Indicators of Central Fever in the Neurologic Intensive Care Unit

Abstract

IMPORTANCE Fever is common in critically ill neurologic patients. Knowledge of the indicators of central fever may allow greater antibiotic stewardship in this era of rapidly developing super-resistant microorganisms. OBJECTIVE To develop a model to differentiate central from infectious fever in critically ill neurologic patients with fever of an undetermined cause.

Zaburzenia termoregulacji pochodzenia ośrodkowego — jak diagnozować i leczyć

“…According to the retrospective study carried out by Hocker et al [1] involving 526 neurological ICU patients with a fever exceeding 38.3°C, the incidences of systemic inflammatory response syndrome (a set of symptoms induced by systemic inflammatory response caused by various factors) and of isolated leukocytosis were comparable in patients with brain fever and in those with infectious fever. The above two groups differed in the percentage of neutrophils in blood tests, which was higher among patients with infectious fever and may suggest that although leukocytosis is not a reliable criterion for implementing empiric antibiotic therapy or withdrawing it prematurely, the left shifting observed in blood tests can prove useful [1].…”

“…Thermoregulatory effectors are divided into the effectors of physical thermoregulation (the cardiovascular system and sweat glands) and the effectors of chemical regulation ( the skeletal muscles, liver and adipose tissue). The centre of thermoregulation is situated in the hypothalamus and consists of two parts: the centre of heat elimination regulating its loss and the centre of heat maintenance in the body [1,2].…”

“…According to Hocker et al [1], patients with negative microbiological results and normal chest X-ray pictures, who developed fever within three days of hospitalisation, constitute the group that should be particularly suspected of central thermoregulatory disorders. The authors have reported that brain fever develops earlier and lasts longer than infectionrelated fever.…”

“…Having excluded the infectious aetiology and other non-infectious causes of fever, especially in patients with central nervous system (CNS) disorders, thermoregulatory disturbances of central origin should be considered. Proper diagnosis of the causes of fever enables healthcare professionals to implement the management protecting one against the harmful effects of hyperthermia on the CNS and to avoid the consequences of inappropriate treatment [1].…”

Preventive Antibiotics and Delayed Cerebral Ischaemia in Patients with Aneurysmal Subarachnoid Haemorrhage Admitted to the Intensive Care Unit

“…Several explanations for the negative result of our study should be addressed. First of all, neurogenic or central fever, as defined by fever in neurological patients without associated infection, is common in patients with aSAH in the ICU and is associated with DCI after aSAH [20,21]. Both neurogenic fever and the presence of a systemic inflammatory response syndrome (SIRS) without associated infection may have attributed to DCI or poor outcome.…”