Hyperthermia and fever control in brain injury

Fever in the neurocritical care setting is common and has a negative impact on outcome of all disease types. Meta-analyses have demonstrated that fever at onset and in the acute setting after ischemic brain injury, intracerebral hemorrhage, and cardiac arrest has a negative impact on morbidity and mortality. Data support that the impact of fever is sustained for longer durations after subarachnoid hemorrhage and traumatic brain injury. Recent advances have made eliminating fever and maintaining normothermia feasible. However, there are no prospective randomized trials demonstrating the benefit of fever control in these patient populations, and important questions regarding indications and timing remain. The purpose of this review is to analyze the data surrounding the impact of fever across a range of neurologic injuries to better understand the optimal timing and duration of fever control. Prospective randomized trials are needed to determine whether the beneficial impact of secondary injury prevention is outweighed by the potential risks of prolonged fever control.

[1]  Hank Lin,et al.  Increasing Mean Skin Temperature Linearly Reduces the Core‐ temperature Thresholds for Vasoconstriction and Shivering in Humans , 1995, Anesthesiology.

[2]  F. Buonanno,et al.  Fever in subarachnoid hemorrhage , 2001, Neurology.

[3]  A. Algra,et al.  Reduction of Body Temperature with Paracetamol in Patients with Acute Stroke: Randomised Clinical Trials Are Needed , 2004, Cerebrovascular Diseases.

[4]  D. Brown,et al.  Fever and infection in spinal cord injury patients. , 1982, JAMA.

[5]  E. Mellits,et al.  Acetaminophen: more harm than good for chickenpox? , 1989, The Journal of pediatrics.

[6]  J. Grotta,et al.  Acetaminophen for Altering Body Temperature in Acute Stroke: A Randomized Clinical Trial , 2002, Stroke.

[7]  A. Weyland,et al.  Efficiency of a new radiant heater for postoperative rewarming , 1994, Acta anaesthesiologica Scandinavica.

[8]  M. Tramèr,et al.  Magnesium as an Adjuvant to Postoperative Analgesia: A Systematic Review of Randomized Trials , 2007, Anesthesia and analgesia.

[9]  W. D. Dietrich,et al.  Tumor Necrosis Factor &agr; Expression and Protein Levels after Fluid Percussion Injury in Rats: The Effect of Injury Severity and Brain Temperature , 2004, Neurosurgery.

[10]  C. Levi,et al.  Influence of admission body temperature on stroke mortality. , 2000, Stroke.

[11]  R. Steele,et al.  Evaluation of sponging and of oral antipyretic therapy to reduce fever. , 1970, The Journal of pediatrics.

[12]  V. Valtonen,et al.  Factors Associated with Improved Outcome of Pseudomonas aeruginosa Bacteremia in a Finnish University Hospital , 1998, European Journal of Clinical Microbiology and Infectious Diseases.

[13]  J. Montgomerie,et al.  Infections in patients with spinal cord injuries. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  L. Kappelle,et al.  Effect of Paracetamol (Acetaminophen) on Body Temperature in Acute Ischemic Stroke: A Double-Blind, Randomized Phase II Clinical Trial , 2001, Stroke.

[15]  A. Algra,et al.  Timing of the effect of acetaminophen on body temperature in patients with acute ischemic stroke , 2003, Neurology.

[16]  J. Weiner,et al.  A PHYSIOLOGICAL BODY-COOLING UNIT FOR TREATMENT OF HEAT STROKE , 1980, The Lancet.

[17]  Daniel E. Huddleston,et al.  Fever after subarachnoid hemorrhage , 2007, Neurology.

[18]  J. Newman.  Evaluation of sponging to reduce body temperature in febrile children. , 1985, Canadian Medical Association journal.

[19]  F. Clergue,et al.  Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia. , 1989, Anesthesiology.

[20]  J. Powers,et al.  Fever in neurologic diseases. , 1996, Infectious disease clinics of North America.

[21]  J. V. van Rensburg,et al.  Body cooling as a method for reducing hyperthermia. An evaluation of techniques. , 1986, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[22]  H. Thompson,et al.  Neurogenic fever after traumatic brain injury: an epidemiological study , 2003, Journal of neurology, neurosurgery, and psychiatry.

[23]  S. Mayer,et al.  Predictors and clinical implications of shivering during therapeutic normothermia , 2007, Neurocritical care.

[24]  A. Young,et al.  The acute-phase response of the brain-injured patient. , 1988, Journal of neurosurgery.

[25]  A. Rabinstein,et al.  Non-infectious fever in the neurological intensive care unit: incidence, causes and predictors , 2007, Journal of Neurology, Neurosurgery, and Psychiatry.

[26]  S. Bernard,et al.  Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. , 2002, The New England journal of medicine.

[27]  S. Mayer,et al.  Risk factors for fever in the neurologic intensive care unit , 2003, Neurology.

[28]  P. Beraldo,et al.  Pyrexia in hospitalised spinal cord injury patients , 1993, Paraplegia.

[29]  P. Alfonsi.  Postanaesthetic shivering: epidemiology, pathophysiology, and approaches to prevention and management. , 2003, Drugs.

[30]  G. Citerio,et al.  Pyrexia in head-injured patients admitted to intensive care , 2002, Intensive Care Medicine.

[31]  Sandra P. Morgan,et al.  A Comparison of Three Methods of Managing Fever in the Neurologic Patient , 1990, The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses.

[32]  N. Badjatia,et al.  Rapid infusion of cold saline (4 degrees C) as adjunctive treatment of fever in patients with brain injury. , 2006, Neurology.

[33]  J. Ramirez,et al.  Community-Acquired Pneumonia in the Elderly: Association of Mortality With Lack of Fever and Leukocytosis , 1997, Southern medical journal.

[34]  Fischer Dk,et al.  Neurogenic hyperthermia in subarachnoid hemorrhage. , 1989 .

[35]  O. Alonso,et al.  The effect of brain temperature on hemoglobin extravasation after traumatic brain injury. , 2002, Journal of neurosurgery.

[36]  M. Holzer,et al.  Hyperthermia after cardiac arrest is associated with an unfavorable neurologic outcome. , 2001, Archives of internal medicine.

[37]  T. Olsen,et al.  Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome , 1996, The Lancet.

[38]  H. Ito,et al.  Brain temperature modifies glutamate neurotoxicity in vivo. , 1999, Journal of neurotrauma.

[39]  J. M. Lipton,et al.  Effect of radiant heat on the metabolic cost of postoperative shivering. , 1993, British journal of anaesthesia.

[40]  D. Greer,et al.  Impact of Fever on Outcome in Patients With Stroke and Neurologic Injury: A Comprehensive Meta-Analysis , 2008, Stroke.

[41]  R. Busto,et al.  Combating hyperthermia in acute stroke: a significant clinical concern. , 1998, Stroke.

[42]  T. Sakamoto,et al.  Hyperthermia: is it an ominous sign after cardiac arrest? , 2001, Resuscitation.

[43]  G. Bernard,et al.  The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group. , 1997, The New England journal of medicine.

[44]  Tm Brouwers,et al.  VIRUS-INFECTION OF URINARY-TRACT , 1974 .

[45]  M. Diringer,et al.  Elevated body temperature independently contributes to increased length of stay in neurologic intensive care unit patients* , 2004, Critical care medicine.

[46]  P. Koudstaal,et al.  Bmc Cardiovascular Disorders Effect of Paracetamol (acetaminophen) and Ibuprofen on Body Temperature in Acute Ischemic Stroke Pisa, a Phase Ii Double-blind, Randomized, Placebo-controlled Trial [isrctn98608690] on Behalf of the Pisa-investigators , 2022 .

[47]  P. Mackowiak,et al.  Concepts of fever. , 1998, Archives of internal medicine.

[48]  P. Andrews,et al.  Management of hyperthermia in traumatic brain injury , 2002, Current opinion in critical care.

[49]  M. Frosini,et al.  Rectal temperature and prostaglandin E2 increase in cerebrospinal fluid of conscious rabbits after intracerebroventricular injection of hemoglobin , 1999, Experimental Brain Research.

[50]  S. Mayer,et al.  Clinical trial of a novel surface cooling system for fever control in neurocritical care patients* , 2004, Critical care medicine.

[51]  P. Talke,et al.  Dexmedetomidine Does Not Alter the Sweating Threshold, But Comparably and Linearly Decreases the Vasoconstriction and Shivering Thresholds , 1997, Anesthesiology.

[52]  S. Schwab,et al.  Status epilepticus in stroke , 2000, Neurology.

[53]  J. Weber,et al.  Effects of carbohydrate availability on sustained shivering II. Relating muscle recruitment to fuel selection. , 2004, Journal of applied physiology.

[54]  Michael Holzer,et al.  Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest , 2002 .

[55]  D. Sessler,et al.  Core cooling by central venous infusion of ice-cold (4 degrees C and 20 degrees C) fluid: isolation of core and peripheral thermal compartments. , 2000, Anesthesiology.

[56]  P. Koudstaal,et al.  PISA. The effect of paracetamol (acetaminophen) and ibuprofen on body temperature in acute stroke: Protocol for a phase II double-blind randomised placebo-controlled trial [ISRCTN98608690] , 2002, BMC cardiovascular disorders.

[57]  H. Thompson.  Elevated body temperature in the neuroscience intensive care unit. , 2005, Critical care medicine.

[58]  M. Diringer,et al.  Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system , 2004, Critical care medicine.

[59]  S. Hajat,et al.  Effects of poststroke pyrexia on stroke outcome : a meta-analysis of studies in patients. , 2000, Stroke.

[60]  G. Citerio,et al.  Continuous low dose diclofenac sodium infusion to control fever in neurosurgical critical care , 2007, Neurocritical care.

[61]  M M Przelomski,et al.  Fever in the wake of a stroke , 1986, Neurology.

[62]  J. M. Lipton,et al.  Inhibition of postanesthetic shivering with radiant heat. , 1987, Anesthesiology.

[63]  P. Axelrod,et al.  Use and effectiveness of hypothermia blankets for febrile patients in the intensive care unit. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[64]  M. Chopp,et al.  Journal of Cerebral Blood Flow and Metabolism Temperature Modulation of Cerebral Depolarization during Focal Cerebral Ischemia in Rats: Correlation with Ischemic Injury , 2022 .

[65]  H. Bramlett,et al.  Hyperthermia and central nervous system injury. , 2007, Progress in brain research.

[66]  Hilaire J Thompson,et al.  Hyperthermia following traumatic brain injury: a critical evaluation , 2003, Neurobiology of Disease.

[67]  V. Valtonen,et al.  Prognostic factors associated with improved outcome ofEscherichia coli bacteremia in a Finnish university hospital , 1997, European Journal of Clinical Microbiology and Infectious Diseases.

[68]  K. Welch,et al.  Effect of mild hyperthermia on recovery of metabolic function after global cerebral ischemia in cats. , 1988, Stroke.

[69]  O. Alonso,et al.  Interleukin-1beta messenger ribonucleic acid and protein levels after fluid-percussion brain injury in rats: importance of injury severity and brain temperature. , 2002, Neurosurgery.

[70]  B. Ehni,et al.  Neurogenic hyperthermia in subarachnoid hemorrhage. , 1989, Southern medical journal.

[71]  R. Lennon,et al.  Evaluation of a Forced‐Air System for Warming Hypothermic Postoperative Patients , 1990, Anesthesia and analgesia.

[72]  S. Leistner,et al.  Prophylactic antipyretic treatment with acetaminophen in acute ischemic stroke: , 2001, Neurology.

[73]  N. Badjatia,et al.  Rapid infusion of cold saline (4 °C) as adjunctive treatment of fever in patients with brain injury , 2006, Neurology.

[74]  Patricia J. Solomon,et al.  Application of therapeutic hypothermia in the intensive care unit , 2004, Intensive Care Medicine.

[75]  K. Polderman,et al.  Application of therapeutic hypothermia in the intensive care unit , 2004, Intensive Care Medicine.

[76]  Robert Greif,et al.  Core Cooling by Central Venous Infusion of Ice-cold (4°C and 20°C) Fluid Isolation of Core and Peripheral Thermal Compartments , 2000 .

[77]  S. Bernard,et al.  Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. , 2003, Resuscitation.

[78]  R. Busto,et al.  The influence of delayed postischemic hyperthermia following transient focal ischemia: Alterations of gene expression , 1998, Journal of the Neurological Sciences.

[79]  K. Kinoshita,et al.  The role of inflammatory processes in the pathophysiology and treatment of brain and spinal cord trauma. , 2004, Acta neurochirurgica. Supplement.

[80]  M. Ginsberg,et al.  Hyperthermia enhances spectrin breakdown in transient focal cerebral ischemia , 1997, Brain Research.

[81]  J. Marrugat,et al.  Timing for fever-related brain damage in acute ischemic stroke. , 1998, Stroke.

[82]  P. Kochanek,et al.  The effect of brain temperature on acute inflammation after traumatic brain injury in rats. , 1997, Journal of neurotrauma.

[83]  J L Tocher,et al.  Measuring the burden of secondary insults in head-injured patients during intensive care. , 1994, Journal of neurosurgical anesthesiology.

[84]  A. Algra,et al.  PAIS: paracetamol (acetaminophen) in stroke; protocol for a randomized, double blind clinical trial. [ISCRTN 74418480] , 2005, BMC cardiovascular disorders.

[85]  R. Busto,et al.  Effect of hyperthermia on glutamate release in ischemic penumbra after middle cerebral artery occlusion in rats. , 1994, The American journal of physiology.

[86]  B. Holtzclaw.  Postoperative shivering after cardiac surgery: a review. , 1986, Heart & lung : the journal of critical care.

[87]  N. Stocchetti,et al.  Brain temperature, body core temperature, and intracranial pressure in acute cerebral damage , 2001, Journal of neurology, neurosurgery, and psychiatry.

[88]  N. B. Strydom,et al.  Methods of cooling subjects with hyperpyrexia. , 1959, Journal of applied physiology.

[89]  R. Albrecht,et al.  Occurrence of potentially detrimental temperature alterations in hospitalized patients at risk for brain injury. , 1998, Mayo Clinic proceedings.

[90]  J. Ramsay,et al.  The effects of shivering on oxygen consumption and carbon dioxide production in patients rewarming from hypothermic cardiopulmonary bypass , 1988, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[91]  P. Hoopes,et al.  Hyperthermia induced pathophysiology of the central nervous system , 2003, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[92]  D. Sessler,et al.  Perioperative Shivering: Physiology and Pharmacology , 2002, Anesthesiology.

[93]  D. Marion,et al.  Hyperthermia in the Neurosurgical Intensive Care Unit , 2000, Neurosurgery.

[94]  S. Mayer,et al.  Metabolic Impact of Shivering During Therapeutic Temperature Modulation: The Bedside Shivering Assessment Scale , 2008, Stroke.

[95]  C. Ayata,et al.  Achieving normothermia in patients with febrile subarachnoid hemorrhage , 2004, Neurocritical care.

[96]  S. Mayer,et al.  Clinical trial of an air-circulating cooling blanket for fever control in critically ill neurologic patients , 2001, Neurology.

[97]  K. Polderman.  Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality. Part 1: Indications and evidence , 2004, Intensive Care Medicine.

[98]  O. Alonso,et al.  Importance of Posttraumatic Hypothermia and Hyperthermia on the Inflammatory Response after Fluid Percussion Brain Injury: Biochemical and Immunocytochemical Studies , 2000, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[99]  G. Jackson,et al.  Increased virus shedding with aspirin treatment of rhinovirus infection. , 1975, JAMA.

[100]  Guo-yi Gao,et al.  Early indicators of prognosis in 846 cases of severe traumatic brain injury. , 2002, Journal of neurotrauma.

[101]  C. Pichard,et al.  Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients. , 1997, British journal of anaesthesia.

[102]  A. Kampfl,et al.  Safety and efficacy of a novel intravascular cooling device to control body temperature in neurologic intensive care patients: A prospective pilot study* , 2002, Critical care medicine.

[103]  G. Rinkel,et al.  Fever After Aneurysmal Subarachnoid Hemorrhage: Relation With Extent of Hydrocephalus and Amount of Extravasated Blood , 2008, Stroke.

[104]  P. Kochanek,et al.  The relationship between brain temperature and neutrophil accumulation after traumatic brain injury in rats. , 1997, Acta neurochirurgica. Supplement.

[105]  R. Little,et al.  Heat production after injury. , 1985, British medical bulletin.

[106]  D. Marion,et al.  Comparison of brain temperature with bladder and rectal temperatures in adults with severe head injury. , 1998, Neurosurgery.