Effects of Hyperthermia on Intracranial Pressure and Cerebral Autoregulation in Patients with an Acute Brain Injury.

Abstract

Hyperthermia is a common detrimental condition in patients with an acute brain injury (ABI), which can worsen their prognosis and outcome. The aim of this study was to evaluate the effects of hyperthermia on intracranial pressure (ICP) and cerebral autoregulation (CA).Eight patients with ABI were studied. CA was assessed on the basis of the pressure reactivity index (PRx) coefficient. The ICP, cerebral perfusion pressure (CPP), and PRx were compared before and during development of hyperthermia. Hyperthermia was defined as an increase in cerebral temperature above 38.3°C.Thirty-three episodes of hyperthermia were analyzed: 25 of these occurred on a background of initially normal ICP whereas 8 occurred on a background of initially elevated ICP, and 17 of the 33 episodes occurred on a background of initially intact autoregulation whereas 16 occurred on a background of initially impaired autoregulation.During hyperthermia, elevated ICP was found in 52% of instances where it was initially normal, and further progression of intracranial hypertension occurred in 100% of instances where ICP was initially elevated. The median ICP during hyperthermia was 24 [range quartiles 22-28] mmHg in instances where it was initially normal and 31 [quartiles 27-32] mmHg in instances where it was initially elevated (p<0.01). The correlation coefficient between the brain temperature and ICP was 0.11 (p<0.01). During hyperthermia, the number of episodes of ICP >20mmHg increased by 41% in instances with intact autoregulation but ICP was above 20 mmHg and by 38% (p>0.05) in instances with impaired autoregulation and ICP was 20 mmHg. The cerebral hyperthermia-associated increase in ICP was not associated with impaired autoregulation.