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Induced Normothermia Attenuates Intracranial Hypertension and Reduces Fever Burden after Severe Traumatic Brain Injury

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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 ≤ 8) treated with induced normothermia [36–36.5°C rectal probe setting; intravascular cooling catheter (CoolLine®, Alsius Corporation, Irvine, 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.

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Acknowledgments

This research was supported by the University of Pittsburgh Brain Trauma Research Center (C.E.D.; NIH ProNS30318). We thank the nurses and residents for excellent patient care at the University of Pittsburgh Medical Center.

Disclosure

After initial public presentation of these results at the 36th Society of Critical Care Medicine Educational and Scientific Symposium, the senior author (DOO) received an unrestricted educational gift from Alsius Corporation.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, B-400 PUH, Pittsburgh, PA, 15213, USA

    Ava M. Puccio, Michael R. Fischer, Brian T. Jankowitz & David O. Okonkwo

  2. Department of Neurosurgery, University of New Mexico, MSC 10 5610, Albuquerque, NM, 87131, USA

    Howard Yonas

  3. Department of Critical Care Medicine, University of Pittsburgh Medical Center, 3550 Terrace Street, 615 Scaife Hall, Pittsburgh, PA, 15213, USA

    Joseph M. Darby

Authors
  1. Ava M. Puccio
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  2. Michael R. Fischer
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  3. Brian T. Jankowitz
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  4. Howard Yonas
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Correspondence to Ava M. Puccio.

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Puccio, A.M., Fischer, M.R., Jankowitz, B.T. et al. Induced Normothermia Attenuates Intracranial Hypertension and Reduces Fever Burden after Severe Traumatic Brain Injury. Neurocrit Care 11, 82–87 (2009). https://doi.org/10.1007/s12028-009-9213-0

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  • DOI: https://doi.org/10.1007/s12028-009-9213-0

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