We had a patient who underwent hypothermia after cardiac arrest and was brought back to 37°C. The physicians removed the cooling device, and the patient's temperature escalated to 38°C 12 hours later. What are the best methods to control temperature once the patient is back at normothermia if the device has been removed?

摘要

Maintaining a period of normothermia after the completion of a hypothermia protocol has been instituted in many hospitals. Fever is believed to raise the inflammatory response, increasing free radical production and breakdown of the blood-brain barrier (Mcllvoy, 2012). Maintaining normothermia may continue to protect the still vulnerable brain from further injury. One recent study questioned if the outcome benefits seen in hypothermia after cardiac arrest protocols were related to fever management or other physiologic mechanisms. Nielsen et al. (2013) studied hypothermia at 33°C versus 36°C. They concluded the hypothermia did not confer a benefit when compared with normothermia. The authors describe limitations, including lack of data about length of sedation factors known to affect outcome, but suggest that preventing fever may also be necessary to ensure better outcome.