Related Experiment Videos
Pyrexia in head-injured patients admitted to intensive care
Nino Stocchetti1, Sandra Rossi, Elisa Roncati Zanier
1Terapia Intensiva Neuroscienze, Ospedale Maggiore, Policlinico IRCCS, Via S Sforza, 3520 122 Milan, Italy.
Insights
Fever is common after head injury and linked to worse outcomes. Antipyretic treatments for fever may reduce cerebral perfusion pressure (CPP) and are not very effective.
Area of Science:
- Neuroscience
- Critical Care Medicine
- Trauma Surgery
Background:
- Pyrexia (fever) is a frequent complication in the acute phase following traumatic brain injury (TBI).
- Understanding the impact of pyrexia on neurological outcomes and intensive care unit (ICU) management is crucial.
Purpose of the Study:
- To quantify the occurrence of pyrexia within the first week after head injury.
- To examine the relationship between pyrexia, neurological severity, ICU length of stay, intracranial hypertension, and cerebral perfusion pressure (CPP).
- To describe the effects of antipyretic therapy on temperature, intracranial pressure (ICP), and CPP.
Main Methods:
- A multicenter retrospective observational study was conducted across three ICUs in the Milan area.
- Data from 110 patients with traumatic brain injury were analyzed.
- Pyrexia was defined as an external temperature >38°C or internal temperature >38.4°C.
Main Results:
- Eighty patients (72.7%) experienced pyrexia during the first week post-injury.
- Pyrexia occurrence and duration correlated with neurological impairment severity and prolonged ICU stay.
- Antipyretic therapy showed limited effectiveness in reducing temperature and significantly decreased CPP.
Conclusions:
- Pyrexia is highly prevalent after head injury, particularly in severe cases, and is associated with longer ICU stays.
- While pyrexia may influence ICP, its precise contribution is challenging to isolate amidst other factors.
- Antipyretic treatment for fever in TBI patients is largely ineffective for temperature control and potentially harmful to CPP.
Objectives:
(a) To quantify the occurrence of pyrexia during the first week after head injury; (b) to elucidate the relationships between pyrexia and neurological severity, length of stay in the ICU, intracranial hypertension, and cerebral perfusion pressure (CPP); and (c) to describe the effects of antipyretic therapy on temperature, intracranial pressure (ICP) and CPP.
Design And Setting:
Multicenter retrospective observational study in three ICUs in the Milan area.
Patients:
110 patients with traumatic brain injury.
Measurements And Results:
Eighty patients suffered pyrexia, defined as an external temperature higher than 38 degrees C or internal temperature higher than 38.4 degrees C. Occurrence and duration of pyrexia were associated with the degree of neurological impairment and with prolonged ICU stay. In patients with normal perimesencephalic cisterns the episodes of increased ICP were more frequent in febrile cases. Various antipyretic therapies were used in 66 patients. Pharmacological treatment was slightly effective (mean temperature reduction 0.58+/-0.7 degrees C) but caused a significant drop in CPP (6.5+/-12.5 mmHg).
Conclusions:
Pyrexia is extremely frequent in the acute phase after head injury. Its incidence is higher in more severe cases and is correlated with a longer ICU stay. It may affect ICP, but its contribution is difficult to assess when other major causes of increased intracranial volume are present. Antipyretic therapy is poorly effective for controlling body temperature and may be deleterious for CPP.