Importance of Early Postoperative Body Temperature Management for Treatment of Subarachnoid Hemorrhage

Suehiro, Eiichi; Sadahiro, Hirokazu; Goto, Hisaharu; Oku, Takayuki; Oka, Fumiaki; Fujiyama, Yuichi; Shirao, Satoshi; Yanagawa, Hiroshi; Koizumi, Hiroyasu; Ishihara, Hideyuki; Suzuki, Michiyasu

doi:10.1016/j.jstrokecerebrovasdis.2016.01.053

Cited by 19 publications

(10 citation statements)

References 34 publications

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“…In patients after SAH, a systemic inflammatory response syndrome (SIRS) is seen commonly independent of infection. 41 The SIRS is associated with hyperthermia in the acute phase and is associated with the development of vasospasms and poor outcome. 27,42 A raised mean body temperature predicted a poor outcome (odds ratio 31.6 per 1°C) in patients with SIRS.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for development of postoperative cerebellar mutism syndrome in children after medulloblastoma surgery

Pols¹,

Veelen²,

Aarsen³

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEPostoperative cerebellar mutism syndrome (pCMS) occurs in 7%–50% of children after cerebellar tumor surgery. Typical features include a latent onset of 1–2 days after surgery, transient mutism, emotional lability, and a wide variety of motor and neurobehavioral abnormalities. Sequelae of this syndrome usually persist long term. The principal causal factor is bilateral surgical damage (regardless of tumor location) to any component of the proximal efferent cerebellar pathway, which leads to temporary dysfunction of cerebral cortical regions as a result of diaschisis. Tumor type, cerebellar midline location, and brainstem involvement are risk factors for pCMS that have been identified repeatedly, but they do not explain its latent onset. Ambiguous or negative results for other factors, such as hydrocephalus, postoperative meningitis, length of vermian incision, and tumor size, have been reached. The aim of this study was to identify perioperative clinical, radiological, and laboratory factors that also increase risk for the development of pCMS. The focus was on factors that might explain the delayed onset of pCMS and thus might provide a time window for taking precautionary measures to prevent pCMS or reduce its severity. The study was focused specifically on children who had undergone surgery for medulloblastoma.METHODSIn this single-center retrospective cohort study, the authors included 71 children with medulloblastoma, 28 of whom developed pCMS after primary resection. Clinical and laboratory data were collected prospectively and analyzed systematically. Variables were included for univariate and multivariate analysis.RESULTSUnivariate regression analysis revealed 7 variables that had a significant influence on pCMS onset, namely, tumor size, maximum tumor diameter > 5 cm, tumor infiltration or compression of the brainstem, significantly larger decreases in hemoglobin (p = 0.010) and hematocrit (p = 0.003) in the pCMS group after surgery than in the no-pCMS group, significantly more reported incidents of severe bleeding in the tumor bed during surgery in the pCMS group, preoperative hydrocephalus, and a mean body temperature rise of 0.5°C in the first 4 days after surgery in the pCMS group. Multiple regression analysis revealed that tumor size, tumor infiltration into or compression of the brainstem, and higher mean body temperature in the first 4 postoperative days were independent and highly significant predictors for pCMS.CONCLUSIONSThe authors confirmed earlier findings that tumor-associated preoperative conditions, such as a maximum tumor diameter ≥ 5 cm and infiltration into or compression of the brainstem, are associated with a higher risk for the development of pCMS. Most importantly, the authors found that a 0.5°C higher mean body temperature in the first 4 postoperative days increased the odds ratio for the development of pCMS almost 5-fold. These data suggest that an important focus for the prevention of pCMS in children who have undergone medulloblastoma surgery might be rigorous maintenance of normothermia as standard care after surgery.

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Section: Discussionmentioning

confidence: 99%

Risk factors for development of postoperative cerebellar mutism syndrome in children after medulloblastoma surgery

Pols¹,

Veelen²,

Aarsen³

et al. 2017

Journal of Neurosurgery: Pediatrics

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“…La hemorragia intracerebral es un evento complejo con alta incidencia de morbilidad y mortalidad (23). La fiebre puede considerarse parte de la sintomatología del proceso hemorrágico si no hay infecciones asociadas o si esta se presenta dentro de las primeras 72 horas de inicio del evento (24,25)and it has been associated with the occurrence of delayed cerebral ischemia and worse outcomes in previous studies. Frequently, fever is not the result of bacterial infections, and distinction between infection-related fever and fever secondary to brain injury (also referred as central fever.…”

Section: Fiebre Y Hemorragia Intracerebralmentioning

confidence: 99%

“…Existen reportes de episodios febriles en el contexto de la hemorragia intracerebral, en particular con HSA, en los cuales a la fiebre se le atribuye un origen central y su incidencia varía entre el 70 % y el 80 % de los casos (12,25,26,28). El origen de estos episodios de hipertermia neurogénica está dado por un daño en el hipotálamo, al aumentar la vasoconstricción con la disminución del flujo sanguíneo junto con un incremento en la producción de prostaglandinas y citocinas proinflamatorias, que ocasionan un daño hemotóxico con posterior muerte axonal (12,15,23).…”

Section: Fiebre Y Hemorragia Intracerebralunclassified

“…En este contexto, la fiebre se vincula con la posterior presencia de isquemia, y su persistencia puede desencadenar peores resultados que acentúan el edema cerebral, la presión intracraneal y, por consiguiente, disminuye el grado de conciencia (25,28). Dado que se han asociado peores resultados, en cuanto a mortalidad, estancia hospitalaria y secuelas, surge la necesidad de una adecuada termorregulación.…”

Section: Fiebre Y Hemorragia Intracerebralunclassified

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Fiebre y sus implicaciones en el diagnóstico del paciente neurológico, revisión narrativa de la literatura

Gutiérrez-Torres¹,

Hernández-Cubides²,

Sánchez-Neira

2021

Revista Investig. Salud Univ. Boyacá

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Introducción. La fiebre, se considera uno de los primeros síntomas registrados en pacientes hospitalizados, convirtiéndose en un importante marcador de enfermedad. La presente revisión buscó recopilar evidencia, en torno a la fiebre y su importancia en los diferentes escenarios clínicos que se presentan en el paciente neurológico, ya que en los últimos años se ha logrado comprender mejor el papel que desempeña el sistema nervioso central dentro de la termorregulación. Metodología. Se realizó una búsqueda de la literatura en bases de datos como Pubmed, Ovid, Epistemonikos, Scielo y Google Scholar durante los años 2009 al 2019 en idiomas español e inglés, sobre fiebre e implicaciones en pacientes neurológicos, usando palabras clave como fiebre, sensibilidad, especificidad, likelihood ratio, enfermedades del sistema nervioso, neurología, encefalitis, neuritis y traumatismo del sistema nervioso. Resultados. Se encontraron un total de 374 artículos, de los cuales 48 artículos cumplieron los criterios de inclusión, para la construcción del presente artículo de revisión. Se incluyeron libros de texto, como metaanálisis, revisiones sistemáticas, revisiones scoping, artículos de revisión y estudios observacionales. se analizaron y subdivieron en 8 apartados con temáticas en común para su estudio. Conclusiones. En etapas tempranas de ECV isquémicos o hemorrágicos la fiebre se comporta como una respuesta sistémica secundaria a la injuria de base, siendo crucial corregirla tempranamente. Al mismo tiempo en traumatismo del SNC la fiebre en las primeras 72 horas se identifica como un marcador de mal pronóstico.

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“…Fever is a common complication after acute brain injury affecting up to 40% of patients suffering from spontaneous subarachnoid haemorrhage (SAH) already within the first 48 h. Early development of fever is commonly referred to as non-infectious fever, whereas the majority of SAH patients develop fever during hospitalization (up to 72%) which represents both neurogenic and infectious fever. 1,2 Recent data suggest that fever is associated with more complications during hospitalization, including a higher rate of delayed cerebral ischemia (DCI), leading to poor long-term functional outcome after SAH. [3][4][5] Although guideline recommendations are not very precise on targeting normothermia in neurocritical care patients, most intensivists have adapted a protocol for aggressive fever management in their intensive care units (ICUs) which is supported by expert recommendations.…”

Section: Introductionmentioning

confidence: 99%

Brain temperature regulation in poor-grade subarachnoid hemorrhage patients – A multimodal neuromonitoring study

Addis

Gaasch

Schiefecker

et al. 2020

J Cereb Blood Flow Metab

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Elevated body temperature (Tcore) is associated with poor outcome after subarachnoid hemorrhage (SAH). Brain temperature (Tbrain) is usually higher than Tcore. However, the implication of this difference (Tdelta) remains unclear. We aimed to study factors associated with higher Tdelta and its association with outcome. We included 46 SAH patients undergoing multimodal neuromonitoring, for a total of 7879 h of averaged data of Tcore, Tbrain, cerebral blood flow, cerebral perfusion pressure, intracranial pressure and cerebral metabolism (CMD). Three-months good functional outcome was defined as modified Rankin Scale ≤2. Tbrain was tightly correlated with Tcore (r = 0.948, p < 0.01), and was higher in 73.7% of neuromonitoring time (Tdelta +0.18°C, IQR −0.01 – 0.37°C). A higher Tdelta was associated with better metabolic state, indicated by lower CMD-glutamate ( p = 0.003) and CMD-lactate ( p < 0.001), and lower risk of mitochondrial dysfunction (MD) (OR = 0.2, p < 0.001). During MD, Tdelta was significantly lower (0°C, IQR −0.2 – 0.1; p < 0.001). A higher Tdelta was associated with improved outcome (OR = 7.7, p = 0.002). Our study suggests that Tbrain is associated with brain metabolic activity and exceeds Tcore when mitochondrial function is preserved. Further studies are needed to understand how Tdelta may serve as a surrogate marker for brain function and predict clinical course and outcome after SAH.

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Importance of Early Postoperative Body Temperature Management for Treatment of Subarachnoid Hemorrhage

Cited by 19 publications

References 34 publications

Risk factors for development of postoperative cerebellar mutism syndrome in children after medulloblastoma surgery

Risk factors for development of postoperative cerebellar mutism syndrome in children after medulloblastoma surgery

Fiebre y sus implicaciones en el diagnóstico del paciente neurológico, revisión narrativa de la literatura

Brain temperature regulation in poor-grade subarachnoid hemorrhage patients – A multimodal neuromonitoring study

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