Fever control and application of hypothermia using intravenous cold saline

Abstract

Objectives: To describe the use and feasibility of cold saline to decrease body temperature in pediatric neurocritical care.

Design: Retrospective chart review.

Setting: Pediatric tertiary care university hospital.

Patients: Children between 1 wk and 17 yrs of age admitted to the pediatric intensive care unit with acute brain injury and having received intravenous cold saline between June and August 2009.

Interventions: None.

Measurements and main results: Eighteen subjects accounted for 20 infusions with mean infusion volume 18 ± 10 mL/kg. Eight subjects had traumatic brain injury, two had intracranial hemorrhage, six had cardiac arrest, and one each had ischemic stroke and status epilepticus. The mean age was 9.5 ± 4.8 yrs. Temperature decreased from 38.7 ± 1.1°C to 37.7 ± 1.2°C and from 37.0 ± 2.0°C to 35.3 ± 1.6°C 1 hr after infusion for fever (n = 14; p < .05) or hypothermia induction (n = 6; p = .05), respectively. Cold saline was not bloused but rather infused over 10-15 mins. Mean arterial blood pressure and oxygenation parameters (PaO2/FIO2 ratio, mean airway pressure) were unchanged, but heart rate decreased in those with hypothermia (121 ± 4 beats per minute vs. 109 ± 12 beats per minute; p < .05). Serum sodium concentration and international normalized ratio were significantly increased after cold saline infusion. There were no differences between preinfusion and postinfusion serum glucose and hematocrit, or between cerebral perfusion pressure and intracranial pressure in traumatic brain injury patients.

Conclusions: Cold saline was an effective method of reducing temperature in children with acute brain injury. This approach can be considered to treat fever or to induce hypothermia. A prospective study comparing safety and efficacy vs. other cooling measures should be considered.

Figure 1

Figures 1a, b, and c. Temperature, heart rate, and mean arterial blood pressure 1 hour pre and post-cold saline infusion. *p < .05 post-infusion versus pre-infusion Error bars are reported as standard error *p < .05 post-infusion versus pre-infusion

Figure 1

Figures 1a, b, and c. Temperature, heart rate, and mean arterial blood pressure 1 hour pre and post-cold saline infusion. *p < .05 post-infusion versus pre-infusion Error bars are reported as standard error *p < .05 post-infusion versus pre-infusion

Figure 1

Figures 1a, b, and c. Temperature, heart rate, and mean arterial blood pressure 1 hour pre and post-cold saline infusion. *p < .05 post-infusion versus pre-infusion Error bars are reported as standard error *p < .05 post-infusion versus pre-infusion

Figure 2

Figures 2a and b. Expanded temperature curves for subjects with hypothermia and fever.

Figure 2

Figures 2a and b. Expanded temperature curves for subjects with hypothermia and fever.