Send us a text🧠 Clinical ContextFever is known to be associated with worse neurologic outcomes in stroke, both ischemic and hemorrhagic. Intuitively, preventing fever seems like a slam-dunk goal, right? This study took that theory to trial, literally.🧪 Study Highlights: The INTREPID TrialDesign: Open-label, randomized controlled trial with blinded outcome assessmentSetting: 43 ICUs across 7 countriesParticipants: 686 critically ill stroke patients (254 ischemic, 223 ICH, 200 SAH)Intervention:Fever prevention group: Surface cooling via automated gel pads, targeted at 37.0°CStandard care group: Fever treatment only when temps hit ≥38.0°CDuration: Cooling maintained for 14 days or until ICU discharge📈 OutcomesPrimary:Fever burden significantly reduced in the cooling group: 0.37 vs 0.73 °C-hour (P < .001)Greatest fever reduction seen in ICH and SAH subtypesSecondary (Functional):No difference in 3-month Modified Rankin Scale (mRS median = 4 in both groups)Odds ratio for favorable shift: 1.09 (P = .54) — not statistically significantAdverse Events:Higher total AEs in the cooling group (82% vs 76%)Similar rates of infections, cardiac, and respiratory complications⚠️ CaveatsTrial halted early due to futility in primary functional outcomeNo significant improvement in functional recoveryFever control alone may not be enough — context and patient-specific variables likely matter🧩 Clinical TakeawayCooling blankets do reduce fever after stroke, but don’t translate to better outcomes. Despite intuitive appeal and clear thermal control, the mRS at 3 months didn’t budge.🏛️ Functional recovery from stroke remains complex. It's not just about temperature — we may need to refine who benefits and how we target them. More nuanced strategies are still needed.

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