Document Detail


Influence of prophylactic, endovascularly based normothermia on inflammation in patients with severe cerebrovascular disease: a prospective, randomized trial.
MedLine Citation:
PMID:  21030704     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: We analyzed the impact of long-term endovascularly based prophylactic normothermia versus conventional temperature management on inflammatory parameters in patients with severe cerebrovascular disease.
METHODS: This was a prospective, randomized, controlled trial comparing the course of inflammatory parameters between the 2 treatment arms: (1) prophylactically endovascular long-term normothermia; and (2) conventional, stepwise fever management with antiinflammatory drugs and surface cooling. Inclusion criteria were (1) spontaneous subarachnoid hemorrhage with Hunt-Hess grade between 3 and 5; (2) spontaneous intracerebral hemorrhage with a Glasgow Coma Scale score of ≤ 10; or (3) complicated cerebral infarction requiring intensive care unit treatment with a NIH Stroke Scale score of ≥ 15. Treatment period was 336 hours in subarachnoid hemorrhage patients and 168 hours in patients with complicated stroke or intracerebral hemorrhage patients.
RESULTS: A total of 102 patients (56 female) were enrolled during a 3.5-year period. Overall median total fever burden during the course of treatment was 0.0°C hour and 4.3°C hours in the catheter and conventional group, respectively (P < 0.0001). C-reactive protein and interleukin-6 were significantly elevated in the endovascular group (P < 0.05). Nonsteroidal antiinflammatory drugs, used as additional treatment of fever, significantly reduced mean C-reactive protein in endovascular treated patients (P < 0.01).
CONCLUSIONS: The proinflammatory cytokines C-reactive protein and interleukin-6 were significantly elevated in patients receiving prophylactic endovascularly based long-term normothermia. Nonsteroidal antiinflammatory drugs significantly affected the course of proinflammatory parameters; thus, future trials should investigate the role of nonsteroidal antiinflammatory drugs in severe cerebrovascular disease patients and their interaction with temperature management. Clinical Trial Registration-Trial not registered; enrollment began before July 2005.
Authors:
Gregor Broessner; Peter Lackner; Marlene Fischer; Ronny Beer; Raimund Helbok; Bettina Pfausler; Dietmar Schneider; Erich Schmutzhard
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-10-28
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  41     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-30     Completed Date:  2010-12-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2969-72     Citation Subset:  IM    
Affiliation:
Department of Neurology, Neurologic Intensive Care Unit, Innsbruck Medical University, Austria. gregor.broessner@i-med.ac.at
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MeSH Terms
Descriptor/Qualifier:
Aged
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Biological Markers
Body Temperature*
C-Reactive Protein / metabolism
Cerebrovascular Disorders / pathology*,  therapy*
Female
Fever / complications,  pathology
Humans
Inflammation / pathology*,  prevention & control*
Intensive Care
Interleukin-10 / blood
Interleukin-6 / blood
Longitudinal Studies
Male
Middle Aged
Prospective Studies
Socioeconomic Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 0/Biological Markers; 0/Interleukin-6; 130068-27-8/Interleukin-10; 9007-41-4/C-Reactive Protein

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


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