Cavazzoni Elena, Boakye Thomas
Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Westmead, Australia.
Children's Critical Care Unit, Gold Coast University Hospital, Gold Coast, Australia.
Ther Hypothermia Temp Manag. 2024 Dec;14(4):e316-e322. doi: 10.1089/ther.2022.0026. Epub 2022 Nov 10.
Hyperthermia exposure is associated with poor neurological outcomes in patients with severe traumatic brain injury (TBI). Our aim was to describe fever in children with severe TBI admitted to a pediatric intensive care unit (PICU) for at least 72 hours and to evaluate associations between fever using a novel approach to describe thermal exposure and neurobehavioral outcomes. The cohort included children from birth to 17 years of age admitted to the PICU between 2000 and 2012 for at least 72 hours who had severe TBI with intracranial pressure monitoring. Patients with non-accidental TBI or pre-existing developmental delays were excluded. Hyperthermia was defined as a core temperature >37.5°C. Hourly temperature measurements were used to calculate the area under the curve (AUC) using the linear trapezoidal rule. Each participant was followed up at the Brain Injury Clinic 6 and 18 months postinjury. Neurobehavioral outcome scores were analyzed against AUC using standard statistical methods. Ninety-eight patients admitted with severe TBI met the study inclusion criteria. Hyperthermia/fever was common (89.7%), and patients remained hyperthermic for a median of 9.4 hours. However, no statistically significant association was found between AUC and abnormal neurological outcomes. The follow-up rates were good at 6 (86.7%) and 18 months (83.7%). The neurological deficit improved with time, with "favorable outcomes" increasing from 72% to 94% at the respective follow-up months. Our study used a novel method to describe patients' fever, providing a different indicator of thermal exposure than that previously reported. In addition, the AUC was well correlated with the maximum temperature recorded and the proportion of time >37.5°C, indicating that it is a good surrogate for thermal exposure. Interestingly, the neurological disabilities of the patients improved over time.
高温暴露与重型颅脑损伤（TBI）患者不良神经学预后相关。我们的目的是描述入住儿科重症监护病房（PICU）至少72小时的重型TBI患儿的发热情况，并使用一种描述热暴露的新方法评估发热与神经行为预后之间的关联。该队列包括2000年至2012年间入住PICU至少72小时、患有重型TBI且进行颅内压监测的出生至17岁儿童。非意外性TBI或既往存在发育迟缓的患者被排除。体温过高定义为核心温度>37.5°C。使用线性梯形法则，通过每小时的体温测量值计算曲线下面积（AUC）。在脑损伤诊所对每位参与者在伤后6个月和18个月进行随访。使用标准统计方法分析神经行为预后评分与AUC的关系。98例重型TBI入院患者符合研究纳入标准。体温过高/发热很常见（89.7%），患者体温过高的中位时长为9.4小时。然而，未发现AUC与异常神经学预后之间存在统计学显著关联。6个月（86.7%）和18个月（83.7%）的随访率良好。神经功能缺损随时间改善，在各自的随访月份，“良好预后”从72%增至94%。我们的研究使用了一种新方法来描述患者的发热情况，提供了一种与先前报道不同的热暴露指标。此外，AUC与记录的最高温度以及>37.5°C的时间比例密切相关，表明它是热暴露的良好替代指标。有趣的是，患者的神经功能障碍随时间有所改善。
