Document Detail


Continuous low dose diclofenac sodium infusion to control fever in neurosurgical critical care.
MedLine Citation:
PMID:  17522789     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Aim of this randomized prospective clinical trial is to compare two methods of antipyretics and evaluate their efficacy in controlling fever during the acute phase of brain damage. METHODS: Twenty-two febrile comatose patients: 12 severe traumatic brain injury and 10 subarachnoid hemorrhage divided in 2 groups: Diclofenac low-dose infusion (10 patients) and extemporaneous boluses of NSAIDs (CTRL, 12 patients). The primary outcome measure was length of time with temperature>38 degrees C. Secondary outcome measures were: 1) to assess the effects of each antipyretic strategy on intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial pressure (MAP) and heart rate; 2) to monitor adverse effects of each antipyretic strategy. The baseline characteristics in the two treatment groups were similar. RESULTS: Primary findings: percentage of time per patient with temperature>38 degrees C was significantly lower (P<0.0001) in the DCF group, 4% (0-22%), vs. 34% (8-56%) in CTRL group. In addition, mean T degrees , max T degrees were lower in DCF than in CTRL (P<0.05). Secondary findings: CPP and MAP were significantly higher in DCF group (P<0.05) while ICP was not different (NS). However, if ICP pre randomization was <25 mmHg, CTRL suffered a worst ICP (24+/-11 vs. 16+/-7 P=0.01), MAP (89+/-10 vs. 104+/-10 P=0.01) and CPP (75+/-10 vs. 94+/-17 P=0.01) compared to DCF. No differences between the two treatment were recorded when ICP>or=25 mmHg before randomization. There was no gastrointestinal or intracranial bleeding. CONCLUSIONS: Low dose DCF infusion is a potential useful strategy for a successful control temperature better than intermittent NSAIDs dosing, minimizing potentially brain-damaging effects of fever.
Authors:
Manuela Cormio; Giuseppe Citerio
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Neurocritical care     Volume:  6     ISSN:  1541-6933     ISO Abbreviation:  Neurocrit Care     Publication Date:  2007  
Date Detail:
Created Date:  2007-05-24     Completed Date:  2007-11-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101156086     Medline TA:  Neurocrit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  82-9     Citation Subset:  IM    
Affiliation:
Neurorianimazione, Dipartimento di Medicina Perioperatoria e Terapie Intensive, Ospedale San Gerardo, Via Pergolesi 33, 20052, Monza, MI, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
Blood Pressure
Brain Injuries / complications*,  physiopathology
Critical Care*
Diclofenac / administration & dosage*
Dose-Response Relationship, Drug
Female
Fever / drug therapy*,  etiology,  physiopathology
Humans
Infusions, Intravenous
Intracranial Pressure
Male
Middle Aged
Subarachnoid Hemorrhage / complications*,  physiopathology
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 15307-86-5/Diclofenac
Comments/Corrections
Comment In:
Neurocrit Care. 2007;6(2):79-81   [PMID:  17522788 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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