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

Stephan A. Mayer*, Robert G. Kowalski, Mary Presciutti, Noeleen D. Osiapkovich, Elaine McGann, Brian Fred Fitzsimmons, Dileep R. Yavagal, Y. Evelyn Du, Andrew M. Naidech, Nazli A. Janjua, Jan Claassen, Kurt T. Kreiter, Augusto Parra, Christopher Commichau

*Corresponding author for this work

Research output: Contribution to journalArticle

165 Scopus citations

Abstract

Objective: To compare the efficacy of a nosel 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 subaractinoid hemorrhage (60%), cerebral infarction (23%), infracerebral 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. 8.3 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.

Original languageEnglish (US)
Pages (from-to)2508-2515
Number of pages8
JournalCritical Care Medicine
Volume32
Issue number12
DOIs
StatePublished - Dec 1 2004

Keywords

  • Cooling blankets
  • Fever
  • Intracerebral hemorrhage
  • Stroke
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Mayer, S. A., Kowalski, R. G., Presciutti, M., Osiapkovich, N. D., McGann, E., Fitzsimmons, B. F., Yavagal, D. R., Du, Y. E., Naidech, A. M., Janjua, N. A., Claassen, J., Kreiter, K. T., Parra, A., & Commichau, C. (2004). Clinical trial of a novel surface cooling system for fever control in neurocritical care patients. Critical Care Medicine, 32(12), 2508-2515. https://doi.org/10.1097/01.CCM.0000147441.39670.37