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CS360
Hot Brain? Cool Treatment! Guidelines for Fever Management of Stroke Patients
By: S. Styron, A. Agudelo, E. Angeles, S. Livesay, M. Mokracek & S. Reize; St. Lukes Episcopal Hospital, Houston, TX
For further information, please contact: sstyron@sleh.com
Purpose: Literature shows that fever contributes to morbidity/mortality and increased length of stay in Neuro ICU patients. Fever control and the use of hypothermia to manage elevated ICP refractory to medical therapy is critically important. We had no standard of care to treat such patients in our ICU.
Description: An interdisciplinary team of nurses, advanced practice nurses, clinical pharmacists and a Neurointensivist formed a team to review the literature. The review revealed strikingly persistent and persuasive evidence demonstrating that moderate hyperthermia during or after brain ischemia or trauma markedly exacerbates neuronal injury. Articles were disseminated and inservices held for staff to increase awareness and education. Clinical Practice Guidelines (CPGs) were drafted to direct the treatment of fever in hemorrhagic and ischemic stroke patients and to induce hypothermia in patients with elevated ICP refractory to medical management (CPG and case study application will be shared). Standard treatments include scheduled administration of acetaminophen, room cooling, application of cooling devices, as well as astute attention to skin care and shiver control. External and internal fever control technology was piloted by the staff. The Medivance Arctic Sun was used for external cooling and the Innercool Celcius system for internal cooling.
Evaluation and Outcomes: Based upon the success of the pilot, a change in nursing practice was observed in our NICU. Aggressive fever management has become the standard of care for our stroke patients. Program success was dependent on the active nursing involvement in the implementation of the CPG. As a result of the project, the nursing staff is involved in ongoing technology design to improve external cooling in conjunction with a major temperature management company.
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