Fever Prevention in Patients with Acute Vascular Brain Injury

Results from the INTREPID (NCT02996266) clinical trial have revealed that an automated surface temperature management device effectively reduces fever burden in patients with acute vascular brain injury but fails to improve functional outcomes after 3 months compared to standard fever care. 

Researchers randomized 677 critically ill stroke patients (median age 62 years) across 43 intensive care units (ICUs) in 7 countries into fever prevention (n=339) or standard care (n=338) groups. Prevention patients were fitted with the Arctic Sun Temperature Management System (BD, Franklin Lakes, NJ), an automated device targeting 37.0°C for 14 days or until ICU discharge, while standard care patients were provided tiered fever treatment, including intermittent antipyretics, cooling blankets, and, when necessary, advanced temperature management devices, for temperatures ≥38°C. 

Results showed a significantly lower daily mean fever burden (°C-hour) in the prevention group (0.37 °C-hour; range, 0.0–8.0) compared to the standard care group (0.73 °C-hour; range, 0.0–10.3) (difference, -0.35 [95% CI, -0.51 to -0.20]; P<.001). Subgroup analyses revealed significant reductions in fever burden across all stroke subtypes (P<.001).

Despite effective fever reduction, there was no significant difference in functional recovery at 3 months as measured by the modified Rankin Scale (mRS) (median score 4.0 in both groups; odds ratio for favorable shift, 1.09 [95% CI, 0.81 to 1.46]; P=.54).

Major adverse events occurred in 82.2% of the prevention group versus 75.9% in the standard care group, including 

-Infections (33.8% vs 34.5%)

-Cardiac disorders (14.5% vs 14.0%)

-Respiratory disorders (24.5% vs 20.5%)

Additional details may be found in the complete article available in JAMA.