Fever in subarachnoid hemorrhage

Oliveira‐Filho, Jamary; Ezzeddine, Mustapha A.; Segal, Alan Z.; Buonanno, Ferdinando S.; Chang, Ya Ting; Ogilvy, Christopher S.; Rordorf, Guy; Schwamm, Lee H; Koroshetz, Walter J.; McDonald, Colin T.

doi:10.1212/wnl.56.10.1299

Cited by 245 publications

(145 citation statements)

References 31 publications

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“…Most studies of fever in patients with aSAH have addressed the incidence of fever throughout the ICU stay. 6,18 Fernandez et al 6 demonstrated that fever in aSAH, with an average temperature elevation of about 0.6°C ± 0.58°C, is seen as early as the first 24 hours of admission. These studies also suggest that in 91% of TBI patients 35 and 73% aSAH patients 18 staying in an ICU the development of fever may be explained by infections.…”

Section: Discussionmentioning

confidence: 99%

“…6,18 Fernandez et al 6 demonstrated that fever in aSAH, with an average temperature elevation of about 0.6°C ± 0.58°C, is seen as early as the first 24 hours of admission. These studies also suggest that in 91% of TBI patients 35 and 73% aSAH patients 18 staying in an ICU the development of fever may be explained by infections. As infection or sepsis may be unlikely within the first 24 hours of ICU admission in patients with TBI or aSAH, it is possible that an early fever represents an acute response to injury or inflammation, or that it may be related to damage of thermoregulatory pathways.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

Rincón

Hunter²,

Schorr

et al. 2014

JNS

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Brain injuries from stroke and head trauma are leading causes of morbidity and death in the world. 3,27 In patients with these injuries, early fever 9 and hypothermia 13,29 (dysthermia) and the onset of systemic complications are associated with poor outcomes. Plausible theories of the underlying reasons for disturbance in thermoregulation after brain injury are based on observations in animal models. These findings suggest that potential causes of fever include damage to the hypothalamus, midbrain, or pons by enhanced sympathetic activity; acute or delayed ischemia; toxic blood metabolites; physical distortion; or inflammation.7,34 Accordingly, dysfunction of or damage to these thermoregulatory pathways is common in patients with brain injuries, putting them at increased risk for dysthermia. 7,30,34 Because dysthermia is known to be associated with poor outcomes in all forms Object. Fever and hypothermia (dysthermia) are associated with poor outcomes in patients with brain injuries. The authors sought to study the epidemiology of dysthermia on admission to the intensive care unit (ICU) and the effect on in-hospital case fatality in a mixed cohort of patients with brain injuries.Methods. The authors conducted a multicenter retrospective cohort study in 94 ICUs in the United States. Critically ill patients with neurological injuries, including acute ischemic stroke (AIS), aneurysmal subarachnoid hemorrhage (aSAH), intracerebral hemorrhage (ICH), and traumatic brain injury (TBI), who were older than 17 years and consecutively admitted to the ICU from 2003 to 2008 were selected for analysis.Results. In total, 13,587 patients were included in this study; AIS was diagnosed in 2973 patients (22%), ICH in 4192 (31%), aSAH in 2346 (17%), and TBI in 4076 (30%). On admission to the ICU, fever was more common among TBI and aSAH patients, and hypothermia was more common among ICH patients. In-hospital case fatality was more common among patients with hypothermia (OR 12.7,) than among those with fever (OR 1.9, 95% CI 1.7-2.1). Compared with patients with ICH (OR 2.0, 95% CI 1.8-2.3), TBI (OR 1.5, 95% CI 1.3-1.8), and aSAH (OR 1.4, 95% CI 1.2-1.7), patients with AIS who developed fever had the highest risk of death (OR 3.1, 95% CI 2.5-3.7). Although all hypothermic patients had an increased mortality rate, this increase was not significantly different across subgroups. In a multivariable analysis, when adjusted for all other confounders, exposure to fever (adjusted OR 1.3, 95% CI 1.1-1.5) or hypothermia (adjusted OR 7.8, 95% CI 3.9-15.4) on admission to the ICU was found to be significantly associated with in-hospital case fatality.Conclusions. Fever is frequently encountered in the acute phase of brain injury, and a small proportion of patients with brain injuries may also develop spontaneous hypothermia. The effect of fever on mortality rates differed by neurological diagnosis. Both early spontaneous fever and hypothermia conferred a higher risk of in-hospital death after brain injury. Abbreviations used in this paper: AIS ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

Rincón

Hunter²,

Schorr

et al. 2014

JNS

View full text Add to dashboard Cite

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“…Family structure was recorded as living alone, living with a spouse only, or living with children. A complicating infection was defined as a body temperature 38.3°C for two or more consecutive days, based on a preceding study (Oliveira-Filho et al 2001). All patients were diagnosed using CT scan or MRI.…”

Section: Methodsmentioning

confidence: 99%

Gender and Family Composition Related to Discharge Destination and Length of Hospital Stay after Acute Stroke

Ohwaki

Hashimoto

Tokuda

et al. 2005

Tohoku J. Exp. Med.

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Informal care by family members still plays an important role in home care after acute stroke. This study determined the clinical and demographic factors, such as family structure, that predict discharge to home and length of hospital stay (LOS) after acute stroke hospitalization. We reviewed the sex, age, family structure before stroke, type of stroke, size of the lesion, activities of daily living (ADL) function at discharge, discharge destination, and LOS of stroke patients (114 cerebral infarctions and 44 intracerebral hemorrhages) admitted to a neurosurgical hospital. Patients with cerebral infarction were older than those with intracerebral hemorrhage (median 75 vs 66 years). Ninety-eight were discharged to home (62%). In the logistic regression analysis, low ADL function, medium or large infarction, and intracerebral hemorrhage (vs lacunar infarction) were significantly associated with discharge to a destination other than home. Of the patients discharged home, low ADL function was strongly associated with LOS in the multiple regression analysis. In addition, living with a spouse only had the opposite effect on LOS in men and women ( p = 0.050 and 0.071, respectively). LOS tended to be shorter for men with a wife, but longer for women with a husband. The structure and gender roles in a stroke patient's household may need further attention for the efficient use of hospital resources.gender; family; stroke outcome; hospitalization © 2005 Tohoku University Medical PressStroke remains the third highest cause of mortality in Japan, resulting in 130,000 deaths per year (Ministry of Health, Labour and Welfare 2004). Although the fatality rate has decreased in the last few decades, a large number of acute survivors still suffer functional disabilities that lead to institutionalization and a consequent economic burden on the patient's household and society as a whole. With the rapid increase in the population of elderly, it is even more important to identify stroke patients who are at risk of a prolonged hospital stay in order to enhance their return home.

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“…Fever has been associated with worse outcomes [123,124], so that the most recently published guidelines for SAH recommend aggressive treatment of fever to normothermia [125]. No clear evidence exists in using hypothermia after SAH.…”

Section: Subarachnoid Hemorrhagementioning

confidence: 99%

Therapeutic Hypothermia for Acute Neurological Injuries

2012

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Therapeutic hypothermia (TH) is the intentional reduction of core body temperature to 32°C to 35°C, and is increasingly applied by intensivists for a variety of acute neurological injuries to achieve neuroprotection and reduction of elevated intracranial pressure. TH improves outcomes in comatose patients after a cardiac arrest with a shockable rhythm, but other off-label applications exist and are likely to increase in the future. This comprehensive review summarizes the physiology and cellular mechanism of action of TH, as well as different means of TH induction and maintenance with potential side effects. Indications of TH are critically reviewed by disease entity, as reported in the most recent literature, and evidence-based recommendations are provided.

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Fever in subarachnoid hemorrhage

Abstract: Fever in SAH is associated with vasospasm and poor outcome independently of hemorrhage severity or presence of infection.

Cited by 245 publications

References 31 publications

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

Gender and Family Composition Related to Discharge Destination and Length of Hospital Stay after Acute Stroke

Therapeutic Hypothermia for Acute Neurological Injuries

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