Temperature management targeted on normothermia versus conventional fever control in patients with ruptured intracranial aneurysms A single center, retrospective study

Background: Fever is associated with adverse outcomes in patients with subarachnoid hemorrhage. Nevertheless, the efficacy of targeted temperature management (TTM) in maintaining normothermia requires empirical validation. The objective of this study was to investigate the differences using distinct temperature control strategies. Materials and Methods: This was a single-center, retrospective study. Patients (n=136) diagnosed with aneurysmal subarachnoid hemorrhage were included. Participants were categorized into two groups: those receiving TTM for normothermia (maintaining a temperature range of 36.5 °C to 37.5 °C; n=72) during the period from 2018 to 2020, and those subjected to conventional fever control (CFC, maintaining temperatures below 38.3 °C; n=64) during the period from 2013 to 2014. The fever burden was quantified as the product of the duration of fever and the temperature deviation exceeding 38 °C (expressed in hours x °C), calculated from the first to the fourteenth day. The Modified Rankin Scale scores were evaluated at one and six months. Results: The fever burden of the TTM-N group was lower than that of the CFC group. The change in the mRS scores was higher in the TTM-N group than in the CFC group (p=0.039), particularly among participants classified with a modified Fisher grade of 4. The TTM-N group was associated with a lower rate of early infarction (10% vs. 23%, p=0.003) compared to the CFC group. Conclusion: TTM-N is likely associated with improved functional outcomes and a lower rate of early infarction. Aggressive fever control should be considered in patients with subarachnoid hemorrhage.