INTREPID
Trial question
What is the effect of fever prevention in patients with acute vascular brain injury?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
51.0% female
49.0% male
N = 677
677 patients (345 female, 332 male).
Inclusion criteria: critically ill patients with stroke.
Key exclusion criteria: fever for > 1 hour or > 1 instance; preexisting neurologic, psychiatric, or other condition that would confound neurologic assessment or make accurate assessment of functional outcome difficult; premorbid condition with poor likelihood of 6-month survival; brain death.
Interventions
N=339 fever prevention (use of automated surface temperature management device).
N=338 standard care (standardized tiered fever treatment on occurrence of temperature ≥ 38 °C).
Primary outcome
Daily mean fever burden
0.37
0.73
0.7 °C-hour
0.5 °C-hour
0.4 °C-hour
0.2 °C-hour
0.0 °C-hour
Fever
prevention
Standard
care
Significant
decrease ▼
Significant decrease in daily mean fever burden (0.37 °C-hour vs. 0.73 °C-hour; MD -0.35, 95% CI -0.51 to -0.2).
Secondary outcomes
No significant difference in median mRS score at 3 months, functional recovery (4 points vs. 4 points; OR 1.09, 95% CI 0.81 to 1.46).
No significant difference in median mRS score of 0-3 (39.2% vs. 42.8%; RR 0.92, 95% CI 0.76 to 1.12).
No significant difference in median mRS score of 0-3, ischemic stroke patients (38.1% vs. 35.4%; RR 1.08, 95% CI 0.76 to 1.52).
Safety outcomes
No significant differences in major adverse events, infections, cardiac events, and respiratory disorders.
Significant difference in shivering (85.5% vs. 24.3%).
Conclusion
In critically ill patients with stroke, fever prevention was superior to standard care with respect to daily mean fever burden.
Reference
David M Greer, Raimund Helbok, Neeraj Badjatia et al. Fever Prevention in Patients With Acute Vascular Brain Injury: The INTREPID Randomized Clinical Trial. JAMA. 2024 Nov 12;332(18):1525-1534.
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