Introduction: Fever, defined as temperature greater than 38 degrees Celsius, occurs in up to one half of patients with severe acute brain injury (SABI), and up to one-third are non-infectious. Hyperthermia is detrimental to brain recovery after SABI. Central hyperthermia is caused by disruption of thermoregulatory signals after hypothalamic-brainstem network injury and is often refractory to antipyretics. This study investigated the efficacy of bromocriptine, a dopamine agonist, for the treatment of central fever. Methods: Retrospective study of bromocriptine utilization for central fever in patients admitted to the neuroscience intensive care unit from January to October 2024 for SABI who received at least one dose of bromocriptine. 39 patients were included in the analysis. Temperature data 24 hours before and 24, 48, and 72 hours after bromocriptine administration were compared. Additional variables obtained included utilization of antipyretics, cooling devices, and antibiotics. Results: The primary outcome of temperature 24-hours before and 24-hours after bromocriptine administration trended towards significance (t=-0.3°C, p=0.079). No covariate was significantly associated with temperature change at 24-hours (dose, type of brain injury, acetaminophen use, ibuprofen use) except antibiotic use, although nearly all febrile patients were treated with scheduled acetaminophen. No adverse events were noted (e.g. liver dysfunction) after bromocriptine administration. In patients without antibiotic use, reduction in 24-hour body temperature was statistically significant (p=0.0175). A linear mixed-effects model was performed to characterize the trajectory of body temperature from 24-hours before treatment through 24-, 48-, and 72-hours post-treatment. In the adjusted model, the overall effect of time on body temperature reduction was statistically significant (p=.007), with the largest effect at 72 hours. Conclusions: Bromocriptine administration in SABI patients for central fever resulted in a non-significant reduction in temperature 24 hours after treatment. A robust and statistically significant decline in body temperature was seen over 72 hours. Bromocriptine is a safe and effective treatment for central fever in patients with SABI.
Mancilla et al. (Sun,) studied this question.