Evidence-Base for Fever Interventions Following Stroke
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The febrile response is an important and adaptive host defense. In the context of brain injury, however, fever is thought to induce secondary brain injury and be associated with worse outcomes and higher mortality rates. For many years, researchers and clinicians have identified fever as a critical concern in the management of patients after stroke. Recent work has focused on care processes in fever management of the stroke patient. Most studies have focused solely on frequency of temperature measurement or antipyretic administration rather than examining the full scope of possible intervention.
Background and Significance
Fever is an adaptive response of the host to a perceived threat and is frequently encountered by healthcare professionals. Instead of being an adaptive response, in the presence of an acute neurological insult such as stroke, fever has been associated with worsened outcomes, such as larger infarct volume, higher rates of mortality, and greater disability and dependence.1–6 The underlying mechanism for the secondary injury related to fever is the heightened inflammatory response induced by the elevation in temperature. This makes the blood–brain barrier more permeable to immune cells, leading to cerebral edema and neuronal death. Additionally, fever increases the production of free radicals, promoting glutamate release and resulting in excitotoxicity.6,7
Fever is seen in between 40% and 60% of patients after stroke.8,9 The American Heart Association (AHA) stroke guidelines state that maintenance of normothermia (T<99.6°F; 37.6°C) should be the standard of care.10 This point is echoed in the AHA Scientific Overview of Nursing and Interdisciplinary Care of the Ischemic Stroke Patient, which states that “Temperatures of >99.6°F should be managed aggressively” as a Class I recommendation (p. 2926).11 Similarly, the European Stroke Initiative recommends treating temperature >37.5°C.12 Nurses frequently must manage fever, and their decision-making is relevant …