{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T02:58:44Z","timestamp":1792897124772,"version":"4.5.0"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"18","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2024,11,12]]},"abstract":"\n Importance<\/jats:title>\n Fever is associated with worse outcomes in patients with stroke, but whether preventing fever improves outcomes is unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether fever prevention after acute vascular brain injury is achievable and impacts functional outcome.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Open-label randomized clinical trial with blinded outcome assessment that enrolled 686 of 1176 planned critically ill patients with stroke at 43 intensive care units in 7 countries from March 2017 to April 2021 (last date of follow-up was May 12, 2022).<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Patients randomized to fever prevention (n\u2009=\u2009339) were targeted to 37.0 \u00b0C for 14 days or intensive care unit discharge using an automated surface temperature management device. Standard care patients (n\u2009=\u2009338) received standardized tiered fever treatment on occurrence of temperature of 38 \u00b0C or greater.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcome was daily mean fever burden: the area under the temperature curve above 37.9 \u00b0C (total fever burden) divided by the total number of hours in the acute phase, multiplied by 24 hours (\u00b0C-hour). The principal secondary outcome was 3-month functional recovery by shift analysis of the 6-category modified Rankin Scale, which is scored from 0 (no symptoms) to 6 (death). Major adverse events included death, pneumonia, sepsis, and malignant cerebral edema.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Enrollment was stopped after a planned interim analysis demonstrated futility of the principal secondary end point. In total, 686 patients were enrolled, and 9 were consented but not randomized, leaving a primary analysis population of 677 patients (254 ischemic stroke, 223 intracerebral hemorrhage, 200 subarachnoid hemorrhage; 345 were female [51%]; median age, 62 years) with 433 (64%) completing the study through 12 months. Daily mean (SD) fever burden was significantly lower in the fever prevention group (0.37 [1.0] \u00b0C-hour; range, 0.0-8.0 \u00b0C-hour) compared with the standard care group (0.73 [1.1] \u00b0C-hour; range, 0.0-10.3 \u00b0C-hour) (difference, \u22120.35 [95% CI, \u22120.51 to \u22120.20];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Between-group differences for the primary outcome by stroke subtype were \u22120.10 (95% CI, \u22120.35 to 0.15) for ischemic stroke, \u22120.50 (95% CI, \u22120.78 to \u22120.22) for intracerebral hemorrhage, and \u22120.52 (95% CI, \u22120.81 to \u22120.23) for subarachnoid hemorrhage (all\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001 by Wilcoxon rank-sum test). There was no significant difference in functional recovery at 3 months (median modified Rankin Scale score, 4.0 vs 4.0, respectively; odds ratio for a favorable shift in functional outcome, 1.09 [95% CI, 0.81 to 1.46];\n P<\/jats:italic>\n \u2009=\u2009.54). Major adverse events occurred in 82.2% of participants in the fever prevention group vs 75.9% in the standard care group, including 33.8% vs 34.5% for infections, 14.5% vs 14.0% for cardiac disorders, and 24.5% vs 20.5% for respiratory disorders.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In patients with acute vascular brain injury, preventive normothermia using an automated surface temperature management device effectively reduced fever burden but did not improve functional outcomes.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT02996266<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2024.14745","type":"journal-article","created":{"date-parts":[[2024,9,25]],"date-time":"2024-09-25T17:40:05Z","timestamp":1727286005000},"page":"1525","source":"Crossref","is-referenced-by-count":40,"title":["Fever Prevention in Patients With Acute Vascular Brain 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