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Fever control and application of hypothermia using intravenous cold saline

Fink, Ericka L. MD; Kochanek, Patrick M. MD, FCCM; Clark, Robert S. B. MD; Bell, Michael J. MD

Pediatric Critical Care Medicine: January 2012 - Volume 13 - Issue 1 - p 80–84
doi: 10.1097/PCC.0b013e3181fe27c7
Neurocritical Care

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.

Measurements and Main Results: Eighteen subjects accounted for 20 infusions with mean infusion volume 18 ± 10 mL/kg. Eight subjects had traumatic brain injury, two had intracranial hemorrhage, six had cardiac arrest, and one each had ischemic stroke and status epilepticus. The mean age was 9.5 ± 4.8 yrs. Temperature decreased from 38.7 ± 1.1°C to 37.7 ± 1.2°C and from 37.0 ± 2.0°C to 35.3 ± 1.6°C 1 hr after infusion for fever (n = 14; p < .05) or hypothermia induction (n = 6; p = .05), respectively. Cold saline was not bloused but rather infused over 10–15 mins. Mean arterial blood pressure and oxygenation parameters (PaO2/FIO2 ratio, mean airway pressure) were unchanged, but heart rate decreased in those with hypothermia (121 ± 4 beats per minute vs. 109 ± 12 beats per minute; p < .05). Serum sodium concentration and international normalized ratio were significantly increased after cold saline infusion. There were no differences between preinfusion and postinfusion serum glucose and hematocrit, or between cerebral perfusion pressure and intracranial pressure in traumatic brain injury patients.

Conclusions: Cold saline was an effective method of reducing temperature in children with acute brain injury. This approach can be considered to treat fever or to induce hypothermia. A prospective study comparing safety and efficacy vs. other cooling measures should be considered.

From the Department of Critical Care Medicine (ELF, PMK, RSBC, MJB) and the Safar Center for Resuscitation Research (ELF, PMK, RSBC, MJB), University of Pittsburgh School of Medicine and the Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA.

Supported, in part, by National Institutes of Health grants 1K23NS065132, 5K12HD047349, and NS052478; and The Laerdal Foundation.

The authors have not disclosed any potential conflicts of interest.

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©2012The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies