Efficacy of prophylactic enteral bromocriptine in reducing the neurogenic fever in severe traumatic brain injury patients in the trauma intensive care unit - A randomized placebo-controlled study

Abstract

Introduction: Neurogenic fever (NF) is a noninfectious, centrally mediated hyperthermia seen in patients with traumatic brain injury (TBI) and other neurological conditions. Fever exacerbates secondary brain injury, increases metabolic demand, and worsens patient outcomes. Dopamine agonists such as bromocriptine, which modulate hypothalamic thermoregulation, have been proposed as potential therapeutic agents. This study evaluates the efficacy of prophylactic bromocriptine in preventing NF in patients with severe TBI. Methods: In this randomized, double-blind, placebo-controlled trial, 100 adult patients with isolated severe TBI admitted within 24 h of injury were assigned to receive either bromocriptine (5 mg twice daily, n = 50) or placebo (n = 50) through enteral administration. NF was defined as a temperature >38.3°C for at least one episode over 2 consecutive days after excluding infectious causes. The primary outcome was NF incidence. Secondary outcomes included fever severity, frequency, onset, mortality, and heart rate-temperature correlation. Data were analyzed using parametric and nonparametric statistical methods. Results: After exclusions and dropouts, 43 patients in the bromocriptine group and 45 in the placebo group were analyzed. NF incidence was lower in the bromocriptine group (41.86%) compared to placebo (55.56%), but the difference was not statistically significant (P = 0.199). No differences were observed in fever onset, mortality, or heart rate-temperature correlation. Bromocriptine was associated with a reduction in peak temperature on day 5 (P < 0.05). Conclusion: Prophylactic bromocriptine did not significantly reduce NF incidence in severe TBI but showed trends toward lower fever severity. Further research with larger cohorts and optimized dosing is warranted. © 2025 International Journal of Critical Illness and Injury Science.