What is the treatment for central fever?

From the Guidelines

The treatment for central fever should prioritize controlled normothermia, targeting a temperature range of 36.0-37.5 °C, as recommended in the setting of neurogenic fever developing in comatose patients with acute traumatic encephalopathies 1.

Key Considerations

• Central fever, also known as neurogenic fever, is common in intensive care and is associated with an increased risk of complications and unfavorable outcomes 1.
• Differentiating central fever from fever of infectious origin is crucial, as failing to identify a treatable condition can have significant consequences 1.
• The development of fever in traumatic brain injury (TBI) cases can precipitate secondary brain injury and adversely affect patient outcome, making it essential to prevent or promptly treat fever when detected 1.

Treatment Approach

• Controlled normothermia is the primary treatment approach, aiming to maintain a temperature range of 36.0-37.5 °C 1.
• Antipyretic medications, such as acetaminophen or ibuprofen, may be used to reduce fever, but their routine use is not recommended unless the patient values comfort by reducing temperature 1.
• External cooling methods, like cooling blankets or ice packs, can help lower body temperature.
• Maintaining adequate hydration is essential, often requiring intravenous fluids in hospitalized patients.

Underlying Condition Management

• The underlying neurological condition causing central fever must be treated simultaneously, which may involve:
  • Neurosurgical interventions for traumatic brain injuries
  • Anticonvulsants for seizure disorders
  • Appropriate management of stroke or infections

Monitoring and Multimodal Approach

• Close monitoring of neurological status and temperature is crucial throughout treatment.
• A multimodal approach is necessary, as central fever may not respond as well to standard antipyretics due to the dysfunction in the hypothalamus, which normally regulates body temperature 1.

From the FDA Drug Label

Use temporarily relieves minor aches and pains due to: ... temporarily reduces fever Purpose Pain reliever/fever reducer

The treatment for central fever may include acetaminophen (PO), which is a pain reliever/fever reducer.

• Key benefits: temporarily reduces fever
• Important consideration: the FDA label does not explicitly state that acetaminophen is used to treat central fever, only that it reduces fever 2 2

From the Research

Treatment of Central Fever

The treatment of central fever, also known as neurogenic fever, is a complex process that requires careful consideration of the underlying cause and the patient's overall condition.

• The use of antipyretic medications, such as paracetamol or ibuprofen, is a common approach to managing fever in patients with central fever 3.
• However, the effectiveness of these medications can vary depending on the underlying cause of the fever and the patient's individual response to treatment 4.
• In some cases, more advanced cooling methods, such as catheter-based heat exchange systems, may be necessary to effectively manage fever in patients with central fever 5.
• The mechanisms of action of antipyretic medications, including their ability to inhibit the enzyme cyclooxygenase and reduce the levels of prostaglandin E(2) within the hypothalamus, are important considerations in the treatment of central fever 6.
• Additionally, the potential risks and benefits of antipyretic medication, including the potential for adverse effects and the impact on the patient's immune response, must be carefully weighed in the treatment of central fever 7.

Key Considerations

When treating central fever, it is essential to consider the following key factors:

• The underlying cause of the fever: Identifying and addressing the underlying cause of the fever is critical to effective treatment.
• The patient's overall condition: The patient's age, medical history, and current condition must be taken into account when selecting a treatment approach.
• The potential risks and benefits of treatment: The potential risks and benefits of antipyretic medication and other treatment approaches must be carefully weighed to ensure the best possible outcome for the patient.
• The need for advanced cooling methods: In some cases, more advanced cooling methods, such as catheter-based heat exchange systems, may be necessary to effectively manage fever in patients with central fever.