Fever control in the neuro-ICU: why, who, and when?

Abstract

Fever in the neurocritical care setting is very common and has a negative impact on outcome of all disease types. Recent advances have made eliminating fever and maintaining normothermia feasible. However, important questions regarding indications and timing remain. The purpose of this review is to analyze the data surrounding the impact of fever across a range of neurologic injuries to better understand the optimal timing and duration of fever control. Meta-analyses have demonstrated that fever at onset and in the acute setting after ischemic brain injury, intracerebral hemorrhage, and cardiac arrest have a negative impact on morbidity and mortality. There are data to support that the impact of fever is sustained for longer durations after subarachnoid hemorrhage and traumatic brain injury. However, there are currently no prospective randomized trials demonstrating the benefit of fever control in these patient populations. The negative impact of fever after neurologic injury is well understood. Prospective randomized trials are needed to determine whether the beneficial impact of secondary injury prevention is outweighed by the potential infectious risk of prolonged fever control.