Induced Normothermia Attenuates Intracranial Hypertension and Reduces Fever Burden after Severe Traumatic Brain Injury
- PDF / 285,350 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 109 Downloads / 227 Views
ORIGINAL ARTICLE
Induced Normothermia Attenuates Intracranial Hypertension and Reduces Fever Burden after Severe Traumatic Brain Injury Ava M. Puccio Æ Michael R. Fischer Æ Brian T. Jankowitz Æ Howard Yonas Æ Joseph M. Darby Æ David O. Okonkwo
Published online: 1 April 2009 Ó Humana Press Inc. 2009
Abstract 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 B 8) treated with induced normothermia [36–36.5°C rectal probe setting; intravascular cooling catheter (CoolLineÒ, Alsius Corporation, Irvine,
A. M. Puccio (&) M. R. Fischer B. T. Jankowitz D. O. Okonkwo Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, B-400 PUH, Pittsburgh, PA 15213, USA e-mail: [email protected] M. R. Fischer e-mail: [email protected] B. T. Jankowitz e-mail: [email protected] D. O. Okonkwo e-mail: [email protected]
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. Keywords Traumatic brain injury Fever Normothermia Intracranial pressure Critical care medicine
H. Yonas Department of Neurosurgery, University of New Mexico, MSC 10 5610, Albuquerque, NM 87131, USA e-mail: [email protected]
Introduction
J. M. Darby Department of Critical Care Medicine, University of Pittsburgh Medical Center, 3550 Terrace Street, 615 Scaife Hall, Pittsburgh, PA 15213, USA e-mail: [email protected]
Hyperthermia in the acute postinjury period in traumatic brain injury (TBI) patients is known to potentiate several pathophysiologic processes ongoing in the injured brain. Excitotoxicity, free radical production, blood–brai
Data Loading...
