Background: Shivering is a common adverse effect of achieving and maintaining normothermia in neurocritical care patients. We compared the burden of shivering and shivering-related interventions between a novel trans-nasal temperature modulating device(tnTMD) and surface cooling temperature modulating devices(sTMDs) during the first 24 hours of targeted normothermia in mechanically ventilated febrile neurocritical care patients. Methods: This is a case: control study controlling for factors that impact shiver burden: age, sex, body surface area. All patients underwent transnasal cooling (COOLSTAT, KeyTech, Inc) as part of an ongoing multicenter clinical trial(NCT03360656). Patients undergoing treatment with sTMDs were selected from consecutively treated patients during the same time-period. Data collected included: core body temperature (every 2 hours), bedside shivering assessment scale(BSAS) score (every 2 hours), and administration of anti-shivering medication for BSAS>1.Time to normothermia(<=37.5 C), as well as temperature burden>37.5 C(C*hr) were compared between groups using student’s t-test for mean differences. Proportion of patients requiring interventions as well as number of interventions per patient were compared using Chi-Square test. Significance was determined based on a P value < 0.05. Results: There were 10 tnTMD patients and 30 sTMD patients included in the analysis (mean age: 62+/-4, 30% women, BSA = 1.97+/-0.25). There were no differences between groups in temperature at cooling initiation (tnTMD: 38.5+/-0.2 C vs sTMD: 38.7+/-0.5 C, P=0.3), time to <=37.5 C (tnTMD: 1.8+/-1.5 hours vs. sTMD: 2.9+/-1.4 hours, P=0.1), or temperature burden >37.5 (tnTMD:: -0.4 +/- 1.13 C*hr vs. sTMD median (IQR): -0.57 +/- 0.58 C*hr, P=0.67). The number of tnTMD patients who received pharmacologic shivering interventions was lower than the controls (20%vs.67%,p=0.01). tnTMD patients also had fewer shivering interventions per patient (0 (range: 0-3)vs.4(range: 0 – 23 ), p<0.001). Conclusion: A transnasal cooling approach achieved similar time to normothermia and temperature burden with less shivering than surface cooling. This approach may be a feasible option to consider for mechanically ventilated febrile neurocritical care patients. Trial registration: Clinical trials.gov: NCT03360656. Registered December 4, 2017. https://clinicaltrials.gov/ct2/show/NCT03360656

OBJECTIVES/GOALS: Accurate classification of disorders of consciousness (DoC) is key in developing rehabilitation plans following brain injury. The Coma Recovery Scale-Revised (CRS-R) is a sensitive measure of consciousness. We explore feasibility, safety and impact of CRS-R guided rehab in hemorrhagic stroke patients with DoC and evaluate predictors of recovery. METHODS/STUDY POPULATION: Consecutive patients with non-traumatic hemorrhagic stroke, defined as subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH), receiving serial CRS-R assessments during their ICU stay at University of Maryland Medical Center from 2017-2021 were retrospectively identified. Outcomes of interest included the association with CRS-R and discharge disposition, therapy-based function and mobility and occurrence of safety events during CRS assessment. We also examined the association between CRS-R and physiological and anatomical injury pattern on electroencephalography (EEG) and magnetic resonance imaging (MRI), respectively. CRS-R RESULTS/ANTICIPATED RESULTS: 76 patients with≥2 CRS-R assessments were identified (22 SAH, 54 ICH, median age = 59, 50% female). Median CRS-R completed was 3 with no SAEs identified during sessions. We identified 4 patterns: persistent VS/UWS (49%), persistent MCS or better (13%), emergence from VS/UWS to MCS or better (27%) and regression from MCS or better to VS/UWS (11%). Persistent low CRS-R correlated with older age in SAH (p=0.01), female gender in ICH (p=0.04), and history of diabetes (p=0.01). 2% of patients with final CRS-R DISCUSSION/SIGNIFICANCE: Early neurorehabilitation guided by CRS-R appears to be feasible and safe acutely following hemorrhagic stroke complicated by prolonged DoC and may enhance access to inpatient rehabilitation with a lasting benefit on recovery. Further characterization of DoC patterns and their correlation to clinical markers, including EEG and MRI is needed.

Background: Shivering is a common adverse effect of achieving and maintaining normothermia in neurocritical care patients. We compared the burden of shivering and shivering-related interventions between a novel trans-nasal temperature modulating device(tnTMD) and surface cooling temperature modulating devices(sTMDs) during the rst 24 hours of targeted normothermia in mechanically ventilated febrile neurocritical care patients.Methods: This is a case: control study controlling for factors that impact shiver burden: age, sex, body surface area. All patients underwent transnasal cooling (COOLSTAT, KeyTech, Inc) as part of an ongoing multicenter clinical trial(NCT03360656). Patients undergoing treatment with sTMDs were selected from consecutively treated patients during the same time-period. Data collected included: core body temperature (every 2 hours), bedside shivering assessment scale(BSAS) score (every 2 hours), and administration of anti-shivering medication for BSAS>1.Time to normothermia(<=37.5 C), as well as temperature burden>37.5 C(C*hr) were compared between groups using student's t-test for mean differences. Proportion of patients requiring interventions as well as number of interventions per patient were compared using Chi-Square test. Signi cance was determined based on a P value < 0.05.Results: There were 10 tnTMD patients and 30 sTMD patients included in the analysis (mean age: 62+/-4, 30% women, BSA = 1.97+/-0.25). There were no differences between groups in temperature at cooling initiation (tnTMD: 38.5+/-0.2 C vs sTMD: 38.7+/-0.5 C, P=0.3), time to <=37.5 C (tnTMD: 1.8+/-1.5 hours vs. sTMD: 2.9+/-1.4 hours, P=0.1), or temperature burden >37.5 (tnTMD:: -0.4 +/-1.13 C*hr vs. sTMD median (IQR): -0.57 +/-0.58 C*hr, P=0.67). The number of tnTMD patients who received pharmacologic shivering interventions was lower than the controls (20%vs.67%,p=0.01). tnTMD patients also had fewer shivering interventions per patient (0 (range: 0-3)vs.4(range: 0 -23 ), p<0.001).Conclusion: A transnasal cooling approach achieved similar time to normothermia and temperature burden with less shivering than surface cooling. This approach may be a feasible option to consider for mechanically ventilated febrile neurocritical care patients.