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Monitoring Inflammation (Including Fever) in Acute Brain Injury

  • Review Article
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Abstract

Inflammation is an important part of the normal physiologic response to acute brain injury (ABI). How inflammation is manifest determines if it augments or hinders the resolution of ABI. Monitoring body temperature, the cellular arm of the inflammatory cascade, and inflammatory proteins may help guide therapy. This summary will address the utility of inflammation monitoring in brain-injured adults. An electronic literature search was conducted for English language articles describing the testing, utility, and optimal methods to measure inflammation in ABI. Ninety-four articles were included in this review. Current evidence suggests that control of inflammation after ABI may hold promise for advances in good outcomes. However, our understanding of how much inflammation is good and how much is deleterious is not yet clear. Several important concepts emerge form our review. First, while continuous temperature monitoring of core body temperature is recommended, temperature pattern alone is not useful in distinguishing infectious from noninfectious fever. Second, when targeted temperature management is used, shivering should be monitored at least hourly. Finally, white blood cell levels and protein markers of inflammation may have a limited role in distinguishing infectious from noninfectious fever. Our understanding of optimal use of inflammation monitoring after ABI is limited currently but is an area of active investigation.

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Abbreviations

SAH:

Subarachnoid hemorrhage

DCI:

Delayed cerebral injury associated with vasospasm

IL-6:

Intraleukin 6

CRP:

C-reactive protein

TTM:

Therapeutic temperature modulation

WBC:

White blood cell count

TNFα:

Tumor necrosis factor

SIRS:

Systemic inflammatory response syndrome

BSAS:

Bedside Shivering Assessment Scale

IDC:

Indirect calorimetry

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Conflict of interest

Neeraj Badjatia receives consulting fees form Bard and Medivance and is a Scientific Advisor to Cumberland Pharmaceuticals. J. Javier Provencio receives research funding from NIH, Bard Medivance, and Advanced Circulatory Systems, and is on the scientific advisory board of Edge Therapeutics and Minnetronix.

Author information

Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine, NC30, 9500 Euclid Ave., Cleveland, OH, 44195, USA

    J. Javier Provencio

  2. University of Maryland School of Medicine, Baltimore, MD, USA

    Neeraj Badjatia

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  1. J. Javier Provencio
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Consortia

And the Participants in the International Multi-disciplinary Consensus Conference on Multimodality Monitoring

Corresponding author

Correspondence to J. Javier Provencio.

Additional information

The Participants in the International Multi-disciplinary Consensus Conference on Multimodality Monitoring are listed in “Appendix”.

Appendix: Participants in the International Multi-Disciplinary Consensus Conference on Multimodality Monitoring

Appendix: Participants in the International Multi-Disciplinary Consensus Conference on Multimodality Monitoring

Peter Le Roux, MD, FACS

Brain and Spine Center

Suite 370, Medical Science Building

Lankenau Medical Center

100 East Lancaster Avenue

Wynnewood, PA 19096, USA

lerouxp@mlhs.org

David K Menon, MD, PhD, FRCP, FRCA, FFICM, FMedSci

Head, Division of Anaesthesia, University of Cambridge

Consultant, Neurosciences Critical Care Unit

Box 93, Addenbrooke’s Hospital

Cambridge CB2 2QQ, UK

dkm13@wbic.cam.ac.uk

Paul Vespa, MD, FCCM, FAAN, FNCS

Professor of Neurology and Neurosurgery

Director of Neurocritical Care

David Geffen School of Medicine at UCLA

Los Angeles, CA 90095, USA

PVespa@mednet.ucla.edu

Giuseppe Citerio

Director NeuroIntensive Care Unit

Department of Anesthesia and Critical Care

Ospedale San Gerardo, Monza

Via Pergolesi 33, Monza 20900, Italy

g.citerio@hsgerardo.org

Mary Kay Bader RN, MSN, CCNS, FAHA, FNCS

Neuro/Critical Care CNS

Mission Hospital

Mission Viejo, CA 92691, USA

Marykay.Bader@stjoe.org

Gretchen M. Brophy, PharmD, BCPS, FCCP, FCCM

Professor of Pharmacotherapy & Outcomes Science and Neurosurgery

Virginia Commonwealth University

Medical College of Virginia Campus

410 N. 12th Street

Richmond, VA 23298-0533, USA

gbrophy@vcu.edu

Michael N. Diringer, MD

Professor of Neurology, Neurosurgery & Anesthesiology

Chief, Neurocritical Care Section

Washington University

Dept. of Neurology, Campus Box 8111

660 S Euclid Ave

St Louis, MO 63110, USA

diringerm@neuro.wustl.edu

Nino Stocchetti, MD

Professor of Anesthesia and Intensive Care

Department of physiopathology and transplant

Milan University

Director Neuro ICU

Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico

Via F Sforza, 35, 20122 Milan, Italy

stocchet@policlinico.mi.it

Walter Videtta, MD

ICU Neurocritical Care

Hospital Nacional ‘Prof. a. Posadas’

El Palomar - Pcia. de Buenos Aires

Argentina

wvidetta@ar.inter.net

Rocco Armonda, MD

Department of Neurosurgery

MedStar Georgetown University Hospital

Medstar Health, 3800 Reservoir Road NW

Washington, DC 20007, USA

Rocco.Armonda@gmail.com

Neeraj Badjatia, MD

Department of Neurology

University of Maryland Medical Center

22 S Greene St

Baltimore, MD 21201, USA

nbadjatia@umm.edu

Julian Bösel, MD

Department of Neurology

Ruprect-Karls University

Hospital Heidelberg, Im Neuenheimer Feld 400

D-69120 Heidelberg, Germany

Julian.Boesel@med.uni-heidelberg.de

Randal Chesnut, MD, FCCM, FACS

Harborview Medical Center

University of Washington Mailstop 359766

325 Ninth Ave

Seattle, WA 98104-2499, USA

chesnutr@u.washington.edu

Sherry Chou, MD, MMSc

Department of Neurology

Brigham and Women’s Hospital

75 Francis Street

Boston, MA 02115 USA

schou1@partners.org

Jan Claassen, MD, PhD, FNCS

Assistant Professor of Neurology and Neurosurgery

Head of Neurocritical Care and Medical Director of the Neurological Intensive Care Unit

Columbia University College of Physicians & Surgeons

177 Fort Washington Avenue, Milstein 8 Center room 300

New York, NY 10032, USA

jc1439@cumc.columbia.edu

Marek Czosnyka, PhD

Department of Neurosurgery

University of Cambridge

Addenbrooke’s Hospital, Box 167

Cambridge CB20QQ, United Kingdom

mc141@medschl.cam.ac.uk

Michael De Georgia, MD

Professor of Neurology

Director, Neurocritical Care Center

Co-Director, Cerebrovascular Center

University Hospital Case Medical Center

Case Western Reserve University School of Medicine

11100 Euclid Avenue

Cleveland, OH 44106, USA

michael.degeorgia@uhhospitals.org

Anthony Figaji, MD, PhD

Head of Pediatric Neurosurgery

University of Cape Town

617 Institute for Child Health

Red Cross Children’s Hospital

Rondebosch, 7700 Cape Town, South Africa

anthony.figaji@uct.ac.za

Jennifer Fugate, DO

Department of Neurology

Mayo Clinic

200 First Street SW

Rochester, MN 55905, USA

Fugate.Jennifer@mayo.edu

Raimund Helbok, MD

Department of Neurology, Neurocritical Care Unit

Innsbruck Medical University

Anichstr. 35, 6020 Innsbruck, Austria

raimund.helbok@uki.at

David Horowitz, MD

Associate Chief Medical Officer

University of Pennsylvania Health System

3701 Market Street

Philadelphia, PA 19104, USA

david.horowitz@uphs.upenn.edu

Peter Hutchinson, MD

Professor of Neurosurgery

NIHR Research Professor

Department of Clinical Neurosciences

University of Cambridge

Box 167 Addenbrooke’s Hospital

Cambridge CB2 2QQ, United Kingdom

pjah2@cam.ac.uk

Monisha Kumar, MD

Department of Neurology

Perelman School of Medicine, University of Pennsylvania

3 West Gates, 3400 Spruce Street

Philadelphia, PA 19104, USA

monisha.kumar@uphs.upenn.edu

Molly McNett, RN, PhD

Director, Nursing Research

The MetroHealth System

2500 MetroHealth Drive

Cleveland, OH 44109, USA

mmcnett@metrohealth.org

Chad Miller, MD

Division of Cerebrovascular Diseases and Neurocritical Care

The Ohio State University

395 W. 12th Ave, 7th Floor

Columbus, OH 43210, USA

ChadM.Miller@osumc.edu

Andrew Naidech, MD, MSPH

Department of Neurology

Northwestern University Feinberg SOM 710

N Lake Shore Drive, 11th floor

Chicago, IL 60611, USA

ANaidech@nmff.org

Mauro Oddo, MD

Department of Intensive Care Medicine

CHUV University Hospital, BH 08-623

Faculty of Biology and Medicine, University of Lausanne

1011 Lausanne, Switzerland

Mauro.Oddo@chuv.ch

DaiWai Olson, RN, PhD

Associate Professor of Neurology, Neurotherapeutics and Neurosurgery

University of Texas Southwestern

5323 Harry Hines Blvd.

Dallas, TX 75390-8897, USA

daiwai.olson@utsouthwestern.edu

Kristine O’Phelan, MD

Director of Neurocritical Care

Associate Professor, Department of Neurology

University of Miami, Miller School of Medicine

JMH, 1611 NW 12th Ave, Suite 405

Miami, FL 33136, USA

USA

kophelan@med.miami.edu

J. Javier Provencio, MD

Associate Professor of Medicine

Cerebrovascular Center and Neuroinflammation Research Center

Lerner College of Medicine

Cleveland Clinic

9500 Euclid Ave, NC30

Cleveland, OH 44195, USA

provenj@ccf.org

Corina Puppo, MD

Assistant Professor, Intensive Care Unit

Hospital de Clinicas, Universidad de la República

Montevideo, Uruguay

coripuppo@gmail.com

Richard Riker, MD

Critical Care Medicine

Maine Medical Center

22 Bramhall Street

Portland, ME 04102-3175, USA

RRiker@cmamaine.com

Claudia Robertson, MD

Department of Neurosurgery

Medical Director of Center for Neurosurgical Intensive Care

Ben Taub Hospital

Baylor College of Medicine

1504 Taub Loop

Houston, TX 77030, USA

claudiar@bcm.tmc.edu

J. Michael Schmidt, PhD, MSc

Director of Neuro-ICU Monitoring and Informatics

Columbia University College of Physicians and Surgeons

Milstein Hospital 8 Garden South, Suite 331

177 Fort Washington Avenue

New York, NY 10032 ,USA

mjs2134@columbia.edu

Fabio Taccone, MD

Department of Intensive Care, Laboratoire de Recherche Experimentale

Erasme Hospital

Route de Lennik, 808

1070 Brussels, Belgium

ftaccone@ulb.ac.be

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Provencio, J.J., Badjatia, N. & And the Participants in the International Multi-disciplinary Consensus Conference on Multimodality Monitoring. Monitoring Inflammation (Including Fever) in Acute Brain Injury. Neurocrit Care 21 (Suppl 2), 177–186 (2014). https://doi.org/10.1007/s12028-014-0038-0

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