{"id":26878,"date":"2024-11-20T04:48:00","date_gmt":"2024-11-19T20:48:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=26878"},"modified":"2024-11-20T05:52:19","modified_gmt":"2024-11-19T21:52:19","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e9%a2%84%e9%98%b2%e6%80%a5%e6%80%a7%e8%a1%80%e7%ae%a1%e6%80%a7%e8%84%91%e6%8d%9f%e4%bc%a4%e6%82%a3%e8%80%85%e5%8f%91%e7%83%ad","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=26878","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u9884\u9632\u6025\u6027\u8840\u7ba1\u6027\u8111\u635f\u4f24\u60a3\u8005\u53d1\u70ed"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

September 25, 2024<\/p>\n\n\n\n

Fever Prevention in Patients With Acute Vascular Brain Injury: The INTREPID Randomized Clinical Trial<\/h1>\n\n\n\n

David M. Greer, Raimund Helbok, Neeraj Badjatia, et al<\/h3>\n\n\n\n

JAMA. <\/em>Published online September 25, 2024. doi:10.1001\/jama.2024.14745<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Is an automated surface temperature management device effective in prevention of fever in patients with acute vascular brain injury, and does it improve functional outcomes compared with standard fever care?<\/p>\n\n\n\n

Findings<\/strong>  In this randomized clinical trial of 677 critically ill patients with stroke, temperature modulation significantly reduced daily mean fever burden compared with standard fever care (0.37 \u00b0C-hour vs 0.73 \u00b0C-hour), but there was no significant difference in functional outcomes at 3 months.<\/p>\n\n\n\n

Meaning<\/strong>  Fever prevention in patients with acute vascular brain injury using an automated surface temperature management device reduced fever burden but did not improve functional outcomes.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Fever is associated with worse outcomes in patients with stroke, but whether preventing fever improves outcomes is unclear.<\/p>\n\n\n\n

Objective<\/strong>  To determine whether fever prevention after acute vascular brain injury is achievable and impacts functional outcome.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  Open-label randomized clinical trial with blinded outcome assessment that enrolled 686 of 1176 planned critically ill patients with stroke at 43 intensive care units in 7 countries from March 2017 to April 2021 (last date of follow-up was May 12, 2022).<\/p>\n\n\n\n

Intervention<\/strong>  Patients randomized to fever prevention (n\u2009=\u2009339) were targeted to 37.0 \u00b0C for 14 days or intensive care unit discharge using an automated surface temperature management device. Standard care patients (n\u2009=\u2009338) received standardized tiered fever treatment on occurrence of temperature of 38 \u00b0C or greater.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  Primary outcome was daily mean fever burden: the area under the temperature curve above 37.9 \u00b0C (total fever burden) divided by the total number of hours in the acute phase, multiplied by 24 hours (\u00b0C-hour). The principal secondary outcome was 3-month functional recovery by shift analysis of the 6-category modified Rankin Scale, which is scored from 0 (no symptoms) to 6 (death). Major adverse events included death, pneumonia, sepsis, and malignant cerebral edema.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Enrollment was stopped after a planned interim analysis demonstrated futility of the principal secondary end point. In total, 686 patients were enrolled, and 9 were consented but not randomized, leaving a primary analysis population of 677 patients (254 ischemic stroke, 223 intracerebral hemorrhage, 200 subarachnoid hemorrhage; 345 were female [51%]; median age, 62 years) with 433 (64%) completing the study through 12 months. Daily mean (SD) fever burden was significantly lower in the fever prevention group (0.37 [1.0] \u00b0C-hour; range, 0.0-8.0 \u00b0C-hour) compared with the standard care group (0.73 [1.1] \u00b0C-hour; range, 0.0-10.3 \u00b0C-hour) (difference, \u22120.35 [95% CI, \u22120.51 to \u22120.20];\u00a0P<\/em>\u2009<\u2009.001). Between-group differences for the primary outcome by stroke subtype were \u22120.10 (95% CI, \u22120.35 to 0.15) for ischemic stroke, \u22120.50 (95% CI, \u22120.78 to \u22120.22) for intracerebral hemorrhage, and \u22120.52 (95% CI, \u22120.81 to \u22120.23) for subarachnoid hemorrhage (all\u00a0P<\/em>\u2009<\u2009.001 by Wilcoxon rank-sum test). There was no significant difference in functional recovery at 3 months (median modified Rankin Scale score, 4.0 vs 4.0, respectively; odds ratio for a favorable shift in functional outcome, 1.09 [95% CI, 0.81 to 1.46];\u00a0P<\/em>\u2009=\u2009.54). Major adverse events occurred in 82.2% of participants in the fever prevention group vs 75.9% in the standard care group, including 33.8% vs 34.5% for infections, 14.5% vs 14.0% for cardiac disorders, and 24.5% vs 20.5% for respiratory disorders.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In patients with acute vascular brain injury, preventive normothermia using an automated surface temperature management device effectively reduced fever burden but did not improve functional outcomes.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT02996266<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  September 25, 20 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26878"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=26878"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26878\/revisions"}],"predecessor-version":[{"id":27253,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26878\/revisions\/27253"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26878"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=26878"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=26878"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}