Critical Care Medicine

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Critical Care Medicine:
doi: 10.1097/01.CCM.0000147441.39670.37
Neurologic Critical Care

Clinical trial of a novel surface cooling system for fever control in neurocritical care patients*

Mayer, Stephan A. MD; Kowalski, Robert G. BS; Presciutti, Mary RN; Ostapkovich, Noeleen D. MS; McGann, Elaine RN; Fitzsimmons, Brian-Fred MD; Yavagal, Dileep R. MD; Du, Y Evelyn PhD; Naidech, Andrew M. MD; Janjua, Nazli A. MD; Claassen, Jan MD; Kreiter, Kurt T. PhD; Parra, Augusto MD; Commichau, Christopher MD

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Objective: To compare the efficacy of a novel water-circulating surface cooling system with conventional measures for treating fever in neuro-intensive care unit patients.

Design: Prospective, unblinded, randomized controlled trial.

Setting: Neurologic intensive care unit in an urban teaching hospital.

Patients: Forty-seven patients, the majority of whom were mechanically ventilated and sedated, with fever ≥38.3°C for >2 consecutive hours after receiving 650 mg of acetaminophen.

Interventions: Subjects were randomly assigned to 24 hrs of treatment with a conventional water-circulating cooling blanket placed over the patient (Cincinnati SubZero, Cincinnati OH) or the Arctic Sun Temperature Management System (Medivance, Louisville CO), which employs hydrogel-coated water-circulating energy transfer pads applied directly to the trunk and thighs.

Measurements and Main Results: Diagnoses included subarachnoid hemorrhage (60%), cerebral infarction (23%), intracerebral hemorrhage (11%), and traumatic brain injury (4%). The groups were matched in terms of baseline variables, although mean temperature was slightly higher at baseline in the Arctic Sun group (38.8 vs. 38.3°C, p = .046). Compared with patients treated with the SubZero blanket (n = 24), Arctic Sun-treated patients (n = 23) experienced a 75% reduction in fever burden (median 4.1 vs. 16.1 C°-hrs, p = .001). Arctic Sun-treated patients also spent less percent time febrile (T ≥38.3°C, 8% vs. 42%, p < .001), spent more percent time normothermic (T ≤37.2°C, 59% vs. 3%, p < .001), and attained normothermia faster than the SubZero group median (2.4 vs. 8.9 hrs, p = .008). Shivering occurred more frequently in the Arctic Sun group (39% vs. 8%, p = .013).

Conclusion: The Arctic Sun Temperature Management System is superior to conventional cooling-blanket therapy for controlling fever in critically ill neurologic patients.

© 2004 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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