Hyperpyrexia in major burn injury: describing the epidemiology and evaluating the effectiveness of an intravascular temperature management device.

INTRODUCTION

Hyperpyrexia is a complication of burn injury, likely caused by systemic inflammation and infection, the pathophysiology of which is poorly understood. This study aimed to describe the patient cohort who developed hyperpyrexia (≥39.5°C) and evaluate the effectiveness of the Thermogard XP Icy®, an intravascular temperature management device, in restoring normothermia.

METHODS

This was a retrospective cohort study of adult patients admitted to Glasgow Royal Infirmary's intensive care unit with major burns (TBSA ≥20%) between January 2016 and October 2024. A central database and electronic medical records were used to collect data on demographics, burn severity, interventions and outcomes. Episodes of hyperpyrexia and Thermogard XP® use were also recorded. A multilevel interrupted time series analysis was used to assess the effectiveness of the Thermogard XP® device in reducing body temperature in comparison to historic controls.

RESULTS

Fifty-six patients were analysed, of which 30 (56.3%) developed hyperpyrexia. This cohort were more likely to have sustained a flame burn (p = 0.003), have a greater burn TBSA (p = 0.006) and longer hospital stay (p = 0.005) when compared to non-hyperpyrexic patients; however, mortality rates did not differ significantly. Eight patients were managed with a Thermogard XP®; this appeared to achieve normothermia quicker than standard interventions.

CONCLUSION

Hyperpyrexia was associated with more severe burn injuries and greater intervention requirements but not increased mortality. The Thermogard XP® seemed effective at controlling temperatures ≥ 39.5°C in this small single-centre observational study; future studies are needed to further explore its effectiveness and impact on outcomes such as survival.