Cooling strategies for patients with severe cerebral insult in ICU (Part 2)

Abstract

Critically ill patients who have sustained a severe cerebral insult will be actively cooled should they develop an elevated body core temperature. Patients who require therapeutic hypothermia for neuroprotection may require the same cooling strategies. A literature review suggested limited evidence to support cooling strategies currently used within one intensive care unit. An experimental approach was used to examine the effects of paracetamol and four external cooling strategies on patients with severe cerebral insult It is suggested that paracetamol is effective in reducing body core temperature and that fans may not. However, data obtained from the study of the four external cooling strategies were inconclusive.

Fever Management in SAH

“…A total of 24 original research studies evaluating fever in SAH were identified: 9 studies evaluating fever and outcome (Table 1) [1-3, 5, 9, 12-15], 12 studies evaluating temperature control strategies (Table 2) [16][17][18][19][20][21][22][23][24][25][26][27], and 3 shivering (Table 3) [29,30]. Outcome data included 4 prospective studies, with the remainder cohort data or retrospective analyses.…”

“…One small study, including SAH patients, testing the efficacy of paracetamol compared with external means (fanning, evaporative cooling using cool cloths and sponging, ice packs, and cooling blanket) reported a reduction in body core temperature in 57% of patients receiving paracetamol [19]. Two other studies including SAH patients demonstrated efficacy in controlling temperature elevation with very low doses of continuously infused diclofenac [16,17].…”

“…External cooling with surface cooling devices has been tested in SAH population, with poor efficacy reported with the use of fanning, evaporative cooling, cool cloths, sponging, ice packs, and cooling blankets [19]. Forty consecutive febrile patients who underwent ''advanced fever control'' (AFC, target temperature 37°C) with a surface cooling device during the first 14 days after SAH were compared with a matched a group of 80 historical SAH patients who underwent conventional fever control (CFC: acetaminophen, 650 mg every 4-6 h orally, with or without the use of a water-circulating cooling blanket) [21].…”

Nursing care of the acute head injury: a review of the evidence

“…Johnson (1999) suggests that hyperpyrexia can be treated with anti‐pyretic drugs and notes that active cooling methods can cause shivering which increases ICP. Price et al . (2003) performed a study comparing the various methods of cooling, including paracetamol, ice packs and airflow blankets.…”

“…Johnson (1999) suggests that hyperpyrexia can be treated with anti-pyretic drugs and notes that active cooling methods can cause shivering which increases ICP. Price et al (2003) performed a study comparing the various methods of cooling, including paracetamol, ice packs and airflow blankets. The small sample size meant that it is difficult to draw firm conclusions, but the researchers felt that paracetamol was an effective agent to reduce hyperpyrexia in patients with intact thermoregulatory function.…”