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  • Poster presentation
  • Open Access

Subcutaneous diclofenac at low dose is very effective in treating fever with an accompanying reduction in intracerebral pressure in NICU patients

  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care20048 (Suppl 1) :P316

  • Published:


  • Traumatic Brain Injury
  • Mean Arterial Pressure
  • Glasgow Coma Scale
  • Cerebral Perfusion Pressure
  • Scale Motor

Although rigorous control of fever is the current standard of care for the brain-injured patient, patient management strategies currently available are often suboptimal and may be contraindicated.


We investigated a subcutaneous very low dose of diclofenac sodium (DCF SC) to treat fever in the NICU.


DCF SC (0.17 mg/kg [≈ 1/6 fl]) was administered to febrile patients and its effect was recorded continuously for 6 hours on the temperature (T°), intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial pressure (MAP), heart rate (HR) and diuresis. Adverse effects of DCF (allergic, gastrointestinal and central nervous system bleeding) were monitored.


Thirty-five NICU patients (age 48.9 ± 19.5 years, male 64%, median Glasgow Coma Scale motor 5) (traumatic brain injury 63%, aneurismal subarachnoid hemorrhage 20%, postoperative 17%) were studied. Infection was clinically suspected in all patients and in 54% of them its was confirmed by microbiological data. We analysed a total of 177 SC doses at a mean 185 ± 89 hours after ICU admission with a median of five administrations per patient. The mean dose was 13.7 ± 6 mg (0.17 ± 0.04 mg/kg). T° decreased significantly after DCF SC, from 38.4 ± 0.4 to 37.6 ± 0.5°C (P < 0.0001), as did the ICP, from 16 ± 8 to 12.8 ± 6 mmHg (P = 0.0002). PaCO2 and SjvO2 were not different pre and post DCF. The CPP was stable after DCF (pre, 71 ± 15 mmHg; post, 69 ± 15 mmHg [NS]). The HR significantly dropped (from 97 ± 21 to 89 ± 20 beats/min, P < 0.0001). Blood gas analysis, renal and hepatic parameters were not different after DCF SC. Diuresis was maintained and it did not decrease much (from 175 ± 97 to142 ± 102 ml/hour, P < 0.05). The effects of DCF on T° and ICP are shown in Fig. 1. The effects of DCF on MAP, CPP and hourly urine output are shown in Fig. 2.

Figure 1

Figure 2


We conclude that DCF SC at low dosage was advantageous and effective. It enabled good reductions in body T° with an associated reduction in the ICP. Side effects on CPP or MAP were minimal, and renal and hepatic functions were not affected.

Authors’ Affiliations

H.S. Gerardo, Monza, Italy


© BioMed Central Ltd. 2004