Determinants of temperature abnormalities and influence on outcome of critical illness*

Laupland, Kevin B.; Zahar, Jean Ralph; Adrie, Christophe; Schwebel, Carole; Goldgran-Tolédano, Dany; Azoulay, Élie; Garrouste-Orgeas, Maïté; Cohen, Yves; Jamali, Samir; Souweine, Bertrand; Darmon, Michaël; Timsit, Jean François

doi:10.1097/ccm.0b013e31822f061d

Cited by 82 publications

(73 citation statements)

References 25 publications

(34 reference statements)

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“…These cutoffs were defined a priori by consensus, and they conform to published results from clinical observations 14,22,25,31,33 and practice guidelines. 16 A preplanned secondary analysis was also performed, using a definition of fever as ≥ 38.3°C.…”

Section: Methodsmentioning

confidence: 99%

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

Rincón

Hunter²,

Schorr

et al. 2014

JNS

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Brain injuries from stroke and head trauma are leading causes of morbidity and death in the world. 3,27 In patients with these injuries, early fever 9 and hypothermia 13,29 (dysthermia) and the onset of systemic complications are associated with poor outcomes. Plausible theories of the underlying reasons for disturbance in thermoregulation after brain injury are based on observations in animal models. These findings suggest that potential causes of fever include damage to the hypothalamus, midbrain, or pons by enhanced sympathetic activity; acute or delayed ischemia; toxic blood metabolites; physical distortion; or inflammation.7,34 Accordingly, dysfunction of or damage to these thermoregulatory pathways is common in patients with brain injuries, putting them at increased risk for dysthermia. 7,30,34 Because dysthermia is known to be associated with poor outcomes in all forms Object. Fever and hypothermia (dysthermia) are associated with poor outcomes in patients with brain injuries. The authors sought to study the epidemiology of dysthermia on admission to the intensive care unit (ICU) and the effect on in-hospital case fatality in a mixed cohort of patients with brain injuries.Methods. The authors conducted a multicenter retrospective cohort study in 94 ICUs in the United States. Critically ill patients with neurological injuries, including acute ischemic stroke (AIS), aneurysmal subarachnoid hemorrhage (aSAH), intracerebral hemorrhage (ICH), and traumatic brain injury (TBI), who were older than 17 years and consecutively admitted to the ICU from 2003 to 2008 were selected for analysis.Results. In total, 13,587 patients were included in this study; AIS was diagnosed in 2973 patients (22%), ICH in 4192 (31%), aSAH in 2346 (17%), and TBI in 4076 (30%). On admission to the ICU, fever was more common among TBI and aSAH patients, and hypothermia was more common among ICH patients. In-hospital case fatality was more common among patients with hypothermia (OR 12.7,) than among those with fever (OR 1.9, 95% CI 1.7-2.1). Compared with patients with ICH (OR 2.0, 95% CI 1.8-2.3), TBI (OR 1.5, 95% CI 1.3-1.8), and aSAH (OR 1.4, 95% CI 1.2-1.7), patients with AIS who developed fever had the highest risk of death (OR 3.1, 95% CI 2.5-3.7). Although all hypothermic patients had an increased mortality rate, this increase was not significantly different across subgroups. In a multivariable analysis, when adjusted for all other confounders, exposure to fever (adjusted OR 1.3, 95% CI 1.1-1.5) or hypothermia (adjusted OR 7.8, 95% CI 3.9-15.4) on admission to the ICU was found to be significantly associated with in-hospital case fatality.Conclusions. Fever is frequently encountered in the acute phase of brain injury, and a small proportion of patients with brain injuries may also develop spontaneous hypothermia. The effect of fever on mortality rates differed by neurological diagnosis. Both early spontaneous fever and hypothermia conferred a higher risk of in-hospital death after brain injury. Abbreviations used in this paper: AIS ...

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Section: Methodsmentioning

confidence: 99%

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

Rincón

Hunter²,

Schorr

et al. 2014

JNS

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“…Th ese studies use a variety of defi nitions of fever and a range of methods to record temperature, making comparisons between studies diffi cult. In these studies, the presence of fever was associated with either an increased risk of death [30], [39]- [41] or no diff erence in mortality risk compared to a normal temperature [34]. Only two studies have evaluated the mortality risk of patients with sepsis separately from patients without sepsis [33], [35].…”

Section: Fever In Icu Patients With Infections Observational Studies mentioning

confidence: 99%

“…Th e incidence of fever attributable to infection in observational studies in various critical care settings varies from 8 % to 37 % [31], [34], [36]- [41]. Th ese studies use a variety of defi nitions of fever and a range of methods to record temperature, making comparisons between studies diffi cult.…”

Section: Fever In Icu Patients With Infections Observational Studies mentioning

confidence: 99%

Fever Management in Intensive Care Patients with Infections

Young

Saxena

2014

Annual Update in Intensive Care and Emergency Medicine 2014

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“…Observational studies including hundreds of thousands of patients have documented highly variable results [5,6]. In addition, the overall body of clinical trials to date investigating anti-pyretic therapy in critically ill neurologically intact patients has not shown any overall benefit [7].…”

mentioning

confidence: 99%

Manipulating vital signs in septic shock: which one(s) and how?

Laupland

Jagt

2015

Intensive Care Med

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Determinants of temperature abnormalities and influence on outcome of critical illness*

Abstract: Temperature abnormalities are common among patients presenting to the intensive care unit. Hypothermia is a major, potentially modifiable factor associated with increased risk for death.

Cited by 82 publications

References 25 publications

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

Fever Management in Intensive Care Patients with Infections

Manipulating vital signs in septic shock: which one(s) and how?

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