Mayer Stephan A, Kowalski Robert G, Presciutti Mary, Ostapkovich Noeleen D, McGann Elaine, Fitzsimmons Brian-Fred, Yavagal Dileep R, Du Y Evelyn, Naidech Andrew M, Janjua Nazli A, Claassen Jan, Kreiter Kurt T, Parra Augusto, Commichau Christopher
Neurological Intensive Care Unit, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Crit Care Med. 2004 Dec;32(12):2508-15. doi: 10.1097/01.ccm.0000147441.39670.37.
To compare the efficacy of a novel water-circulating surface cooling system with conventional measures for treating fever in neuro-intensive care unit patients.
Prospective, unblinded, randomized controlled trial.
Neurologic intensive care unit in an urban teaching hospital.
Forty-seven patients, the majority of whom were mechanically ventilated and sedated, with fever > or =38.3 degrees C for >2 consecutive hours after receiving 650 mg of acetaminophen.
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.
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 degrees 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 degrees -hrs, p = .001). Arctic Sun-treated patients also spent less percent time febrile (T > or =38.3 degrees C, 8% vs. 42%, p < .001), spent more percent time normothermic (T < or =37.2 degrees 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).
The Arctic Sun Temperature Management System is superior to conventional cooling-blanket therapy for controlling fever in critically ill neurologic patients.
比较一种新型水循环表面冷却系统与传统措施治疗神经重症监护病房患者发热的疗效。
前瞻性、非盲、随机对照试验。
城市教学医院的神经重症监护病房。
47例患者，大多数接受机械通气和镇静，在服用650mg对乙酰氨基酚后连续2小时以上发热≥38.3℃。
将受试者随机分为两组，一组使用置于患者身上的传统水循环冷却毯（辛辛那提零下公司，俄亥俄州辛辛那提）进行24小时治疗，另一组使用北极太阳温度管理系统（美迪凡斯公司，科罗拉多州路易斯维尔），该系统采用直接贴于躯干和大腿的水凝胶涂层水循环能量传递垫。
诊断包括蛛网膜下腔出血（60%）、脑梗死（23%）、脑出血（11%）和创伤性脑损伤（4%）。两组在基线变量方面匹配，尽管北极太阳组的基线平均温度略高（38.8℃对38.3℃，p = 0.046）。与使用零下冷却毯治疗的患者（n = 24）相比，使用北极太阳治疗的患者（n = 23）发热负担降低了75%（中位数4.1对16.1℃-小时，p = 0.001）。使用北极太阳治疗的患者发热时间百分比也更低（T≥38.3℃，8%对42%，p < 0.001），体温正常时间百分比更高（T≤37.2℃，59%对3%，p < 0.001），且达到体温正常的速度比零下组中位数更快（2.4对8.9小时，p = 0.008）。北极太阳组寒战发生频率更高（39%对8%，p = 0.013）。
北极太阳温度管理系统在控制重症神经科患者发热方面优于传统冷却毯疗法。
