Zaburzenia termoregulacji pochodzenia ośrodkowego — jak diagnozować i leczyć

Abstract

Fever is a common symptom in the Intensive Care Unit. At least half of febrile episodes are caused by infection. Excluding infectious etiology and other non-infectious causes of fever, especially in patients with central nervous system (CNS) disorders, attention should be paid to disturbances of thermoregulatory centre. In particular, subarachnoid haemorrhage, cerebral trauma, along with ischaemic or haemorrhagic stroke are strongly associated with the development of central fever. Proper, speedy diagnosis of the cause of fever makes it possible to implement preventive measures against the harmful effects of hyperthermia on the CNS and to avoid the consequences of inappropriate treatment. The aim of this review is to present the current treatment options for the management of central fever and to analyze recent recommendations for the treatment of hyperthermia, including the use of hypothermia. The recommendations of American and European associations are inconsistent, mainly due to the lack of randomized clinical trials confirming the effectiveness of such treatment. The diagnosis of central fever is still made by the exclusion of other causes. The authors of the review intended to present the characteristic features of central fever, differentiating this state from infectious fever and also analyze the presence of central fever in particular neurological diseases. It seems particularly important to establish diagnostic criteria for central fever or to find diagnostic markers. It is also necessary to conduct further randomized clinical trials evaluating the indications for treatment of hyperthermia.

Accuracy of the defining characteristics of the nursing diagnosis hypothermia in patients on hemodialysis

“…Vasoconstriction prevents the circulation of a greater blood volume in the vessels, reducing cutaneous temperature, explaining the high sensitivity of the defining characteristics skin cool to touch and peripheral vasoconstriction found in the present study. Furthermore, these results confirm the findings of a previous study that reported that the main responses to hypothermia are cutaneous vasoconstriction, thermogenesis without shivering, shivering, and behavioral changes (28) . In this regard, it is assumed that peripheral vasoconstriction attempts to increase temperature, compensating for hypothermia.…”

Hemorrhage of a Cavernous Hemangioma of the Brainstem Presenting with Fever of Unknown Origin: A Case Report

“…The ventricular region surgery is considered a challenge due to the deep location and the intimate association of the cerebral ventricles with critical areas of the brainstem [ 13 ]. Hyperthermia of central origin has been described in various hemorrhagic conditions of the CNS, usually presenting with acute neurologic deficits or meningismus; its pathophysiology usually involving the preoptic area of the hypothalamus [ 14 ]. The preoptic area GABAergic neurons that play a role in thermoregulation are located within sub-regions such as the median preoptic subnucleus, the medial subnuclei, the dorsomedial hypothalamus, the paraventricular nucleus, and the perifornical area of the lateral hypothalamus [ 15 ].…”

Feasibility of a Nurse-driven Protocol for Fever Management in Neurocritical Patients: A Retrospective Cohort Study

“…Patients requiring prolonged sedation in the NICU are generally those with more severe conditions, often with associated dysfunction of the thermoregulatory system. 5 Furthermore, sedation itself influences body temperature homeostasis. 6 Despite some limitations (reported in supplemental digital content 4, http://links.lww.com/JNA/A569), this study demonstrates the feasibility of a nurse-driven protocol for temperature management in the NICU; the overwhelming majority of patients did not require management outside of the protocol.…”

“…The use of hypnotic agents was the only independent risk factor associated with protocol failure in multivariable logistic regression models (odds ratio, 12.3; 95% CI, 2.8-232.2; P =0.019). Patients requiring prolonged sedation in the NICU are generally those with more severe conditions, often with associated dysfunction of the thermoregulatory system 5 . Furthermore, sedation itself influences body temperature homeostasis 6 …”