Zawadzka Marta, Szmuda Marta, Mazurkiewicz-Bełdzińska Maria
Department of Developmental Neurology, Chair of Neurology, Medical University of Gdansk, Poland.
Anaesthesiol Intensive Ther. 2017;49(3):227-234. doi: 10.5603/AIT.2017.0042.
Fever is a common symptom in the Intensive Care Unit. At least half of febrile episodes are caused by infection. Excluding infectious etiology and other non-infectious causes of fever, especially in patients with central nervous system (CNS) disorders, attention should be paid to disturbances of thermoregulatory centre. In particular, subarachnoid haemorrhage, cerebral trauma, along with ischaemic or haemorrhagic stroke are strongly associated with the development of central fever. Proper, speedy diagnosis of the cause of fever makes it possible to implement preventive measures against the harmful effects of hyperthermia on the CNS and to avoid the consequences of inappropriate treatment. The aim of this review is to present the current treatment options for the management of central fever and to analyze recent recommendations for the treatment of hyperthermia, including the use of hypothermia. The recommendations of American and European associations are inconsistent, mainly due to the lack of randomized clinical trials confirming the effectiveness of such treatment. The diagnosis of central fever is still made by the exclusion of other causes. The authors of the review intended to present the characteristic features of central fever, differentiating this state from infectious fever and also analyze the presence of central fever in particular neurological diseases. It seems particularly important to establish diagnostic criteria for central fever or to find diagnostic markers. It is also necessary to conduct further randomized clinical trials evaluating the indications for treatment of hyperthermia.
发热是重症监护病房的常见症状。至少一半的发热发作是由感染引起的。排除感染性病因及其他非感染性发热原因，尤其是在患有中枢神经系统（CNS）疾病的患者中，应注意体温调节中枢的紊乱。特别是蛛网膜下腔出血、脑外伤以及缺血性或出血性中风与中枢性发热的发生密切相关。对发热原因进行正确、快速的诊断，有助于实施预防措施，防止体温过高对中枢神经系统产生有害影响，并避免不恰当治疗的后果。本综述的目的是介绍目前治疗中枢性发热的选择，并分析近期关于治疗体温过高（包括使用低温疗法）的建议。美国和欧洲协会的建议并不一致，主要是因为缺乏随机临床试验来证实这种治疗的有效性。中枢性发热的诊断仍然是通过排除其他原因来进行的。该综述的作者旨在介绍中枢性发热的特征，将这种状态与感染性发热区分开来，并分析特定神经系统疾病中中枢性发热的存在情况。建立中枢性发热的诊断标准或找到诊断标志物似乎尤为重要。还需要进行进一步的随机临床试验，以评估体温过高的治疗指征。
