Stroke is one of the leading causes of disability in the United States, according to the American Stroke Association. Stroke happens when blood flow to the brain is disrupted, either by a blockage or bleeding, which can damage the brain and our ability to function. Fevers are common after strokes, and higher temperatures have been linked with worse outcomes.
STUDY OBJECTIVE
An international research team, led by David Greer, MD, MA, Richard B. Slifka Chief of Neurology at Boston Medical Center (BMC), tested whether trying to prevent fever with a temperature control device in acute stroke patients admitted to intensive care reduces the fever burden, defined as the time with a temperature of at least 100.2 °F, and improves patient outcomes. The INTREPID study (Impact of Fever Prevention in Brain Injured Patients) is the largest randomized clinical trial of temperature modulation in critically ill cerebrovascular patients.
DETAILS
The team treated 677 patients across 43 international sites in a randomized, controlled trial. The researchers assessed whether a temperature control device that regulates patients’ temperatures through an automated closed system using tightly adherent pads with water running through them could lower fever burden and improve outcomes if provided proactively to prevent fevers. The team monitored patient temperatures and shivering hourly.
FINDINGS
The researchers found that stroke patients treated proactively experienced half as much fever on average as those treated reactively after a fever occurred. However, after three months the treatment didn't significantly improve functional or cognitive outcomes.
IMPACT
“The INTREPID study demonstrated that fever prevention is both feasible and effective in the ICU setting using a temperature control device. We are now focused on investigating whether fever prevention improves functional outcomes in patients who have a higher likelihood of developing fever so we can enhance patient recovery and quality of life,” says Greer, who is also professor and chair of neurology at Boston University Chobanian & Avedisian School of Medicine.
Source: Greer, D.M; Helbok, R; Badjatia, N.; Ko, S.; Guanci, M.M.; and Sheth, K. (2024) “Fever Prevention in Patients With Acute Vascular Brain Injury.” JAMA. doi:10.1001/jama.2024.14745