From the Guidelines
Hyperthermia is a poor prognostic indicator because it is associated with increased morbidity and mortality in patients with acute ischemic stroke, as evidenced by a 2-fold increase in short-term mortality in patients with hyperthermia within the first 24 hours of hospitalization 1.
Key Points
- Hyperthermia is a frequent complication in up to 50% of patients with acute ischemic stroke and has been shown to be associated with poor outcome 1.
- The negative effects of hyperthermia may be mediated by increased production of excitotoxins and oxygen radicals, destabilization of cellular membranes, and abnormal electrical depolarizations 1.
- Treatment of hyperthermia is a rational choice to reduce temperature and relieve the symptom of discomfort associated with hyperthermia, but existing data are limited to show any effect on hard clinical outcomes like functional outcome or mortality 1.
Management
- Administration of antipyretics to reduce temperature in a hyperthermic patient and clinical examination and investigation to identify the cause of fever are standard of care worldwide in routine clinical practice 1.
- Rapid cooling measures, such as ice packs, cooling blankets, and cold IV fluids, may be used to lower body temperature, but the effectiveness of these measures in improving outcomes is unclear 1.
Evidence
- A large, 2500-patient, randomized, double-blind, placebo-controlled trial evaluating whether early treatment with acetaminophen improved functional outcome by reducing body temperature and fever prevention found no statistical difference between groups 1.
- A meta-analysis of the relationship of hyperthermia and stroke mortality in patients with acute stroke demonstrated a 2-fold increase in short-term mortality in patients with hyperthermia within the first 24 hours of hospitalization 1.
From the Research
Hyperthermia as a Poor Prognostic Indicator
Hyperthermia is considered a poor prognostic indicator due to its potential to cause severe complications and worsen patient outcomes. Some key points to consider include:
- Hyperthermia can affect almost all endogenous regulatory systems, leading to life-threatening complications, particularly in the cardiovascular and central nervous systems 2.
- Malignant hyperthermia, a rare but potentially lethal disease, can lead to cardiac arrest and requires prompt treatment, including the use of extracorporeal membrane oxygenation in severe cases 3.
- In critically ill patients, hyperthermia can lead to increased metabolic demands, and evidence-based guidelines for temperature management are still lacking 4.
- Moderate elevations of brain temperature can worsen injury after ischemia or trauma, and maintaining normothermic levels is crucial in acute cerebral ischemia or traumatic brain injury 5.
- Malignant hyperthermia can occur in the intensive care unit, even in patients who have not recently undergone surgery, and requires prompt recognition and treatment by critical care nurses 6.
Clinical Implications
The clinical implications of hyperthermia as a poor prognostic indicator include:
- The need for diligent monitoring of patients for incipient fever and prompt measures to maintain core-body temperature at normothermic levels 5.
- The potential for hyperthermia to worsen patient outcomes, particularly in acute stroke and traumatic brain injury 5.
- The importance of recognizing and treating malignant hyperthermia promptly, even in atypical cases 6.
- The need for further research into the pathophysiology and management of hyperthermia, particularly in critically ill patients 2, 4.