An Observational Study on the Use of Intravenous Non-Opioid Analgesics and Antipyretics in Poor-Grade Subarachnoid Hemorrhage: Effects on Hemodynamics and Systemic and Brain Temperature

Ianosi, Bogdan-Andrei; Rass, Verena; Gaasch, Max; Huber, Lukas; Lindner, Anna; Hackl, Werner O.; Kofler, Mario; Schiefecker, Alois Josef; Almashad, Salma S.; Beer, Ronny; Pfausler, Bettina; Helbok, Raimund

doi:10.1089/ther.2018.0046

Cited by 14 publications

(9 citation statements)

References 35 publications

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“…Additionally, our study at least doubles cumulative sample size of previous studies and adds to current evidence due to inclusion of a representative spectrum of mixed surgical critically ill patients. Previous observational studies [ 13 , 14 ] and a small randomized trial [ 21 ] studying the antipyretic effect of dipyrone all showed a maximal temperature decline of about -1.0°C comparable to the effect size of our study, but did not compare results to an untreated control group. Previous studies included nonsurgical and aneurysmal subarachnoid hemorrhage patients, thereby limiting generalization of findings to a postoperative surgical patient collective.…”

Section: Discussionsupporting

confidence: 68%

“…In a small observational study, dipyrone decreased mean temperature by 1.1°C on average as compared to acetaminophen by 0.9°C 120 min after infusion [ 13 ]. In another small observational study in patients with subarachnoid hemorrhage, the maximal decrease of body core temperature after dipyrone was 1.0°C [ 14 ]. Unfortunately, both studies did not include an untreated control group with fever.…”

Section: Introductionmentioning

confidence: 99%

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The antipyretic effectiveness of dipyrone in the intensive care unit: A retrospective cohort study

et al. 2022

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Introduction Dipyrone (metamizol) is regularly used in critical care for pain and fever treatment, especially in Germany and Spain. However, indication for antipyretic therapy in critically ill patients is currently unclear and data for both the risk and benefit of dipyrone treatment in the intensive care environment are scarce. We hypothesized that antipyretic efficiency of dipyrone would not exceed antipyretic efficiency of acetaminophen. We therefore aimed to compare temperature courses in critically ill patients receiving either intravenous dipyrone, acetaminophen or no antipyretic medication. Material and methods We included 937 intensive care unit (ICU) patients with body temperature recordings of at least 37.5°C. We investigated temperature decrease associated with dipyrone or acetaminophen and additionally compared it to an untreated control group. Results Within the eight-hour study interval, maximum body temperature decrease in patients without antipyretic medication was -0.6°C (IQR: -1.0 to -0.4°C; n = 315). Maximal decrease in body temperature was higher both with dipyrone (-0.8°C (IQR: -1.2 to -0.4°C); p = 0.016; n = 341) and acetaminophen (-0.9°C (IQR: -1.6 to -0.6°C); p<0.001; n = 71), but did not differ between dipyrone and acetaminophen (p = 0.066). As compared to untreated patients, dipyrone only led to a marginal additional decrease in body temperature of only -0.1°C. Maximum of antipyretic effectiveness was reached four hours after administration. Conclusion Antipyretic effectiveness of dipyrone in ICU patients may be overestimated. Given the lack of prospective data, clinical evidence for antipyretic dipyrone therapy in the ICU is insufficient and warrants further critical evaluation.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

The antipyretic effectiveness of dipyrone in the intensive care unit: A retrospective cohort study

et al. 2022

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“…Auditory wake-up intervention is also a new type of arousal. The main principle is to provide information coding for patients by calling to form stimulation, to stimulate the body's reflex mechanism, help patients form memory traces, and then promote membrane potential to produce action potential [ 27 – 29 ]. For patients with severe aneurysmal subarachnoid hemorrhage and postoperative coma, the application of whole-course responsibility nursing combined with high-quality nursing intervention can effectively improve the excitability of the patient's cerebral cortex.…”

Section: Discussionmentioning

confidence: 99%

High-Quality Nursing Combined with the Whole-Course Responsibility Nursing Intervention Reduces the Incidence of Complications in Severe Aneurysmal Subarachnoid Hemorrhage

Qian

Lin²,

Zhou

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. The aim of this study is to study the influence of whole-course responsibility nursing combined with high-quality nursing intervention on the level of life and complications of severe aneurysmal subarachnoid hemorrhage patients with postoperative coma. Methods. From December 2018 to December 2020, 90 severe aneurysmal subarachnoid hemorrhage patients with postoperative coma were selected and were divided into two groups, the experimental group and the control group, with 45 cases in each group. The control group adopted conventional nursing care, and the experimental group received whole-course responsibility nursing combined with high-quality nursing intervention. The nursing effect, degree of coma, coma recovery, and incidence of complications between all groups were compared. Results. Compared with the control group, the experimental group yielded more favorable achievement in terms of the nursing effect ( P < 0.05 ). Superior levels of the Glasgow Coma Scale (GCS) score, Coma Recovery Scale-Revised (CRS-R) score, GQOLI-74 score, and BI score of the experimental group were obtained and compared with the control group (all P < 0.05 ). The experimental group witnessed a lower complication rate, as compared to the other group ( P < 0.05 ). Conclusion. The whole-course responsibility nursing combined with high-quality nursing intervention is applied to severe aneurysmal subarachnoid hemorrhage patients with postoperative coma, which can substantially optimize the nursing efficiency, improve the degree of coma, help recover consciousness, ameliorate the mental state and the quality of life, and reduce the incidence of complications, which is worthy of clinical application.

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“…16 in another study, the use of acetaminophen and ibuprofen was an independent predictor of increased mortality in large cohort of septic patients. 17 considering the elevated risk of renal failure in critically ill coViD-19 patients 18 and the unpredictable effects of antipyretic drugs to reduce body temperature, 19 specific temperature control devices might offer a more adequate and targeted control of fever and avoid significant fluctuations in gas exchanges and heart rate, which might be secondary to fever occurrence. this strategy needs to be further described and compared to other potential protocols for fever control, as associated costs accurately quantified.…”

Section: Discussionmentioning

confidence: 99%

Fever management in critically ill COVID-19 patients: a retrospective analysis

et al. 2021

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BacKgroUND: Fever has been reported as a common symptom in coViD-19 patients. the aim of the study was to describe the characteristics of coViD-19 critically ill patients with fever and to assess if fever management had an impact on some physiologic variables. MetHoDs: this is a retrospective monocentric cohort analysis of critically ill coViD-19 patients admitted to the Department of intensive care Unit (icU) of erasme Hospital, Brussels, Belgium, between March 2020 and May 2020. Fever was defined as body temperature ≥38 °C during the ICU stay. We assessed the independent predictors of fever during ICU stay. We reported the clinical and physiological variables before and after the first treated episode of fever during the icU stay. resUlts: a total of 72 critically ill coViD-19 patients were admitted to the icU over the study period and were all eligible for the final analysis; 53 (74%) of them developed fever, after a median of 4 [0-13] hours since ICU admission. In the multivariable analysis, male gender ]; P=0.02) and low PaO 2 /Fio 2 ratio (or 0.99 [C.I. 95% 0.99-1.00]; P=0.04) were independently associated with fever. After the treatment of the first febrile episode, heart rate and respiratory rate significantly decreased together with an increase in PaO 2 and sao 2 . coNclUsioNs: in our study, male gender and severe impairment of oxygenation were independently associated with fever in critically ill coViD-19 patients. Fever treatment reduced heart rate and respiratory rate and improved systemic oxygenation.

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An Observational Study on the Use of Intravenous Non-Opioid Analgesics and Antipyretics in Poor-Grade Subarachnoid Hemorrhage: Effects on Hemodynamics and Systemic and Brain Temperature

Cited by 14 publications

References 35 publications

The antipyretic effectiveness of dipyrone in the intensive care unit: A retrospective cohort study

The antipyretic effectiveness of dipyrone in the intensive care unit: A retrospective cohort study

High-Quality Nursing Combined with the Whole-Course Responsibility Nursing Intervention Reduces the Incidence of Complications in Severe Aneurysmal Subarachnoid Hemorrhage

Fever management in critically ill COVID-19 patients: a retrospective analysis

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