Griffiths Stephen A, Ahmad Javaad, Francoeur Charles L, Gordon Errol, Dangayach Neha S, Wheelwright Danielle, Ramineni Anil, Mayer Stephan A
Mount Sinai Hospital Neuro-ICU, Neurocritical Care Division, Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Mount Sinai Hospital Neuro-ICU, Neurocritical Care Division, Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Clin Neurol Neurosurg. 2019 Sep;184:105412. doi: 10.1016/j.clineuro.2019.105412. Epub 2019 Jul 2.
Fever occurs in up to 50% of critically-ill patients with acute neurological injury. Small temperature elevations have been correlated with increased morbidity and mortality in this patient population. We sought to evaluate a novel single-use surface cooling system for the treatment of fever in patients with acute brain injury.
We conducted a retrospective analysis of a prospective product evaluation using the EMCOOLS Flex.Pad™ system for acute fever (≥38.3 °C) in our 16-bed neuro-ICU. Four refrigerated pads (-18 °C) were applied to the chest, back, and anterior thighs. Core temperature (bladder) was continuously recorded over 4 h, and the highest Bedside Shivering Assessment Scale (BSAS) score was recorded hourly.
Twelve subjects were included in the analysis. Mean age was 55 ± 9 years, 9 patients were men, and mean weight was 85 ± 12 kg. The most common primary diagnoses were subarachnoid (N = 5) and intracerebral (N = 4) hemorrhage. Application of the EMCOOLS system resulted in a linear 1.3 ± 0.6 °C drop (T = 38.9 ⁰C, T = 37.6 ⁰C, P = 0.0032) in mean temperature over 90 min, followed by a plateau with only one subject rebounding to >38 °C within 4 h. Normothermia (<38.0 ⁰C) was achieved in all but one patient (92%) in an average of 65 min. Comatose patients displayed a non-significantly higher degree of cooling at 90 min than did awake subjects (ΔT = 1.74 °C vs ΔT = 0.74 °C hr, P = 0.067). There was no observed skin irritation upon removal of the device for any patients.
The EMCOOLs system is a well-tolerated, safe and effective short-term intervention for control of fever in neurological patients. Future studies are needed to compare efficacy of the EMCOOLs to other devices and interventions.
在急性神经损伤的重症患者中，发热发生率高达50%。体温小幅升高与该患者群体的发病率和死亡率增加相关。我们旨在评估一种新型一次性表面冷却系统用于治疗急性脑损伤患者的发热情况。
我们对在拥有16张床位的神经重症监护病房中使用EMCOOLS Flex.Pad™系统治疗急性发热（≥38.3°C）的前瞻性产品评估进行了回顾性分析。将四个冷藏垫（-18°C）敷于胸部、背部和大腿前部。连续4小时记录核心温度（膀胱温度），并每小时记录最高床边寒战评估量表（BSAS）评分。
12名受试者纳入分析。平均年龄为55±9岁，9例为男性，平均体重为85±12kg。最常见的主要诊断为蛛网膜下腔出血（N = 5）和脑内出血（N = 4）。应用EMCOOLS系统后，平均体温在90分钟内呈线性下降1.3±0.6°C（T = 38.9°C，T = 37.6°C，P = 0.0032），随后趋于平稳，4小时内仅有1名受试者体温回升至>38°C。除1例患者外，所有患者（92%）平均在65分钟内实现体温正常（<38.0°C）。昏迷患者在90分钟时的降温程度比清醒受试者略高，但无显著差异（ΔT = 1.74°C vs ΔT = 0.74°C/小时，P = 0.067）。移除设备后，未观察到任何患者出现皮肤刺激。
EMCOOLs系统是一种耐受性良好、安全有效的控制神经科患者发热的短期干预措施。未来需要进行研究以比较EMCOOLs与其他设备和干预措施的疗效。
