Therapeutic Temperature Modulation for Fever After Intracerebral Hemorrhage

Lord, Aaron; Karinja, Sarah J.; Lantigua, Hector; Carpenter, Amanda; Schmidt, J. Michael; Claassen, Jan; Agarwal, Sachin; Connolly, E. Sander; Mayer, Stephan A.; Badjatia, Neeraj

doi:10.1007/s12028-013-9948-5

Cited by 50 publications

(22 citation statements)

References 12 publications

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“…Treatment of fever appears therefore reasonable but the optimal temperature management is still unclear 7 . Therapeutic normothermia failed to improve outcome in one trial 65 although treatment of fever did improve outcome in another 62 . It appears reasonable to minimize fever, and the role of targeted temperature management in ICH is still under investigation in a randomized clinical trial 66 .…”

Section: Acute Managementmentioning

confidence: 95%

Diagnosis and Management of Acute Intracerebral Hemorrhage

Morotti

Goldstein

2016

Emergency Medicine Clinics of North America

111

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SYNOPSIS Intracerebral hemorrhage (ICH) is the deadliest type of stroke and up to half of patients die in-hospital. Blood pressure management, coagulopathy reversal and intracranial pressure control are the mainstays of acute ICH treatment. Prevention of hematoma expansion and minimally invasive hematoma evacuation are promising therapeutic strategies under investigation. The aim of this paper is to provide an updated review on ICH diagnosis and management in the emergency department (ED).

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Section: Acute Managementmentioning

confidence: 95%

Diagnosis and Management of Acute Intracerebral Hemorrhage

Morotti

Goldstein

2016

Emergency Medicine Clinics of North America

111

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“…However, neither therapeutic hypothermia nor normothermia was shown to improve outcome 6465 In a retrospective case–control study of patients with spontaneous ICH having two consecutive fevers ≥38.3°C despite acetaminophen administration, therapeutic normothermia was shown to be associated with increased duration of sedation, mechanical ventilation and Neuro-ICU length of stay without discharge outcome benefit 65. Normothermia or hypothermia should not be used after ICH except in the setting of clinical trials.…”

Section: Fever Controlmentioning

confidence: 99%

Current management of spontaneous intracerebral haemorrhage

Dastur

2017

Stroke Vasc Neurol

127

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Intracerebral haemorrhage (ICH) is the most devastating and disabling type of stroke. Uncontrolled hypertension (HTN) is the most common cause of spontaneous ICH. Recent advances in neuroimaging, organised stroke care, dedicated Neuro-ICUs, medical and surgical management have improved the management of ICH. Early airway protection, control of malignant HTN, urgent reversal of coagulopathy and surgical intervention may increase the chance of survival for patients with severe ICH. Intensive lowering of systolic blood pressure to <140 mm Hg is proven safe by two recent randomised trials. Transfusion of platelets in patients on antiplatelet therapy is not indicated unless the patient is scheduled for surgical evacuation of haematoma. In patients with small haematoma without significant mass effect, there is no indication for routine use of mannitol or hypertonic saline (HTS). However, for patients with large ICH (volume > 30 cbic centmetre) or symptomatic perihaematoma oedema, it may be beneficial to keep serum sodium level at 140–150 mEq/L for 7–10 days to minimise oedema expansion and mass effect. Mannitol and HTS can be used emergently for worsening cerebral oedema, elevated intracranial pressure (ICP) or pending herniation. HTS should be administered via central line as continuous infusion (3%) or bolus (23.4%). Ventriculostomy is indicated for patients with severe intraventricular haemorrhage, hydrocephalus or elevated ICP. Patients with large cerebellar or temporal ICH may benefit from emergent haematoma evacuation. It is important to start intermittent pneumatic compression devices at the time of admission and subcutaneous unfractionated heparin in stable patients within 48 hours of admission for prophylaxis of venous thromboembolism. There is no benefit for seizure prophylaxis or aggressive management of fever or hyperglycaemia. Early aggressive comprehensive care may improve survival and functional recovery.

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“…Two observational studies showed that hypothermia at 35 °C over 8–10 days had a favourable effect on peri-haemorrhagic oedema and ICP, with no benefit on neurological outcome [109, 110]. A case–control study using TTM at 37 °C found no effect on neurological outcome at ICU discharge, while the duration of mechanical ventilation and length of stay in the ICU was prolonged in patients treated with TTM [111]. The effect of hypothermia at 35 °C during 8 days is ongoing in patients with a large intra-cerebral haemorrhage (25–64 mL) (CINCH trial) [112].…”

Section: Resultsmentioning

confidence: 99%

Targeted temperature management in the ICU: guidelines from a French expert panel

Cariou

Payen

Asehnoune

et al. 2017

Ann. Intensive Care

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Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term “targeted temperature management” (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method. Indications are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of TTM in adult and paediatric critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d’Anesthésie Réanimation [SFAR]) with the participation of the French Emergency Medicine Association (Société Française de Médecine d’Urgence [SFMU]), the French Group for Pediatric Intensive Care and Emergencies (Groupe Francophone de Réanimation et Urgences Pédiatriques [GFRUP]), the French National Association of Neuro-Anesthesiology and Critical Care (Association Nationale de Neuro-Anesthésie Réanimation Française [ANARLF]), and the French Neurovascular Society (Société Française Neurovasculaire [SFNV]). Fifteen experts and two coordinators agreed to consider questions concerning TTM and its practical implementation in five clinical situations: cardiac arrest, traumatic brain injury, stroke, other brain injuries, and shock. This resulted in 30 recommendations: 3 recommendations were strong (Grade 1), 13 were weak (Grade 2), and 14 were experts’ opinions. After two rounds of rating and various amendments, a strong agreement from voting participants was obtained for all 30 (100%) recommendations, which are exposed in the present article.

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Therapeutic Temperature Modulation for Fever After Intracerebral Hemorrhage

Abstract: Therapeutic normothermia is associated with increased duration of sedation, mechanical ventilation, and NICU stay, but is not clearly associated with improved discharge outcome.

Cited by 50 publications

References 12 publications

Diagnosis and Management of Acute Intracerebral Hemorrhage

Diagnosis and Management of Acute Intracerebral Hemorrhage

Current management of spontaneous intracerebral haemorrhage

Targeted temperature management in the ICU: guidelines from a French expert panel

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