Pyrexia in head-injured patients admitted to intensive care

Stocchetti, Nino; Rossi, Sandra; Zanier, Elisa; Colombo, Angelo; Beretta, Luigi; Citerio, Giuseppe
November 2002
Intensive Care Medicine;Nov2002, Vol. 28 Issue 11, p1555
Academic Journal
Objectives. (a) To quantify the occurrence of pyrexia during the first week after head injury; (b) to elucidate the relationships between pyrexia and neurological severity, length of stay in the ICU, intracranial hypertension, and cerebral perfusion pressure (CPP); and (c) to describe the effects of antipyretic therapy on temperature, intracranial pressure (ICP) and CPP. Design and setting. Multicenter retrospective observational study in three ICUs in the Milan area. Patients. 110 patients with traumatic brain injury. Measurements and results. Eighty patients suffered pyrexia, defined as an external temperature higher than 38°C or internal temperature higher than 38.4°C. Occurrence and duration of pyrexia were associated with the degree of neurological impairment and with prolonged ICU stay. In patients with normal perimesencephalic cisterns the episodes of increased ICP were more frequent in febrile cases. Various antipyretic therapies were used in 66 patients. Pharmacological treatment was slightly effective (mean temperature reduction 0.58±0.7°C) but caused a significant drop in CPP (6.5±12.5 mmHg). Conclusions. Pyrexia is extremely frequent in the acute phase after head injury. Its incidence is higher in more severe cases and is correlated with a longer ICU stay. It may affect ICP, but its contribution is difficult to assess when other major causes of increased intracranial volume are present. Antipyretic therapy is poorly effective for controlling body temperature and may be deleterious for CPP.


Related Articles

  • A Review of Non-Invasive Methods of Monitoring Intracranial Pressure. Asiedua, Derek Pobi; Kyoung-Jae Leeb; Millsa, Godfrey; Kaufmannc, Elsie Effah // Journal of Neurology Research;2014, Vol. 4 Issue 1, p1 

    Intracranial pressure (ICP) monitoring is an important aspect of neuro-medicine. ICP is the pressure created by the presence of cerebrospinal fluid. ICP monitoring techniques consist of invasive (in vivo) and non-invasive methods (in vitro). Modern research aims to eliminate invasive monitoring...

  • Craniectomy in severe, life-threatening encephalitis: a report on outcome and long-term prognosis of four cases. Taferner, E.; Pfausler, B.; Kofler, A.; Spiss, H.; Engelhardt, K.; Kampfl, A.; Schmutzhard, E. // Intensive Care Medicine;Aug2001, Vol. 27 Issue 8, p1426 

    Objective:To report the feasibility of craniectomy with duraplasty in four patients with life-threatening encephalitis and, in particular, their long-term outcome. Design: Report of four cases, analysis of the acute clinical course and neurological long-term sequelae. Results: Generous...

  • Intracranial pressure and its monitoring in childhood: a review. Newton, R. W. // Journal of the Royal Society of Medicine;Sep1987, Vol. 80 Issue 9, p566 

    The article focuses on the causes, measurement and management of intracranial pressure (ICP) and indications for monitoring. Too much water in the skull which causes either hycrocephalus or cerebral oedema increases ICP. It is said that ICP can be maintained within fairly strict limits by both...

  • Robust Peak Recognition in Intracranial Pressure Signals. Scalzo, Fabien; Asgari, Shadnaz; Sunghan Kim; Bergsneider, Marvin; Xiao Hu // BioMedical Engineering OnLine;2010, Vol. 9, p61 

    Background: The waveform morphology of intracranial pressure pulses (ICP) is an essential indicator for monitoring, and forecasting critical intracranial and cerebrovascular pathophysiological variations. While current ICP pulse analysis frameworks offer satisfying results on most of the pulses,...

  • Laparoscopic management of distal ventriculoperitoneal shunt complications. Nfonsam, V.; Chand, B.; Rosenblatt, S.; Turner, R.; Luciano, M. // Surgical Endoscopy;Aug2008, Vol. 22 Issue 8, p1866 

    The traditional management of hydrocephalus still is the placement of ventriculoperitoneal (VP) shunts. However, the majority of patients require one or more revisions over their lifetime. Revisions may be required for infections, proximal site malfunction, or distal catheter complications. The...

  • Probable idiopathic intracranial hypertension in pre-pubertal children. Distelmaier, Felix; Mayatepek, Ertan; Tibussek, Daniel // Archives of Disease in Childhood;Apr2008, Vol. 93 Issue 4, p356 

    The article presents a study on idiopathic intracranial hypertension (IIH). IIH is characterized by disturbed cerebrospinal fluid (CSF) hydrodynamics and its diagnosis requires evidence of elevated CSF pressure above 20-25 cm water during lumbar puncture (LP). The study examined three boys and...

  • Intracranial pressure monitoring: Vital information ignored. Joseph, Mathew // Indian Journal of Critical Care Medicine;Jan-Mar2005, Vol. 9 Issue 1, p35 

    Though there is no Class I evidence for the benefit of intracranial pressure (ICP) monitoring, the bulk of the published literature supports its use when indicated. This review deals with the pathophysiology of raised ICP, evidence for and against monitoring, and basic guidelines for monitoring....

  • Increased Intracranial Pressure and Hepatic Encephalopathy in Chronic Liver Disease. Crippin, J. S.; Gross Jr., J. B.; Lindor, K. D. // American Journal of Gastroenterology;Jul1992, Vol. 87 Issue 7, p879 

    Increased intracranial pressure is present in more than 80% of patients with fulminant hepatic failure. However, patients with encephalopathy secondary to chronic liver disease are thought not to develop elevated intracranial pressure. We report two patients with chronic liver disease in hepatic...

  • Predicting the response of intracranial pressure to moderate hyperventilation. Steiner, L. A.; Balestreri, M.; Johnston, A. J.; Coles, J. P.; Smielewski, P.; Pickard, J. D.; Menon, D. K.; Czosnyka, M. // Acta Neurochirurgica;May2005, Vol. 147 Issue 5, p477 

    Background.Hyperventilation may cause brain ischaemia after traumatic brain injury. However, moderate reductions in PaCO2 are still an option in the management of raised intracranial pressure (ICP) under some circumstances. Being able to predict the ICP-response to such an intervention would be...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics