TY - JOUR
T1 - Treatment of refractory fever in the neurosciences critical care unit using a novel, water-circulating cooling device a single-center pilot experience
AU - Carhuapoma, J. Ricardo
AU - Gupta, Kapil
AU - Coplin, William M.
AU - Muddassir, Salman M.
AU - Meratee, Muhammad M.
PY - 2003/10
Y1 - 2003/10
N2 - Fever after acute brain injury affects neuronal function and recovery. Standard therapies have proven to be inadequate in treating hyperthermia in this patient population. We report on safety/efficacy pilot data collected using a noninvasive, novel, water-circulating cooling device in febrile acute brain injury patients. We enrolled patients who developed fever (rectal temperature ≥38.0°C) refractory to pharmacological therapy. The treatment device uses an ice water circulating system embedded in hydrogel-coated, energy transfer pads. Its thermoregulatory feedback control uses cold water (4.0°C-42.0°C) and was set at 36.5°C for this study. We analyzed the temperature response during 600 consecutive minutes of treatment. Six consecutive patients were enrolled and seven episodes of fever were recorded; the mean age of the patients was 59.7 years (range 46-71 years; five male, one female). Diagnoses were as follows: subarachnoid hemorrhage (two), severe traumatic brain injury (two), status epilepticus following massive cerebral infarction (one), and intracerebral/intraventricular hemorrhage (one). Hand warming was applied at treatment onset on all patients; shivering only responsive to meperidine occurred in five of them. Fever of 38.4°C (range 38.0°C-38.9°C) was reduced to 36.9°C (range 36.0°C-38.0°C) after 120 minutes (P < 0.001). Core temperature remained "locked" during the remainder of the treatment (36.6°C, P = 0.5; 36.6°C, P = 0.9; and 36.5°C, P = 0.9 at 180, 300, and 600 minutes, respectively). Skin integrity under the pads was preserved in all study subjects. Our results indicate that use of this novel technique is safe, rapidly effective, and able to maintain sustained normothermia following fever in a cohort of critically ill neurologic/neurosurgical patients.
AB - Fever after acute brain injury affects neuronal function and recovery. Standard therapies have proven to be inadequate in treating hyperthermia in this patient population. We report on safety/efficacy pilot data collected using a noninvasive, novel, water-circulating cooling device in febrile acute brain injury patients. We enrolled patients who developed fever (rectal temperature ≥38.0°C) refractory to pharmacological therapy. The treatment device uses an ice water circulating system embedded in hydrogel-coated, energy transfer pads. Its thermoregulatory feedback control uses cold water (4.0°C-42.0°C) and was set at 36.5°C for this study. We analyzed the temperature response during 600 consecutive minutes of treatment. Six consecutive patients were enrolled and seven episodes of fever were recorded; the mean age of the patients was 59.7 years (range 46-71 years; five male, one female). Diagnoses were as follows: subarachnoid hemorrhage (two), severe traumatic brain injury (two), status epilepticus following massive cerebral infarction (one), and intracerebral/intraventricular hemorrhage (one). Hand warming was applied at treatment onset on all patients; shivering only responsive to meperidine occurred in five of them. Fever of 38.4°C (range 38.0°C-38.9°C) was reduced to 36.9°C (range 36.0°C-38.0°C) after 120 minutes (P < 0.001). Core temperature remained "locked" during the remainder of the treatment (36.6°C, P = 0.5; 36.6°C, P = 0.9; and 36.5°C, P = 0.9 at 180, 300, and 600 minutes, respectively). Skin integrity under the pads was preserved in all study subjects. Our results indicate that use of this novel technique is safe, rapidly effective, and able to maintain sustained normothermia following fever in a cohort of critically ill neurologic/neurosurgical patients.
KW - Acute brain injury
KW - Fever
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UR - http://www.scopus.com/inward/citedby.url?scp=0141864551&partnerID=8YFLogxK
U2 - 10.1097/00008506-200310000-00004
DO - 10.1097/00008506-200310000-00004
M3 - Article
C2 - 14508172
AN - SCOPUS:0141864551
SN - 0898-4921
VL - 15
SP - 313
EP - 318
JO - Journal of Neurosurgical Anesthesiology
JF - Journal of Neurosurgical Anesthesiology
IS - 4
ER -