A Survey On Fever Monitoring and Management in Patients With Acute Brain Injury: The SUMMA Study

Background: Fever is common in patients with acute brain injury and worsens secondary brain injury and clinical outcomes. Currently, there is a lack of consensus on the definition of fever and its management. The aims of the survey were to explore: (a) fever definitions, (b) thresholds to trigger temperature management, and (c) therapeutic strategies to control fever. Materials and Methods: A questionnaire (26 items) was made available to members of the European Society of Intensive Care Medicine via its website between July 2016 and December 2016. Results: Among 231 respondents, 193 provided complete responses to the questionnaire (84%); mostly intensivists (n=124, [54%]). Body temperature was most frequently measured using a bladder probe (n=93, [43%]). A large proportion of respondents considered fever as a body temperature >38.3°C (n=71, [33%]). The main thresholds for antipyretic therapy were 37.5°C (n=74, [34%]) and 38.0°C (n=86, [40%]); however, lower thresholds (37.0 to 37.5°C) were targeted in cases of intracranial hypertension and cerebral ischemia. Among first-line methods to treat fever, ice packs were the most frequently utilized physical method (n=90, [47%]), external nonautomated system was the most frequent utilized device (n=49, [25%]), and paracetamol was the most frequently utilized drug (n=135, [70%]). Among second-line methods, intravenous infusion of cold fluids was the most frequently utilized physical method (n=68, [35%]), external computerized automated system was the most frequently utilized device (n=75, [39%]), and diclofenac was the most frequently utilized drug (n=62, [32%]). Protocols for fever control and shivering management were available to 83 (43%) and 54 (28%) of respondents, respectively. Conclusions: In this survey we identified substantial variability in fever definition and application of temperature management in acute brain injury patients. These findings may be helpful in promoting educational interventions and in designing future studies on this topic. E.P. and F.S.T. were involved in the study design, acquisition of data, analysis and interpretation of data, drafting of manuscript, and critical revision. M.O. was involved in study design, analysis and interpretation of data, drafting of manuscript, and critical revision. L.P. and R.H. were involved in study design, drafting of manuscript, and critical revision. F.S.T. is a lecturer for BARD. F.S.T. is the Chair of the Neuro-Intensive Care (NIC) section of the European Society of Intensive Care Medicine (ESICM). R.H. is a lecturer and received congress support from Bard and Zoll. R.H. is a steering committee member for the INTREPID study supported by Bard. L.P. is the Deputy Chair of the NIC section of the ESICM. The remaining authors have no funding or conflicts of interest to disclose. Address correspondence to: Edoardo Picetti, MD, Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100 Parma, Italy (e-mail: edoardopicetti@hotmail.com). Received March 9, 2018 Accepted August 16, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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