Bohman Leif-Erik, Levine Joshua M
aDepartment of Neurosurgery bDepartment of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Curr Opin Crit Care. 2014 Apr;20(2):182-8. doi: 10.1097/MCC.0000000000000070.
Fever is common in the ICU among patients with severe brain injury. Fever has been consistently shown to exacerbate brain injuries in animal models and has been consistently associated with poor outcome in human studies. However, whether fever control improves outcome and the ideal means of fever control remain unknown. This review will address recent literature on the impact of fever on severe brain injury and on interventions to maintain normothermia.
Current guidelines generally recommend maintenance of normothermia after brain injury but have scant recommendations on methods to do this. Observational trials have continued to demonstrate the association between fever and poor outcome after severe brain injury. Recent trials have shown the efficacy of more aggressive approaches to fever reduction, whereas a large randomized trial showed the relative ineffectiveness of acetaminophen alone for fever control. Several studies have also described the impact of fever and of fever control on brain physiology.
The value of therapeutic normothermia in the neurocritical care unit (NCCU) is increasingly accepted, yet prospective trials that demonstrate a functional benefit to patients are lacking.
在重症监护病房（ICU）中，发热在重度脑损伤患者中很常见。在动物模型中，发热一直被证明会加重脑损伤，并且在人体研究中一直与不良预后相关。然而，控制发热是否能改善预后以及理想的发热控制方法仍不明确。本综述将探讨近期有关发热对重度脑损伤的影响以及维持正常体温干预措施的文献。
当前指南一般建议脑损伤后维持正常体温，但关于实现这一目标的方法却鲜有建议。观察性试验持续表明发热与重度脑损伤后的不良预后之间存在关联。近期试验显示了更积极的降温方法的有效性，而一项大型随机试验表明对乙酰氨基酚单独用于控制发热相对无效。多项研究还描述了发热及发热控制对脑生理学的影响。
治疗性正常体温在神经重症监护病房（NCCU）中的价值越来越被认可，但缺乏能证明对患者有功能益处的前瞻性试验。
