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Catheter-based normothermia cuts fever in patients with cerebrovascular disease

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Prophylactic, catheter-based normothermia reduces fever burden in neurointensive care unit patients with severe cerebrovascular disease, according to a report in the December Stroke.

Brain temperature elevation is markedly deleterious in the setting of severe cerebrovascular disease, the authors explain, suggesting that it might be beneficial to start treatment of fever in patients with severe brain injury at an early stage or even to maintain normothermia prophylactically.

Dr. Gregor Broessner from Innsbruck Medical University, Austria and colleagues investigated the efficacy and safety of prophylactic long-term normothermia with an intravascular device (CoolGard) compared with a strict, escalating, conventional fever management protocol in 102 patients with life-threatening cerebrovascular disease.

The fever burden during the trial was significantly higher in the control group (4.3 degrees Celsius-hours) than in the CoolGard group (0.0 degrees Celsius-hours), the authors report.

The results were similar for the median fever burden per patient per day, and the treatment differences were similar among patients with and without subarachnoid hemorrhage.

The amount of nursing time required for temperature management was quite variable in the control group, the investigators say, whereas patients in the CoolGard group required a consistently low percentage of nursing time for temperature management throughout the study.

The treatment groups did not differ in the number of days spent in the neurointensive care unit after randomization, and neurological assessments were similar between treatment groups at discharge, day 30, and month 6.

The number of patients experiencing adverse events and major adverse events was similar in the 2 groups, but significantly more patients in the CoolGard group (49/51, 96%) than in the control group (41/51, 80%)(P=0.03) had infectious adverse events.

Thirty-two patients died during the study, but none was considered to be related to the study treatment, and no death before discharge was considered due to infection.

“Although significantly reducing the fever burden, we did not find a significant difference in neurologic outcome or overall rate of adverse events (between the groups),” the authors state. “Future studies may investigate different target temperatures or the additional use of anti-inflammatory drugs in combination with physical cooling, such as endovascular devices, in patients with severe stroke.”

Stroke 2009;40:e657-e665.