A recent study published in JAMA Network investigated whether preventing fever in patients with acute vascular brain injury could improve functional outcomes. The open-label, randomized clinical trial, conducted across 43 intensive care units in 7 countries, enrolled 677 critically ill patients with stroke (ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage). The study compared the use of an automated surface temperature management device for fever prevention against standard fever care.
Patients in the fever prevention group (n=339) were targeted to maintain a temperature of 37.0 °C for 14 days or until ICU discharge, using the automated device. The standard care group (n=338) received tiered fever treatment upon reaching a temperature of 38 °C or higher.
The primary outcome measured was the daily mean fever burden, while the principal secondary outcome was functional recovery at 3 months, assessed by shift analysis of the 6-category modified Rankin Scale.
The study revealed that the fever prevention strategy significantly reduced the daily mean fever burden (0.37 °C-hour) compared to the standard care group (0.73 °C-hour) (difference, -0.35; 95% CI, -0.51 to -0.20; P<.001). However, no significant difference was observed in functional recovery at 3 months (median modified Rankin Scale score, 4.0 vs 4.0; odds ratio, 1.09; 95% CI, 0.81 to 1.46; P=.54).
Major adverse events, including infections and respiratory disorders, were similar in both groups. Enrollment was stopped early after an interim analysis indicated futility regarding the secondary endpoint.
These findings suggest that while automated surface temperature management can effectively reduce fever burden in acute vascular brain injury patients, it does not translate to improved functional outcomes. According to the researchers, further investigation is needed to determine alternative strategies for improving patient outcomes after stroke.
