treatment period was 336 hours in subarachnoid hemorrhagepatients and 168 hours in patients with complicated stroke or intracerebral hemorrhagepatients. RESULTS: A total of 102 patients (56 female) were enrolled during a 3.5-year period. Overall median total fever burden during the course of treatment was 0.0°C hour and 4.3°C hours in the catheter and conventional group, respectively (P < 0.0001). C-reactive protein and interleukin-6 were significantly elevated in the endovascular group (P < 0.05). Nonsteroidal antiinflammatory drugs, used as additional treatment of fever, significantly reduced mean C-reactive protein in endovascular treated patients (P < 0.01). CONCLUSIONS: The proinflammatory cytokines C-reactive protein and interleukin-6 were significantly elevated in patients receiving prophylactic endovascularly based long-term normothermia. Nonsteroidal antiinflammatory drugs significantly affected the course of proinflammatory parameters; thus, future trials should investigate the role of nonsteroidal antiinflammatory drugs in severe cerebrovascular diseasepatients and their interaction with temperature management. Clinical Trial Registration-Trial not registered; enrollment began before July 2005.
Authors: Raimund Helbok; Alois Josef Schiefecker; Ronny Beer; Anelia Dietmann; Ana Patrícia Antunes; Florian Sohm; Marlene Fischer; Werner Oskar Hackl; Paul Rhomberg; Peter Lackner; Bettina Pfausler; Claudius Thomé; Christian Humpel; Erich Schmutzhard Journal: Crit Care Date: 2015-03-09 Impact factor: 9.097
Authors: Joshua M Garcia; Stephanie A Stillings; Jenna L Leclerc; Harrison Phillips; Nancy J Edwards; Steven A Robicsek; Brian L Hoh; Spiros Blackburn; Sylvain Doré Journal: Front Neurol Date: 2017-06-12 Impact factor: 4.003