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Fever neurocritical care

Ivan Rocha Ferreira da Silva, Gabriel Rodriguez de Freitas
BACKGROUND: Fever is commonly observed in patients who have had aneurysmal subarachnoid hemorrhage (SAH), and it has been associated with the occurrence of delayed cerebral ischemia and worse outcomes in previous studies. Frequently, fever is not the result of bacterial infections, and distinction between infection-related fever and fever secondary to brain injury (also referred as central fever) can be challenging. OBJECTIVES: The current study aimed to identify risk factors on admission for the development of central fever in patients with SAH...
August 23, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Fawaz Al-Mufti, Elie Dancour, Krishna Amuluru, Charles Prestigiacomo, Stephan A Mayer, E Sander Connolly, Jan Claassen, Joshua Z Willey, Philip M Meyers
Acute ischemic stroke continues to be one of the leading causes of morbidity and mortality worldwide. Recent advances in mechanical thrombectomy techniques combined with prereperfusion computed tomographic angiography for patient selection have revolutionized stroke care in the past year. Peri- and postinterventional neurocritical care of the patient who has had an emergent large-vessel occlusion is likely an equally important contributor to the outcome but has been relatively neglected. Critical periprocedural management issues include streamlining care to speed intervention, blood pressure optimization, reversal of anticoagulation, management of agitation, and selection of anesthetic technique (ie, general vs monitored anesthesia care)...
July 19, 2016: Journal of Intensive Care Medicine
Marlene Fischer, Alois Schiefecker, Peter Lackner, Raimund Helbok, Ronny Beer, Bettina Pfausler, Erich Schmutzhard, Gregor Broessner
Fever is common in neurocritical care patients and is associated with poor outcome. Targeted temperature management (TTM), i.e. therapeutic hypothermia or controlled normothermia, after acute brain injury has been studied as a neuroprotectant for several decades. In contrast to pharmacological agents with specific targets TTM affects multiple pathophysiological mechanisms and is primarily thought to attenuate secondary brain injury. Most promising results have been obtained from experimental studies on cerebral ischemia or traumatic brain injury showing beneficial effects of hypothermia on structural and functional outcome...
July 3, 2016: Current Drug Targets
George A Lopez
Fever in the neurocritical care unit has a high prevalence and is associated with worse outcomes in patients with severe neurologic illness. While it is well accepted that fever is associated with worse outcomes in this patient population, it is unclear if aggressive temperature management will improve outcomes. Temperature should be monitored routinely in this high-risk population, fever worked up appropriately to identify infectious etiology, and reasonable measures taken to control elevated temperature. While infection is a common source of fever in patients with significant neurologic illness, the fever may also be exacerbated by the underlying brain injury...
March 2016: Current Treatment Options in Neurology
Raquel Farias-Moeller, Jessica L Carpenter, Nathan Dean, Elizabeth M Wells
BACKGROUND: Autonomic dysfunction in pediatric patients with acquired brain injury is often encountered and greatly understudied. We sought to identify the incidence of Paroxysmal Sympathetic Hyperactivity (PSH) in critically ill pediatric patients with meningoencephalitis and encephalitis, associated risk factors and influence on outcome. METHODS: Children admitted to the pediatric intensive care unit (PICU) with a diagnosis of meningoencephalitis and/or encephalitis were identified from a single institution Neurocritical Care database...
December 2015: Neurocritical Care
Rajesh Verma, Prithvi Giri, Imran Rizvi
INTRODUCTION: Paroxysmal sympathetic hyperactivity (PSH) is a clinical disorder mainly caused by traumatic brain injury, stroke, encephalitis and other types of brain injury. The clinical features are episodes of hypertension, tachycardia, tachypnea, fever and dystonic postures. In this study, we described clinical profile and outcome of six patients of PSH admitted in neurocritical care unit. MATERIALS AND METHODS: This was a prospective observational study conducted at neurology critical care unit of a tertiary care center...
January 2015: Indian Journal of Critical Care Medicine
Gonçalo M Rodrigues, Carlos Oliveira Amaral, Hugo Dias Valentim, Anita Quintas, Maria Emília Ferreira, João Albuquerque Castro, Luís Mota Capitão
INTRODUCTION: Mycotic pseudoaneurysms are an infrequent complication of infective endocarditis; most cases are secondary to arterial trauma. The commonest site involved are the intracranial arteries, followed by the abdominal aorta and then the peripheral vessels. CASE PRESENTATION: We report a case of a 36-year-old man, admitted in our institution for a subarachnoid haemorrhage, who presented with fever of unknown origin during his stay in the neurocritical care unit and whom was diagnosed infective endocarditis due to Meticilin Sensible Staphylococcus Aureus...
July 2013: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
Juliet G Beniga, Katherine G Johnson, Debra D Mark
Fever is a significant contributor to secondary brain insult and management is a challenge for the neurocritical care team. The absence of standardized guidelines likely contributes to poor surveillance and undertreatment of increased temperature. A need for practice change was identified and this evidence-based practice project was initiated to compile sufficient evidence to develop, implement, and evaluate a treatment guideline to manage fever and maintain normothermia in the neurocritical care population...
September 2014: Nursing Clinics of North America
Jesse J Corry
Used for over 3600 years, hypothermia, or targeted temperature management (TTM), remains an ill defined medical therapy. Currently, the strongest evidence for TTM in adults are for out-of-hospital ventricular tachycardia/ventricular fibrillation cardiac arrest, intracerebral pressure control, and normothermia in the neurocritical care population. Even in these disease processes, a number of questions exist. Data on disease specific therapeutic markers, therapeutic depth and duration, and prognostication are limited...
August 4, 2012: World Journal of Critical Care Medicine
Leif-Erik Bohman, Joshua M Levine
PURPOSE OF REVIEW: Fever is common in the ICU among patients with severe brain injury. Fever has been consistently shown to exacerbate brain injuries in animal models and has been consistently associated with poor outcome in human studies. However, whether fever control improves outcome and the ideal means of fever control remain unknown. This review will address recent literature on the impact of fever on severe brain injury and on interventions to maintain normothermia. RECENT FINDINGS: Current guidelines generally recommend maintenance of normothermia after brain injury but have scant recommendations on methods to do this...
April 2014: Current Opinion in Critical Care
C A C Wijman, S M Smirnakis, P Vespa, K Szigeti, W C Ziai, M M Ning, J Rosand, D F Hanley, R Geocadin, C Hall, P D Le Roux, J I Suarez, O O Zaidat
The daily practice of neurointensivists focuses on the recognition of subtle changes in the neurological examination, interactions between the brain and systemic derangements, and brain physiology. Common alterations such as fever, hyperglycemia, and hypotension have different consequences in patients with brain insults compared with patients of general medical illness. Various technologies have become available or are currently being developed. The session on "research and technology" of the first neurocritical care research conference held in Houston in September of 2009 was devoted to the discussion of the current status, and the research role of state-of-the art technologies in neurocritical patients including multi-modality neuromonitoring, biomarkers, neuroimaging, and "omics" research (proteomix, genomics, and metabolomics)...
February 2012: Neurocritical Care
Navaz Karanjia, Diana Nordquist, Robert Stevens, Paul Nyquist
BACKGROUND: Patients with acute brain injury but normal lung function are often intubated for airway protection, but extubation often fails. Currently, no clinical data exist that describe the events leading to extubation failure in this population. We examined the extubation failure rate, reintubation rate, and clinical characteristics of patients whose reason for intubation was a primary neurological injury. We then identified the clinical characteristics of those patients with primary brain injury who were reintubated...
August 2011: Neurocritical Care
Charmaine Childs, Tadeusz Wieloch, Fiona Lecky, Graham Machin, Bridget Harris, Nino Stocchetti
Temperature disturbances are common in patients with severe traumatic brain injury. The possibility of an adaptive, potentially beneficial role for fever in patients with severe brain trauma has been dismissed, but without good justification. Fever might, in some patients, confer benefit. A cadre of clinicians and scientists met to debate the clinically relevant, but often controversial issue about whether raised brain temperature after human traumatic brain injury (TBI) should be regarded as "good or bad" for outcome...
2010: Frontiers in Neurology
Ericka L Fink, Patrick M Kochanek, Robert S B Clark, Michael J Bell
OBJECTIVES: To describe the use and feasibility of cold saline to decrease body temperature in pediatric neurocritical care. DESIGN: Retrospective chart review. SETTING: Pediatric tertiary care university hospital. PATIENTS: Children between 1 wk and 17 yrs of age admitted to the pediatric intensive care unit with acute brain injury and having received intravenous cold saline between June and August 2009. INTERVENTIONS: None...
January 2012: Pediatric Critical Care Medicine
Susanne Mink, Urs Schwarz, Regina Mudra, Christoph Gugl, Jürg Fröhlich, Emanuela Keller
BACKGROUND: Fever in neurocritical care patients is common and has a negative impact on neurological outcome. The purpose of this prospective observational study was (1) to evaluate the practicability of cooling with newly developed neck pads in the daily setting of neurointensive care unit (NICU) patients and (2) to evaluate its effectiveness as a surrogate endpoint to indicate the feasibility of neck cooling as a new method for intractable fever. METHODS: Nine patients with ten episodes of intractable fever and aneurysmal subarachnoid hemorrhage were treated with one of two different shapes of specifically adapted cooling neck pads...
August 2011: Neurocritical Care
Andrew Losiniecki, Lori Shutter
Traumatic brain injury (TBI) is a complex disease process that requires constant attention as one manages the associated body systems. Even though an "isolated" brain injury may be the cause for admission to the hospital, the injured brain cannot be thought of in isolation from the remainder of the body. All body systems, from cardiac to pulmonary, need to be addressed as one moves from the initial to the long-term management of the TBI. The multiple issues are best addressed with a dedicated neurocritical care team that is in continuous communication with the neurosurgical team throughout the course of treatment...
March 2010: Current Treatment Options in Neurology
Christopher D Anderson, James F Bartscher, Patricia D Scripko, Alessandro Biffi, Deborah Chase, Mary Guanci, David M Greer
BACKGROUND: Extubation failure in the neurocritical care unit (NCCU) is difficult to predict, and is an important source of prolonged intensive care, exposure to morbidity, and increased cost. METHODS: In this observational cohort study in the NCCU of a tertiary care hospital, we examined patients undergoing extubation or tracheostomy with >6 h of intubation. Observational data were collected at the time of the decision to extubate or pursue tracheostomy. The primary end-point was extubation failure within 72 h...
December 2011: Neurocritical Care
Neeraj Badjatia
PURPOSE OF REVIEW: Fever in the neurocritical care setting is very common and has a negative impact on outcome of all disease types. Recent advances have made eliminating fever and maintaining normothermia feasible. However, important questions regarding indications and timing remain. The purpose of this review is to analyze the data surrounding the impact of fever across a range of neurologic injuries to better understand the optimal timing and duration of fever control. RECENT FINDINGS: Meta-analyses have demonstrated that fever at onset and in the acute setting after ischemic brain injury, intracerebral hemorrhage, and cardiac arrest have a negative impact on morbidity and mortality...
April 2009: Current Opinion in Critical Care
Neeraj Badjatia
Fever in the neurocritical care setting is common and has a negative impact on outcome of all disease types. Meta-analyses have demonstrated that fever at onset and in the acute setting after ischemic brain injury, intracerebral hemorrhage, and cardiac arrest has a negative impact on morbidity and mortality. Data support that the impact of fever is sustained for longer durations after subarachnoid hemorrhage and traumatic brain injury. Recent advances have made eliminating fever and maintaining normothermia feasible...
July 2009: Critical Care Medicine
B Vigué, O Fourcade
No abstract text is available yet for this article.
April 2009: Annales Françaises D'anesthèsie et de Rèanimation
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