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Impact of pyrexia on neurochemistry and cerebral oxygenation after acute brain injury

¹ Milan University, Neuroscience Intensive Care, Ospedale Policlinico IRCCS, Milan, Italy
² Neurosurgery Division, Ospedale Policlinico IRCCS

Correspondence to:
Correspondence to:
Professor Nino Stocchetti
Terapia Intensiva Neuroscienze, Ospedale Policlinico IRCCS Milano, Padiglione Beretta Neuro, Via F Sforza 35, 20122 Milan, Italy; stocchet{at}policlinico.mi.it

Background: Postischaemic pyrexia exacerbates neuronal damage. Hyperthermia related cerebral changes have still not been well investigated in humans.

Objective: To study how pyrexia affects neurochemistry and cerebral oxygenation after acute brain injury.

Methods: 18 acutely brain injured patients were studied at the onset and resolution of febrile episodes (brain temperature 38.7°C). Intracranial pressure (ICP), brain tissue oxygen tension (P_brO₂), and brain tissue temperature (T_br) were recorded continuously; jugular venous blood was sampled intermittently. Microdialysis probes were inserted in the cerebral cortex and in subcutaneous tissue. Glucose, lactate, pyruvate, and glutamate were measured hourly. The lactate to pyruvate ratio was calculated.

Results: Mean (SD) T_br rose from 38 (0.5) to 39.3 (0.3)°C. Arteriojugular oxygen content difference (AJDO₂) fell from 4.2 (0.7) to 3.8 (0.5) vol% (p<0.05) and P_brO₂ rose from 32 (21) to 37 (22) mm Hg (p<0.05). ICP increased slightly and no significant neurochemical alterations occurred. Opposite changes were recorded when brain temperature returned towards baseline.

Conclusions: As long as substrate and oxygen delivery remain adequate, hyperthermia on its own does not seem to induce any further significant neurochemical alterations. Changes in cerebral blood volume may, however, affect intracranial pressure.

Abbreviations: AJDO₂, arteriojugular oxygen content difference; CMRgluc, cerebral metabolic rate of glucose; CMRO₂, cerebral metabolic rate of oxygen; CPP, cerebral perfusion pressure; GCS, Glasgow coma scale; GOS, Glasgow outcome scale; ICP, intracranial pressure; MAP, mean arterial pressure; P_brO₂, brain tissue oxygen tension; SJO₂, jugular saturation at the superior jugular bulb; T_br, brain temperature

Keywords: brain temperature; oxygen tension; intracranial pressure; pyrexia

This article has been cited by other articles:

				J. Nortje and A. K. Gupta The role of tissue oxygen monitoring in patients with acute brain injury Br. J. Anaesth., July 1, 2006; 97(1): 95 - 106. [Abstract] [Full Text] [PDF]