Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system
Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system
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DOI：
10.1097/01.ccm.0000108868.97433.3f
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发表时间：
2004-02-01
影响因子：
8.8
通讯作者：
Diringer, MN
中科院分区：
文献类型：
--
作者：
Diringer, MN
背景：升高的温度加重了实验性局灶性和全脑缺血和脑外伤的损伤。发烧在急性神经系统疾病患者中很常见，独立预测预后不良。在这一人群中，传统的退烧方法不是很有效。目的：探讨导管式换热系统在降低神经外科危重症患者体温升高中的作用。设计、干预、环境和人群：这是一项前瞻性随机、非盲法试验，比较了常规治疗发热（对乙酰氨基酚和冷却毯）与常规治疗加血管内导管热交换系统（Alsius, Irvine， CA）。在13个学术医疗中心的神经重症监护病房中，如果患者a)患有蛛网膜下腔出血、脑出血、缺血性梗死或创伤性脑损伤，则符合条件；b)有2次或连续4小时的体温达零下38度；c)需要中心静脉通路。主要观察指标：比较72小时的发热负担（曲线下面积>38°c），进行意向治疗分析。监测导管系统的安全性。结果：在20个月的时间里，共有296名患者入组。蛛网膜下腔出血占41%，外伤性脑损伤占24%，脑出血占23%，缺血性中风占13%。各组在年龄、体重指数、性别和格拉斯哥昏迷量表评分分布方面相匹配。常规组和导管组发热负荷分别为7.92和2.87°c -hrs（降低64%，p < 0.01）。导管组没有较高的感染率，也没有使用镇静剂、麻醉药或抗生素。与中心置管相比，置管并没有显著增加患者的风险。结论：在常规管理中加入导管冷却系统可显著改善神经重症监护病房患者的退烧情况。
Context: Elevated temperature worsens injury in experimental focal and global ischemia and brain trauma. Fever is common in patients with acute neurologic illness and independently predicts poor outcome. Conventional means of treating fever are not very effective in this population.Objective: To study the effectiveness of a catheter-based heat exchange system in reducing elevated temperatures in critically ill neurologic and neurosurgical patients.Design, Intervention, Setting, and Population: This was a prospective randomized, nonblinded trial that compared conventional treatment of fever (acetaminophen and cooling blankets) with conventional treatment plus an intravascular catheter-based heat exchange system (Alsius, Irvine, CA). Patients admitted to one of 13 neurologic intensive care units in academic medical centers were eligible if they a) suffered subarachnoid hemorrhage, intracerebral hemorrhage, ischemic infarction, or traumatic brain injury; b) had a temperature >38degreesC on two occasions or for >4 continuous hrs; and c) required central venous access.Main Outcome Measure: The fever burden (area under the curve >38degreesC) for 72 hrs was compared in an intention to treat analysis. Safety of the catheter system was monitored.Results: A total of 296 patients were enrolled over 20 months. Forty-one percent had subarachnoid hemorrhage, 24% had traumatic brain injury, 23% had intracerebral hemorrhage, and 13% had ischemic stroke. The groups Were matched in terms of age, body mass index, sex, and Glasgow Coma Scale score distribution. Fever burden was 7.92 vs. 2.87degreesC-hrs in the conventional group and catheter groups, respectively (64% reduction, p < .01). There was no higher rate of infection or the use of sedatives, narcotics, or antibiotics in the catheter group. The catheter did not significantly increase risk to the patient beyond that of a central catheter.Conclusions: The addition of this catheter-based cooling system to conventional management significantly improves fever reduction in neurologic intensive care unit patients.