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Fever

Prolonged fever is the common complication in neurosurgical patients. The risks of prolonged fever in patients are attributed to antibiotic therapy, use of central venous catheter and prolonged mechanical ventilation. Indicators of prolonged fever are helpful for better identification of high-risk patients and fever control 1).

Etiology

Fever is a common occurrence in aneurysmal subarachnoid hemorrhage (70%) especially in poor grades, contributes to adverse outcome and may not always respond to conventional treatment 2).

Development of clinical triad of fever, vomiting, and headache in cases of chronic suppurative otitis media (CSOM) suggest the intracranial spread of infective pathology.

Fever occurs frequently in acute brain injury patients, and its occurrence is associated with poorer outcomes, leading to higher rates of mortality, greater disability, and longer lengths of stay. Although clinical practice guidelines exist for ischemic stroke, subarachnoid hemorrhage, and traumatic brain injury, they lack specificity in their recommendations for fever management, making it difficult to formulate appropriate protocols for care. Using survey methods, the aims of a study were to (a) describe how nursing practices for fever management in this population have changed over the last several years, (b) assess if institutional protocols and nursing judgment follow published national guidelines for fever management in neuroscience patients, and © explore whether nurse or institutional characteristics influence decision making. Compared with the previous survey administered in 2007, there was a small increase (8%) in respondents reporting having an institutional fever protocol specific to neurologic patients. Temperatures to initiate treatment either based on protocols or nurse determination did not change from the previous survey. However, nurses with specialty certification and/or working in settings with institutional awards (e.g., Magnet status or Stroke Center Designation) initiated therapy at a lower temperature.

Treatment

Oral acetaminophen continues to be the primary choice for fever management, followed by ice packs and fans. This study encourages the development of a stepwise approach to neuro-specific protocols for fever management. Furthermore, it shows the continuing need to promote further education and specialty training among nurses and encourage collaboration with physicians to establish best practices 3).

Case series

2016

Among 2845 patients, prolonged fever occurred in 466 (16%). The older patients were associated with longer duration of mechanical ventilation and length of stay. It was predominantly occurred in patients with subarachnoid hemorrhage (SAH) and traumatic brain injury. Patients receiving antibiotic treatment tended to manifest prolonged fever more frequently. Multivariate analysis revealed that the use of antibiotics, central venous catheter and prolonged mechanical ventilation were independent risk predictors for prolonged fever. Patients diagnosed with brain tumor seemed to be not associated with prolonged fever.

Prolonged fever is the common complication in neurosurgical patients. The risks of prolonged fever in patients are attributed to antibiotic therapy, use of central venous catheter, and prolonged mechanical ventilation. Indicators of prolonged fever are helpful for better identification of high-risk patients and fever control. 4).

1) , 4)
Wang Z, Shen M, Qiao M, Zhang H, Tang Z. Clinical factors and incidence of prolonged fever in neurosurgical patients. J Clin Nurs. 2016 May 30. doi: 10.1111/jocn.13409. [Epub ahead of print] PubMed PMID: 27240113.
2)
Rose MJ. Aneurysmal subarachnoid hemorrhage: An update on the medical complications and treatments strategies seen in these patients. Curr Opin Anaesthesiol. 2011;24:500–7.
3)
Rockett H, Thompson HJ, Blissitt PA. Fever management practices of neuroscience nurses: what has changed? J Neurosci Nurs. 2015 Apr;47(2):66-75. doi: 10.1097/JNN.0000000000000118. PubMed PMID: 25634653.
fever.txt · Last modified: 2016/12/15 15:47 (external edit)