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.
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: Lewis B Morgenstern; J Claude Hemphill; Craig Anderson; Kyra Becker; Joseph P Broderick; E Sander Connolly; Steven M Greenberg; James N Huang; R Loch MacDonald; Steven R Messé; Pamela H Mitchell; Magdy Selim; Rafael J Tamargo Journal: Stroke Date: 2010-07-22 Impact factor: 7.914
Authors: H Alex Choi; Sang-Bae Ko; Mary Presciutti; Luis Fernandez; Amanda M Carpenter; Christine Lesch; Emily Gilmore; Rishi Malhotra; Stephan A Mayer; Kiwon Lee; Jan Claassen; J Michael Schmidt; Neeraj Badjatia Journal: Neurocrit Care Date: 2011-06 Impact factor: 3.210
Authors: Neeraj Badjatia; Luis Fernandez; J Michael Schmidt; Kiwon Lee; Jan Claassen; E Sander Connolly; Stephan A Mayer Journal: Neurosurgery Date: 2010-04 Impact factor: 4.654
Authors: Gregor Broessner; Peter Lackner; Clemens Hoefer; Ronny Beer; Raimund Helbok; Christoph Grabmer; Hanno Ulmer; Bettina Pfausler; Christian Brenneis; Erich Schmutzhard Journal: Crit Care Med Date: 2009-06 Impact factor: 7.598