Feasibility and advantages of normothermia in patients with acute cerebral damage: preliminary results of a prospective randomised study

Introduction

Even moderate fever soon after head trauma or cerebral ischemia may markedly worsen brain injury. These effects may justify aggressive antipyretic treatment.

Objectives

In this study we compared two modalities to treat fever and to maintain normothermia and examined their influence on: ICP, CPP, SjvO₂, length of ICU stay (LOS) and clinical course of existing infections.

Material and methods

We prospectively randomised patients with severe head injury (TBI) and subarachnoidal hemorrhage (SAH) in two groups: low doses Diclofenac sodium infusion (0.01–0.08 mg/kg/h) [DCF] and extemporaneous antipyretic bolus by unrestricted physician prescription [NSAIDs]. Randomisation was designated when internal temperature was ≥ 38°C lasting longer than 30 min. Drugs were used till clinically necessary. Internal temperature (T°), cerebral and systemic hemodynamic data were continuously recorded.

Results

Eight TBI and three SAH (mean age 40 ± 17 – 64% male) were studied. Median TBI GCS motor score was 5 and all SAH patients were Hunt Hess IV. Five patients were enrolled in NSAIDs group and six in DCF group. Age, admission GCS, cerebral damage, max temperature before randomisation and outcome were not significantly different in the two groups. During treatment, normothermia was easier maintained by DCF than by NSAIDs: mean T°, max T°, % minutes T° ≥ 38°C, and febrile episodes incidence were lower in DCF than in NSAIDs with minor antipyretics use (P < 0.05). During treatment, mean ICP and minutes of ICP > 20 were not while, mean CPP, minutes of CPP < 70 and mean SjvO₂ were significantly different (P < 0.05) between groups. Incidence of infections and LOS were not different between the two groups.

Conclusions

During the infusion period, a better stability of hemodynamic and cerebral parameters demonstrated the superior antipyretic effect of DCF. NSAIDs were associated with deeper CPP reductions and not all febrile episodes were completely managed. We, preliminary, concluded that DCF at low dosage was advantageous and effective.