Outcomes Associated With Application of a Normothermia Protocol in Patients With Severe Neurological Insult and Fever
Status:
Terminated
Trial end date:
2010-07-01
Target enrollment:
Participant gender:
Summary
When fever is present in patients with stroke, traumatic brain injury (TBI), or brain
hemorrhage, it has been associated with worse outcomes including larger areas of tissue
death, increased length of stay, worse degree of coma, lower ability to function, and higher
mortality. Both adult and pediatric TBI national guidelines state that maintenance of normal
body temperature should be a standard of care. However, no further standards or options are
presented to specifically guide practice. The current ischemic stroke guidelines state that
fever should be treated with fever-reducing agents and offer "cooling devices" as an option
but do not provide specifics to guide practice. Over 50% of patients in the Neurosurgical
Intensive Care Unit (ICU) at Harborview Medical Center develop fever during the course of
their stay. With elevated temperatures the body consumes more oxygen than if the temperature
was normal, causing less oxygen to be available to the brain. This may lead to injury of the
brain cells and a diminished capacity for healing. Thus, temperature management in
neurologically vulnerable patients is both a prevalent and problematic challenge. Based on
this information the goal of the present proposal is to evaluate if 1) A standardized,
step-wise approach to temperature management using a Normothermia Protocol is successful in
achieving and maintaining normal temperature in Neurosurgical ICU patients; and 2) If
maintenance of normal temperature will be associated with fewer episodes of diminished
responsiveness in their neurological exams as evidenced by a measure of depth of coma, as
measured by the Glasgow Coma Score (GCS) compared to a control group treated according to
usual care.