Document Detail


Treatment of refractory fever in the neurosciences critical care unit using a novel, water-circulating cooling device. A single-center pilot experience.
MedLine Citation:
PMID:  14508172     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Fever after acute brain injury affects neuronal function and recovery. Standard therapies have proven to be inadequate in treating hyperthermia in this patient population. We report on safety/efficacy pilot data collected using a noninvasive, novel, water-circulating cooling device in febrile acute brain injury patients. We enrolled patients who developed fever (rectal temperature > or =38.0 degrees C) refractory to pharmacological therapy. The treatment device uses an ice water circulating system embedded in hydrogel-coated, energy transfer pads. Its thermoregulatory feedback control uses cold water (4.0 degrees C-42.0 degrees C) and was set at 36.5 degrees C for this study. We analyzed the temperature response during 600 consecutive minutes of treatment. Six consecutive patients were enrolled and seven episodes of fever were recorded; the mean age of the patients was 59.7 years (range 46-71 years; five male, one female). Diagnoses were as follows: subarachnoid hemorrhage (two), severe traumatic brain injury (two), status epilepticus following massive cerebral infarction (one), and intracerebral/intraventricular hemorrhage (one). Hand warming was applied at treatment onset on all patients; shivering only responsive to meperidine occurred in five of them. Fever of 38.4 degrees C (range 38.0 degrees C-38.9 degrees C) was reduced to 36.9 degrees C (range 36.0 degrees C-38.0 degrees C) after 120 minutes (P<0.001). Core temperature remained "locked" during the remainder of the treatment (36.6 degrees C, P=0.5; 36.6 degrees C, P=0.9; and 36.5 degrees C, P=0.9 at 180, 300, and 600 minutes, respectively). Skin integrity under the pads was preserved in all study subjects. Our results indicate that use of this novel technique is safe, rapidly effective, and able to maintain sustained normothermia following fever in a cohort of critically ill neurologic/neurosurgical patients.
Authors:
J Ricardo Carhuapoma; Kapil Gupta; William M Coplin; Salman M Muddassir; Muhammad M Meratee
Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of neurosurgical anesthesiology     Volume:  15     ISSN:  0898-4921     ISO Abbreviation:  J Neurosurg Anesthesiol     Publication Date:  2003 Oct 
Date Detail:
Created Date:  2003-09-25     Completed Date:  2004-02-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8910749     Medline TA:  J Neurosurg Anesthesiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  313-8     Citation Subset:  IM    
Affiliation:
Neurosciences Critical Care Program, Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA. jcarhuap@med.wayne.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Analysis of Variance
Brain Injuries / complications,  physiopathology*
Cryotherapy / adverse effects,  instrumentation*,  methods*
Female
Fever / complications,  therapy*
Humans
Intensive Care Units*
Male
Middle Aged
Pilot Projects
Time Factors
Water
Chemical
Reg. No./Substance:
7732-18-5/Water

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


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