on February 26, 2009
Published online before print February 26, 2009, doi: 10.1161/STROKEAHA.108.534115
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Submitted on August 7, 2008
From the Departments of Neurosurgery (M.O., S.F., A.M., I.C., E.M.-W., E.M.M., M.S., W.A.K., P.D.L., J.M.L.), Neurology (J.M.L.), and Anesthesiology and Critical Care (W.A.K., J.M.L.), University of Pennsylvania Medical Center, Philadelphia. * To whom correspondence should be addressed. E-mail: Mauro.Oddo{at}uphs.upenn.edu.
Background and Purpose—The purpose of this study was to analyze whether fever control attenuates cerebral metabolic distress after aneurysmal subarachnoid hemorrhage (SAH). Methods—Eighteen SAH patients, who underwent intracranial pressure (ICP) and cerebral microdialysis monitoring and were treated with induced normothermia for refractory fever (body temperature Results—Compared to fever, induced normothermia resulted in lower LPR (40±24 versus 32±9, P<0.01) and a reduced incidence of cerebral metabolic crisis (13% versus 5%, P<0.05) at normal ICP. During episodes of high ICP, induced normothermia was associated with a similar reduction of LPR, fewer episodes of cerebral metabolic crisis (37% versus 8%, P<0.01), and lower ICP (32±11 versus 28±12 mm Hg, P<0.05). Conclusions—Fever control is associated with reduced cerebral metabolic distress in patients with SAH, irrespective of ICP.
Revised on October 6, 2008
Accepted on October 16, 2008
Induced Normothermia Attenuates Cerebral Metabolic Distress in Patients With Aneurysmal Subarachnoid Hemorrhage and Refractory Fever
Mauro Oddo MD*;
38.3°C, despite antipyretics), were studied. Levels of microdialysate lactate/pyruvate ratio (LPR) and episodes of cerebral metabolic crisis (LPR >40) were analyzed during fever and induced normothermia, at normal and high ICP (>20 mm Hg).
Key words: fever • induced normothermia • cerebral microdialysis • lactate/pyruvate ratio • SAH