Induced Normothermia After Severe Traumatic Brain Injury: A Prospective Observational Pilot Safety and Feasibility Study

Abstract

Background: Early hyperthermia following traumatic brain injury (TBI) is associated with worsened neurologic outcomes; however, eliminating fever has not been adequately studied. We sought to explore the safety and feasibility of induced normothermia using advanced fever control (AFC) in severe TBI patients. Methods: Eight patients underwent AFC with a surface cooling device for 96 hours, and four patients underwent conventional fever control (CFC). Average daily fever burden (FB) was calculated as the time and extent (°C × hours) above 37 °C. Shivering was evaluated hourly by the bedside shivering assessment scale (BSAS, 0 - 3) and BSAS > 0 was treated using a stepwise protocol. Results: FB was lower for the AFC vs. CFC group: 4.0 vs. 7.0 (P = 0.2) for day 1, 4.3 vs. 7.7 (P = 0.1) for day 2, 3.6 vs. 5.3 (P = 0.5) for day 3, 4.2 vs. 4.8 (P = 0.7) for day 4 respectively. BSAS > 0 developed more often in the AFC group (130 times) than the CFC group (two times). Conclusion: Induced normothermia was associated with less FB and more interventions to treat shivering compared to CFC in severe TBI patients. A large prospective randomized outcome trial of AFC vs. CFC is warranted. J Neurol Res. 2014;4(5-6):127-132 doi: http://dx.doi.org/10.14740/jnr283w