Hyperthermia in the Neurosurgical Intensive Care Unit

Kilpatrick, Megan M.; Lowry, David W.; Firlik, Andrew D.; Yonas, Howard; Marion, Donald W.

doi:10.1097/00006123-200010000-00011

Cited by 221 publications

(119 citation statements)

References 37 publications

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“…While the overall incidence of fever in this population of TBI patients was slightly higher than previously reported (79%), the rate of intervention was substantially lower (31% vs. 86% (Kilpatrick et al, 2000)). Pharmacologic therapy was the most frequently documented intervention used in the present report, which is consistent with previous studies (Grossman et al, 1995;Johnston et al, 2006;Kilpatrick et al, 2000).…”

Section: Discussioncontrasting

confidence: 73%

“…Even when a protocol is in place, the bedside nurse is often the primary clinical decision maker regarding interventions to instigate for fever (O'Donnell et al, 1997;Kilpatrick et al, 2000), as he/she must determine whether or not to follow said protocol. A number of studies conducted prior to the publication of management guidelines revealed an under treatment of fever in patients with neurologic insults (Albrecht et al, 1998;Kilpatrick et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

“…A number of studies conducted prior to the publication of management guidelines revealed an under treatment of fever in patients with neurologic insults (Albrecht et al, 1998;Kilpatrick et al, 2000). One study found that fourteen percent of neurologically vulnerable febrile patients did not receive any intervention and some patients received only non-pharmacologic intervention, despite the presence of a management protocol specifying a first-tier pharmacologic therapy (Kilpatrick et al, 2000). In another study, only seven percent of closed head injury patients received antipyretic medications in doses appropriate to treat fever (Albrecht et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

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Intensive care unit management of fever following traumatic brain injury

Thompson

Kirkness

Mitchell

2007

Intensive and Critical Care Nursing

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SummaryFever, in the presence of traumatic brain injury (TBI), is associated with worsened neurologic outcomes. Studies prior to the publication of management guidelines revealed an undertreatment of fever in patients with neurologic insults. Presently the adult TBI guidelines state that maintenance of normothermia should be a standard of care therefore improvement in management of fever in these patients would be expected. The specific aims of the study were to: 1) determine the incidence of fever (T> 38.5° C) in a population of critically ill patients with TBI. 2) describe what interventions were recorded by intensive care unit (ICU) nurses in managing fever. 3) ascertain the rate of adherence with published normothermia guidelines. Medical record review of available hospital records was conducted on patients admitted to a level I trauma center following severe TBI (N=108) from the parent study. Temperature data was abstracted and contemporaneous nursing documentation was examined for evidence of intervention for fever and adherence with published standards. Data analyses were performed that included descriptive statistics. Seventy-nine percent of TBI patients (85/108) had at least one recorded fever event while in the ICU. However in only 31% of events did the patient receive any documented intervention by nursing staff for the elevated temperature. The most frequently documented intervention was pharmacologic (358/1166 elevations). Other nursing actions (e.g. use of fan) accounted for a minority (<1%) of nursing interventions documented. Patients were more likely to have a high temperature that exceeded 40°C (13%) than a temperature that was normothermic (5%). There continues to be an under treatment of fever in patients with TBI by critical care nurses despite our knowledge of its negative effects on outcomes. There remains a gap in translation between patient outcomes research and bedside practice that needs to be overcome, thus research efforts need to now focus on understanding nurses' decision-making processes and the best methods of fever reduction in patients with TBI.

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Section: Discussioncontrasting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intensive care unit management of fever following traumatic brain injury

Thompson

Kirkness

Mitchell

2007

Intensive and Critical Care Nursing

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“…Fever (body temperature >38.3°C) occurs in up to 70% of neurologically injured patients, and typically it is not an isolated event, but rather a sustained response seen for as long as 2 weeks following injury [17,18]. Elevated body temperature can be secondary to infection or a consequence of severe neurological insults.…”

Section: Detrimental Effects Of Fevermentioning

confidence: 99%

Therapeutic Hypothermia for Acute Neurological Injuries

2012

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Therapeutic hypothermia (TH) is the intentional reduction of core body temperature to 32°C to 35°C, and is increasingly applied by intensivists for a variety of acute neurological injuries to achieve neuroprotection and reduction of elevated intracranial pressure. TH improves outcomes in comatose patients after a cardiac arrest with a shockable rhythm, but other off-label applications exist and are likely to increase in the future. This comprehensive review summarizes the physiology and cellular mechanism of action of TH, as well as different means of TH induction and maintenance with potential side effects. Indications of TH are critically reviewed by disease entity, as reported in the most recent literature, and evidence-based recommendations are provided.

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“…4,5,[7][8][9] Some benefits of hypothermia may result from avoidance of hyperthermia as temperatures over 37°C are common in post-arrest patients and are associated with increased risk of unfavourable neurologic recovery. 7 In fact, in post-arrest patients each degree Celsius over 37 is associated with increased risk of severe disability, coma, or persistent vegetative state.…”

mentioning

confidence: 99%

Management following resuscitation from cardiac arrest: Recommendations from the 2003 Rocky mountain critical care conference

Bell

Brindley

Forrest

et al. 2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To propose a strategy for the management of patients admitted to critical care units after resuscitation from cardiac arrest.S So ou ur rc ce e: : Prior to the conference relevant studies were identified via literature searches and brief reviews circulated on the following topics: glucose and blood pressure management; therapeutic hypothermia; prearrest outcome prediction; post-arrest outcome prediction; and management of myocardial ischemia. Two days were devoted to assessing evidence and developing a management strategy at the conference. Consensus opinion of conference participants [intensive care unit (ICU) physicians] was used when high grade evidence was unavailable. Additional literature searches and data grading were performed post-conference. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : High grade evidence was lacking in most areas. Specific goals of treatment were proposed for: general care; neurologic care; respiratory care; cardiac care; and gastrointestinal care. There was adequate evidence to recommend therapeutic hypothermia for comatose patients who had witnessed ventricular fibrillation or ventricular tachycardia arrests. Conference participants supported extending therapeutic hypothermia to other presenting rhythms in selected circumstances. Additional goals included mean arterial pressure 80 to 100 mmHg, glucose 5 to 8 mmol·L -1 using insulin infusions, and PaO 2 > 100 mmHg for the first 24 hr. Absent withdrawal to pain 72 hr after resuscitation should prompt consideration of palliative care. The level of evidence for other recommendations was low.C Co on nc cl lu us si io on ns s: : The proposed management strategy represents an approach to manage patients in the ICU following resuscitation from cardiac arrest. Most of the recommendations are based on low grade evidence. Additional research is needed to improve the evidence base. A standard post-arrest management strategy could help facilitate future research. Objectif : Proposer une stratégie de traitement à adopter avec les patients admis aux unités de soins intensifs (USI) après la réanimation post-arrêt cardiaque. Source : Avant la conférence, les études utiles ont été repérées dans les publications et de brèves revues ont circulé sur

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Hyperthermia in the Neurosurgical Intensive Care Unit

Cited by 221 publications

References 37 publications

Intensive care unit management of fever following traumatic brain injury

Intensive care unit management of fever following traumatic brain injury

Therapeutic Hypothermia for Acute Neurological Injuries

Management following resuscitation from cardiac arrest: Recommendations from the 2003 Rocky mountain critical care conference

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