A prospective, observational clinical trial of fever reduction to reduce systemic oxygen consumption in the setting of acute brain injury

J Steven Hata; Constance R Shelsky; Bradley J Hindman; Thomas C Smith; Jonathan S Simmons; Michael M Todd

doi:10.1007/s12028-007-9015-1

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A prospective, observational clinical trial of fever reduction to reduce systemic oxygen consumption in the setting of acute brain injury

Journal article

Peer reviewed

A prospective, observational clinical trial of fever reduction to reduce systemic oxygen consumption in the setting of acute brain injury

J Steven Hata, Constance R Shelsky, Bradley J Hindman, Thomas C Smith, Jonathan S Simmons and Michael M Todd

Neurocritical care, Vol.9(1), pp.37-44

2008

DOI: 10.1007/s12028-007-9015-1

PMID: 17985248

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Abstract

Fever after acute brain injury appears to be a detrimental factor, associated with impaired neurological outcomes. This study assessed physiological changes in systemic oxygen consumption (VO2) during cutaneous cooling after severe brain injury. This prospective, observational, clinical study evaluated ten, critically ill, brain-injured patients requiring mechanical ventilation with a core body temperature of greater or equal to 38 degrees C. Febrile patients failing to defervesce after acetaminophen underwent indirect calorimetry for a 1-hour baseline period followed by a 4 h cooling period. The Arctic Sun(R) Temperature Management System (Medivance) directed core temperature to a goal of 36 degrees C. The patients had a mean age of 32 years (95% CI 23, 40), Glasgow Coma Scale of 6 (95% CI 5,7), and APACHE 2 score of 19 (95% CI 15, 22), with 8 of 10 patients suffering traumatic brain injuries. The baseline 1-h core temperature was significantly reduced from 38.6 degrees +/- 0.9 to 36.3 degrees +/- 1.2 degrees C (P < 0.0001) over 4 h. Two cohorts were identified based upon the presence or absence of shivering. Within the non-shivering cohort, systemic VO2 was significantly reduced from 415 +/- 123 to 308 +/- 115 ml/min (-27 +/- 18%) (P < 0.05). In contrast, those with shivering showed no significant reduction in VO2, despite significantly decreasing core temperature. The overall percentage change of VCO2 correlated with VO2 (r (2) = 0.91). Fever reduction in acute brain injury appears to significantly reduce systemic VO2, but is highly dependent on shivering control.

Prospective Studies

Body Temperature - drug effects

Fever - metabolism

Humans

Oxygen Consumption

Male

Combined Modality Therapy

Analgesics, Non-Narcotic - therapeutic use

Brain Injuries - metabolism

Brain Injuries - therapy

Hypnotics and Sedatives - therapeutic use

Respiration, Artificial

Glasgow Coma Scale

Shivering - drug effects

Hypothermia, Induced

Adult

Critical Care

Female

Acetaminophen - therapeutic use

Fever - drug therapy

APACHE

Details

Title: Subtitle: A prospective, observational clinical trial of fever reduction to reduce systemic oxygen consumption in the setting of acute brain injury
Creators: J Steven Hata - The Division of Critical Care, Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. steven-hata@uiowa.edu
Constance R Shelsky
Bradley J Hindman
Thomas C Smith
Jonathan S Simmons
Michael M Todd
Resource Type: Journal article
Publication Details: Neurocritical care, Vol.9(1), pp.37-44
Publisher: United States
DOI: 10.1007/s12028-007-9015-1
PMID: 17985248
ISSN: 1541-6933
eISSN: 1556-0961
Language: English
Date published: 2008
Academic Unit: Emergency Medicine; Anesthesia
Record Identifier: 9984006485802771

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