The Impact of Hyperthermia and Infection on Acute Ischemic Stroke Patients in the Intensive Care Unit
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ORIGINAL ARTICLE
The Impact of Hyperthermia and Infection on Acute Ischemic Stroke Patients in the Intensive Care Unit Woo-Keun Seo Æ Sung-Wook Yu Æ Ji Hyun Kim Æ Kun-Woo Park Æ Seong-Beom Koh
Published online: 5 February 2008 Ó Humana Press Inc. 2008
Abstract Introduction Despite the recognized deleterious effects of hyperthermia on critically ill neurological patients, few investigations have studied hyperthermia after an ischemic stroke in the intensive care unit (ICU) setting. Methods Acute ischemic stroke patients admitted to the ICU were assigned to one of three groups: normothermia, mild hyperthermia (MH), or severe hyperthermia (SH). The etiology of hyperthermia was further divided into infectious and non-infectious groups. Results Among the 150 patients included in the study, MH and SH were observed in 15 and 40 patients, respectively. Hyperthermia and the Glasgow coma scale (GCS) score were independently related to in-hospital mortality and increased length of stay in the ICU (ILOS, C4 days). Discussion Infection (39 patients) was more prevalent in the SH group than in the MH group and was associated with greater ILOS. Conclusions Monitoring and managing infection and reducing body temperature may be important factors for determining the outcomes of patients with acute ischemic stroke admitted to the ICU. Keywords Ischemic stroke Intensive care Body temperature changes Infection
Introduction Hyperthermia is relatively common in critically ill neurological patients [1–3] and has a negative effect on patient survival [1] and outcomes [1, 2]. An acute ischemic stroke is adversely affected by hyperthermia [4–6]. A 1°C difference in body temperature, on admission, is reported to be equivalent to a 4-point difference on the Scandinavian Stroke Scale score, 15 mm difference in infarct size, and an 80% difference in in-hospital mortality for stroke patients [4]. In addition, patients with hyperthermia after a stroke have higher mortality and higher neurological morbidity than patients without hyperthermia [7]. The presence of superimposed infection in stroke patients is a major cause of hyperthermia, affecting 39.5– 83.3% of patients [5, 8–10]. Pneumonia is one of the most common causes of infection in stroke patients and is significantly associated with mortality and neurological morbidity [11]. However, data on infection after an acute ischemic stroke in the ICU setting are limited [11]. We evaluated the impact of hyperthermia after an ischemic stroke on early patient outcomes. Another purpose of this study was to determine the role of infection on the outcome of acute ischemic stroke patients admitted to the ICU by comparing patients with infectious hyperthermia to those with non-infectious hyperthermia.
Subjects and Methods W.-K. Seo S.-W. Yu J. H. Kim K.-W. Park S.-B. Koh (&) Department of Neurology, Korea University College of Medicine at Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 152-703, Korea e-mail: [email protected]
We retrospectively studied patients, admitted to the ICU of a
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