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Neurocritical Care

, Volume 21, Issue 2, pp 200–206 | Cite as

Therapeutic Temperature Modulation for Fever After Intracerebral Hemorrhage

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

Abstract

Background

We sought to determine whether therapeutic temperature modulation (TTM) to treat fever after intracerebral hemorrhage (ICH) is associated with improved hospital complications and discharge outcomes.

Methods

We performed a retrospective case–control study of patients admitted with spontaneous ICH having two consecutive fevers ≥38.3 °C despite acetaminophen administration. Cases were enrolled from a prospective database of patients receiving TTM from 2006 to 2010. All cases received TTM for fever control with goal temperature of 37 °C with a shiver-control protocol. Controls were matched in severity by ICH score and retrospectively obtained from 2001 to 2004, before routine use of TTM for ICH. Primary outcome was discharge-modified Rankin score.

Results

Forty patients were enrolled in each group. Median admission ICH Score, ICH volume, and GCS were similar. TTM was initiated with a median of 3 days after ICH onset and for a median duration of 7 days. Mean daily T max was significantly higher in the control group over the first 12 days (38.1 vs. 38.7 °C, p ≤ 0.001). The TTM group had more days of IV sedation (median 8 vs. 1, p < 0.001) and mechanical ventilation (18 vs. 9, p = 0.003), and more frequently underwent tracheostomy (55 vs. 23 %, p = 0.005). Mean NICU length of stay was longer for TTM patients (15 vs. 11 days, p = 0.007). There was no difference in discharge outcomes between the two groups (overall mortality 33 %, moderate or severe disability 67 %).

Conclusions

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

Keywords

Therapeutic temperature modulation Normothermia Fever Intracerebral hemorrhage 

Notes

Acknowledgments

Stephan Mayer has received consulting fees from Acetlion, Biogen Idec, CSL Behring, Haemonetics, Medivance/CR Bard, Neuroptics, Orsan Technologies, Pfizer, Sage Therapeutics, Sanofi-Aventis, Stryker, and Edge Therapeutics; Stock/Stock Options in Orsan Technologies.

Conflict of interest

Aaron S. Lord, Sarah Karinja, Hector Lantigua, Amanda Carpenter, J. Michael Schmidt, Jan Claassen, Sachin Agarwal, E. Sander Connolly, and Neeraj Badjatia declare no conflicts.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Aaron S. Lord
    • 1
  • Sarah Karinja
    • 2
  • Hector Lantigua
    • 2
  • Amanda Carpenter
    • 3
  • J. Michael Schmidt
    • 2
  • Jan Claassen
    • 2
  • Sachin Agarwal
    • 2
  • E. Sander Connolly
    • 3
  • Stephan A. Mayer
    • 2
    • 3
  • Neeraj Badjatia
    • 4
  1. 1.Department of NeurologyNew York UniversityNew YorkUSA
  2. 2.Division of Neurocritical Care, Department of NeurologyColumbia UniversityNew YorkUSA
  3. 3.Department of NeurosurgeryColumbia UniversityNew YorkUSA
  4. 4.Neurocritical Care and Emergency Neurology Division, Department of NeurologyUniversity of Maryland School of MedicineBaltimoreUSA

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