Analgosedierte / beatmete Patienten
Fever, defined as elevation of body core temperature 38°C, is common in critically ill patients.1,2
More than 80% of all neuro-intensive care unit (ICU) patients will develop at least 1 febrile episode during hospitalization.3,4
Importantly, it has been shown that even elevation of brain temperature alone is markedly deleterious in the setting of intracranial pathology, such as ischemic stroke or intracerebral hemorrhage (ICH).5–7
All of these aspects suggest that it might be beneficial to start treatment of fever in patients with severe brain injury at an early stage or even to maintain normothermia prophylactically.
In many diseases, fever is an independent predictor of unfavorable outcome, and therefore, early treatment of hyperthermia has nowadays become the standard of care.2,6,8–10
Although short-term hypothermia is nowadays considered to improve outcome in patients after resuscitation from cardiac arrest, data on prolonged hypothermia in patients with acute intracranial pathology are controversial. 21
Because severe adverse effects of mild to moderate hypothermia (ie, body core temperature 33°C to 35°C) may outweigh its beneficial effects in ICU patients with various diseases, the use of therapeutic hypothermia is under debate. 25, 26
Clinical rationale for tempedy:
Cooling with “feedback devices” is more efficient compared to conventional methods (cold air, ice packs etc.). 11
As all patients will require infusions anyway, hence tempedy® as an automatic infusion system can easily be implemented into the multimodal ICU treatment approach and facilitate fever therapy as well as prophylactic normothermia strategies.
Peripheral infusions of saline in chilled form can be used as an adjunct therapy to achieve euthermia and control fever. Temperature modulation with tempered fluids is a proven and accepted method, also as e.g. cold infusions also are effective for treatment of refractory fever (elevated temperature despite acetaminophen and cooling blanket application; Neurology 2006; 66; 1739-1741). The temperature modulating efficacy and safety of cold crystalloid fluids have been extensively studied also in the area of cardiac arrest; in this indication, patients were cooled very rapidly with rates of up to -4.0°C/h. 12
Using intravenous coolants in an on-demand, temperature-guided and supervised treatment setting seems most reasonable to avoid potentially unsafe use of extended fluid volumes and infusion times. 13
Furthermore tempedy is an highly effective intravascular approach, yet there is not an increasing risk for thromboembolic events which is present in other modalities (e.g. Mueller et al in Neurocrit Care. 2014 Oct;21(2):207-10; Risk of thromboembolic events (TEE) - patients in the ECC group suffered more frequently from TEE (37 %) than those with a Central-Venous-Line CVL (5 %) .
There is an ongoing debate and clinical indicators that surface approaches have higher rates of shivering and hence require aggressive shivering control measures / more sedation and higher doses of paralytics
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independently contributes to increased length of stay in neurologic
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2. Diringer MN. Treatment of fever in the neurologic intensive care unit
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stroke severity, infarct size, mortality, and outcome. Lancet. 1996;347:
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12. KIiegel, Resuscitation 2007, 46-53
13. Rosengart AJ, J Clin Neurosci. 2009 Jan;16(1):51-5