Pharmacologic Management of Central Fever in Patients With Acute Brain Injury

Central fever is a noninfectious increase in body temperature to >37.5 °C that commonly occurs in patients with acute brain injury. Because central fever has detrimental effects on the injured brain and is associated with prolonged neurointensive care unit stays, timely diagnosis and treatment are imperative. Management includes both pharmacologic and nonpharmacologic methods. However, the optimal pharmacologic approach for the management of central fever remains unclear, so we conducted a scoping review to evaluate the pharmaceutical therapies currently being used.

We screened 183 articles from database searches of PubMed, Embase, and Cochrane. Information on study type, interventions, outcomes, and side effects were extracted and analyzed from 13 articles that met inclusion criteria.

Our literature search showed that acetaminophen, baclofen, baclofen with propranolol, bromocriptine, dantrolene, and diclofenac have been administered to patients with central fever. While most of the articles included in this review are case reports, a randomized clinical trial identified continuous diclofenac infusion as a promising intervention. Acetaminophen reduced fever in patients with central fever; however, when compared to placebo, no significant difference in core temperature reduction was observed. In the articles that included a discussion of side effects, hepatotoxicity was the most commonly mentioned adverse effect.

Diclofenac emerged as the most evidence-supported therapy, backed by higher-quality studies and consistent central fever resolution with relatively few side effects. Because of the paucity of high-quality evidence, further research is needed to establish optimal treatment strategies with minimal adverse effects for patients experiencing central fever.