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PMID: 17985248 Published · ppublish English Clinical Trial Comparative Study Journal Article Research Support, Non-U.S. Gov't

A prospective, observational clinical trial of fever reduction to reduce systemic oxygen consumption in the setting of acute brain injury.

Neurocritical care ·Vol. 9 ·No. 1 ·2008-00-00 ·Pages 37-44

Hata JS, Shelsky CR, Hindman BJ, Smith TC, Simmons JS, Todd MM

Abstract

Fever after acute brain injury appears to be a detrimental factor, associated with impaired neurological outcomes. This study assessed physiological changes in systemic oxygen consumption (VO2) during cutaneous cooling after severe brain injury. This prospective, observational, clinical study evaluated ten, critically ill, brain-injured patients requiring mechanical ventilation with a core body temperature of greater or equal to 38 degrees C. Febrile patients failing to defervesce after acetaminophen underwent indirect calorimetry for a 1-hour baseline period followed by a 4 h cooling period. The Arctic Sun(R) Temperature Management System (Medivance) directed core temperature to a goal of 36 degrees C. The patients had a mean age of 32 years (95% CI 23, 40), Glasgow Coma Scale of 6 (95% CI 5,7), and APACHE 2 score of 19 (95% CI 15, 22), with 8 of 10 patients suffering traumatic brain injuries. The baseline 1-h core temperature was significantly reduced from 38.6 degrees +/- 0.9 to 36.3 degrees +/- 1.2 degrees C (P < 0.0001) over 4 h. Two cohorts were identified based upon the presence or absence of shivering. Within the non-shivering cohort, systemic VO2 was significantly reduced from 415 +/- 123 to 308 +/- 115 ml/min (-27 +/- 18%) (P < 0.05). In contrast, those with shivering showed no significant reduction in VO2, despite significantly decreasing core temperature. The overall percentage change of VCO2 correlated with VO2 (r (2) = 0.91). Fever reduction in acute brain injury appears to significantly reduce systemic VO2, but is highly dependent on shivering control.

MeSH Terms
APACHE Acetaminophen/therapeutic use Adult Analgesics, Non-Narcotic/therapeutic use Body Temperature/drug effects Brain Injuries/metabolism,therapy Combined Modality Therapy Critical Care Female Fever/drug therapy,metabolism Glasgow Coma Scale Humans Hypnotics and Sedatives/therapeutic use Hypothermia, Induced Male Oxygen Consumption Prospective Studies Respiration, Artificial Shivering/drug effects
Chemicals
Analgesics, Non-Narcotic Hypnotics and Sedatives Acetaminophen
Authors & Affiliations
6 authors, click to expand affiliations / ORCID
Hata J Steven
The Division of Critical Care, Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. [email protected]
Shelsky Constance R
Hindman Bradley J
Smith Thomas C
Simmons Jonathan S
Todd Michael M
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Article Info
Journal
Neurocritical care
Abbr.
Neurocrit Care
ISSN
1541-6933
DOI
10.1007/s12028-007-9015-1
Email
[email protected]
Published
2008-00-00
Pages
37-44
Language
English
Region
United States
NLM ID
101156086
Subset
IM
External Links
PubMed source DOI: 10.1007/s12028-007-9015-1 View journal details
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