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Journal of Neurosurgical Sciences 2018 Apr 04

DOI: 10.23736/S0390-5616.18.04397-7


language: English

The course of intracranial pressure after antipyretic therapy in acute brain injury

Edoardo PICETTI 1 , Patrizia CECCARELLI 1, Laura MALCHIODI 1, Francesca MENSI 1, Solange RISOLO 1, Franco SERVADEI 2, Corrado IACCARINO 3, Ilaria ROSSI 1, Sandra ROSSI 1

1 Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria di Parma, Parma, Italy; 2 Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy; 3 Department of Neurosurgery Azienda Ospedaliero Universitaria di Parma, Parma, Italy


BACKGROUND: The present study was performed to evaluate intracranial pressure (ICP) variations after antipyretic therapy and their relationship to ICP at baseline (ICPbas) in acute brain injury (ABI) patients.
METHODS: We completed a retrospective analysis on data derived from 2 previously published prospective observational studies. The first study involved 32 ABI patients and was performed to elucidate the cerebral and hemodynamic effects of intravenous (IV) paracetamol. The second study involved 30 ABI patients and was performed to investigate cerebral and hemodynamic effects of intramuscular IM diclofenac sodium (DCF). Overall patient population was divided into 2 groups: 1) Group A (G-A) when ICPbas was ≤ 15 mmHg and 2) Group B (G-B) when ICPbas was > 15 mmHg. The main objective was to evaluate if ICPbas affects the time course of ICP after antipyretics administration.
RESULTS: Data from 62 ABI patients were analyzed. We failed to observe a significant change in ICP after antipyretic treatment in the overall group of patients (P1 = 0.486). A significant difference, however, was found between the two groups (P2 < 0.001). We observed that in the G-A, ICP increased in response to antipyretic administration, whereas in the G-B, ICP decreased. These opposite responses are reflected in the statistically significant interaction (P3 < 0.001).
CONCLUSIONS: Variation in ICP after antipyretic therapy is influenced by ICPbas. Specifically, patients with ICPbas ≤ 15 mmHg showed a significant increase in ICP after antipyretic therapy, while a significant reduction in ICP was observed in patients with ICPbas > 15 mmHg.

KEY WORDS: Fever - Antipyretics - Body temperature - Intracranial pressure - Acute brain injury

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