Does Brain Temperature Correlate With Intracranial Pressure?

Huschak, Gerald; Hoell, Thomas; Wiegel, Martin; Hohaus, Christian; Stuttmann, R.; Meisel, Hans-Jörg; Mast, H.

doi:10.1097/ana.0b013e31815f528c

Cited by 19 publications

(25 citation statements)

References 14 publications

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“…Such a study would not determine the rapidity of the effect of the medications unless all sites had the ability to capture data with sufficient granularity. An innovative data collection method - one that integrates prospective collection of medication administration data and an automated, high-density database of continuous physiological variables from a single institution - could provide evidence suggesting the effectiveness of these therapies(10-12). Thus, this prospective study reports the effects of four commonly used therapies in the treatment of intracranial hypertension after severe TBI in children.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Pharmacological Therapies for Intracranial Hypertension in Children With Severe Traumatic Brain Injury—Results From an Automated Data Collection System Time-Synched to Drug Administration

Shein

Ferguson

Kochanek

et al. 2016

Pediatric Critical Care Medicine

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Objective To describe acute cerebral hemodynamic effects of medications commonly used to treat intracranial hypertension in children with traumatic brain injury (TBI). Currently, data supporting the efficacy of these medications are insufficient. Design In this prospective observational study, intracranial hypertension (intracranial pressure [ICP] ≥ 20 mm Hg for > 5 min) was treated by clinical protocol. Administration times of medications for intracranial hypertension (fentanyl, 3% sodium chloride [HTS], mannitol and pentobarbital) were prospectively recorded and synchronized with an automated database that collected ICP and cerebral perfusion pressure (CPP) every 5 seconds. ICP crises confounded by external stimulation or mechanical ventilator adjustments were excluded. Mean ICP and CPP from epochs following drug administration were compared to baseline values using Kruskal-Wallis ANOVA and Dunn's test. Frailty modeling was used to analyze the time to ICP crisis resolution. Mixed effect models compared ICP and CPP 5min after the medication vs. baseline, and rates of treatment failure. Setting A tertiary care children's hospital. Patients Children with severe TBI (Glasgow Coma Scale score ≤ 8). Interventions None. Measurements and Main Results We analyzed 196 doses of fentanyl, HTS, mannitol and pentobarbital administered to 16 children (median: 12 doses/patient). Overall, ICP significantly decreased following fentanyl, HTS and pentobarbital. After controlling for administration of multiple medications, ICP was decreased following HTS and pentobarbital administration; CPP was decreased following fentanyl and was increased following HTS. After adjusting for significant covariates (including age, GCS score and ICP), HTS was associated with a two-fold faster resolution of intracranial hypertension than either fentanyl or pentobarbital. Fentanyl was significantly associated with the most frequent treatment failure. Conclusions ICP decreased after multiple drugs, but HTS may warrant consideration as the first-line drug for treating intracranial hypertension, as it was associated with the most favorable cerebral hemodynamics and fastest resolution of intracranial hypertension.

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Section: Introductionmentioning

confidence: 99%

Effectiveness of Pharmacological Therapies for Intracranial Hypertension in Children With Severe Traumatic Brain Injury—Results From an Automated Data Collection System Time-Synched to Drug Administration

Shein

Ferguson

Kochanek

et al. 2016

Pediatric Critical Care Medicine

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“…Furthermore, vasogenic edema leads to increased fluid in the extracellular space and accumulation of intracellular fluid resulting in cytotoxic edema. Despite evidence suggesting that hyperthermia does not impact the partial pressure of oxygen 11 or a causal relationship between elevated brain temperature and increased intracranial pressure, 12 current therapy suggests otherwise. Fever exacerbates ischemic neuronal damage and physiologic dysfunction after acute traumatic brain injury, subarachnoid hemorrhage, and major neurosurgery.…”

Section: Infectious Fever Versus Non-infectious Fevermentioning

confidence: 87%

Fever and Infection in the Neurosurgical Intensive Care Unit

Laws¹,

Jallo²

2010

JHN Journal

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“…Rossi, Zanier, Mauri, Columbo, and Stocchetti (2001) found that ICP was significantly increased during febrile episodes. However, multiple research groups have failed to find any clear relationship between absolute brain temperature and absolute ICP (Huschak et al, 2008;Mcilvoy, 2007;Rossi et al, 2001). Although the available evidence fails to show a clear causal relationship between fever and elevated ICP, the effects of therapeutic interventions contradict this (Huschak et al, 2008;Mcilvoy, 2007).…”

Section: Traumatic Brain Injurymentioning

confidence: 99%

“…However, multiple research groups have failed to find any clear relationship between absolute brain temperature and absolute ICP (Huschak et al, 2008;Mcilvoy, 2007;Rossi et al, 2001). Although the available evidence fails to show a clear causal relationship between fever and elevated ICP, the effects of therapeutic interventions contradict this (Huschak et al, 2008;Mcilvoy, 2007). Evidence from animal models of TBI clearly supports the negative impact of fever on the brain, showing increased mortality, contusion volume, axonal damage, and cerebral edema (Clasen, Pandolfi, Laing, & Casey, 1974;Dietrich, Alonso, Halley, & Busto, 1996).…”

Section: Traumatic Brain Injurymentioning

confidence: 99%

Fever Management Practices of Neuroscience Nurses

Rockett

Thompson

Blissitt

2015

Journal of Neuroscience Nursing

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Current evidence shows that fever and hyperthermia are especially detrimental to patients with neurologic injury, leading to higher rates of mortality, greater disability, and longer lengths of stay. Although clinical practice guidelines exist for ischemic stroke, subarachnoid hemorrhage, and traumatic brain injury, they lack specificity in their recommendations for fever management, making it difficult to formulate appropriate protocols for care. Using survey methods, the aims of this study were to (a) describe how nursing practices for fever management in this population have changed over the last several years, (b) assess if institutional protocols and nursing judgment follow published national guidelines for fever management in neuroscience patients, and (c) explore whether nurse or institutional characteristics influence decision making. Compared with the previous survey administered in 2007, there was a small increase (8%) in respondents reporting having an institutional fever protocol specific to neurologic patients. Temperatures to initiate treatment either based on protocols or nurse determination did not change from the previous survey. However, nurses with specialty certification and/or working in settings with institutional awards (e.g., Magnet status or Stroke Center Designation) initiated therapy at a lower temperature. Oral acetaminophen continues to be the primary choice for fever management, followed by ice packs and fans. This study encourages the development of a stepwise approach to neuro-specific protocols for fever management. Furthermore, it shows the continuing need to promote further education and specialty training among nurses and encourage collaboration with physicians to establish best practices.

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Does Brain Temperature Correlate With Intracranial Pressure?

Abstract: These data do not support the notion of a clinically useful correlation between brain temperature and ICP.

Cited by 19 publications

References 14 publications

Effectiveness of Pharmacological Therapies for Intracranial Hypertension in Children With Severe Traumatic Brain Injury—Results From an Automated Data Collection System Time-Synched to Drug Administration

Effectiveness of Pharmacological Therapies for Intracranial Hypertension in Children With Severe Traumatic Brain Injury—Results From an Automated Data Collection System Time-Synched to Drug Administration

Fever and Infection in the Neurosurgical Intensive Care Unit

Fever Management Practices of Neuroscience Nurses

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