Electroacupuncture-inspired neuroimmune modulation in sepsis: evidence appraisal and ICU trial-design priorities.

Craniocerebral injury is a common acute and critical illness in pediatric clinical practice, mainly caused by external factors such as accidental impact, falls from heights, and traffic accidents (Zhong et al. ). It is characterized by acute onset, critical condition, and rapid progression, which seriously threatens the life safety and growth of children (Chong et al. ). With the continuous advancement of neurosurgical medical technology, surgical treatment has become the core method to save the lives of children with craniocerebral injury and improve neurological prognosis. However, the occurrence of postoperative complications remains a key factor restricting the therapeutic effect, among which fever is one of the most common postoperative complications (Ahmed et al. ). Clinical data (Meng et al. ; Lin et al. ) show that the incidence of fever in children after craniocerebral injury surgery can reach 30% ~ 50%, with the fever duration usually exceeding 24 h and the body temperature often maintaining above 38.5℃. Its pathogenesis is complex, closely related to various factors such as stress response caused by surgical trauma, intracranial infection, central thermoregulatory dysfunction, and absorption fever from postoperative hematoma or necrotic tissue. Persistent fever can significantly increase the oxygen consumption of children's brain tissue, induce or aggravate cerebral edema and increased intracranial pressure, thereby leading to further deterioration of neurological damage (Alsayegh et al. ; Lundstedt et al. ). At the same time, it may also involve multiple organ functions such as respiratory, circulatory, and digestive systems, which not only prolongs the hospital stay of children but also increases the risk of mortality and long-term sequelae, bringing a heavy physical, psychological, and economic burden to children's families and posing a severe challenge to clinical medical and nursing work (Lang et al. ; Cavazzoni and Boakye ; Goyal-Honavar et al. ). Pediatric patients are in the stage of growth and development, with immature nervous and immune systems and imperfect central thermoregulatory function. Their tolerance to high fever is significantly lower than that of adults, so the pathophysiological damage caused by persistent hyperthermia after craniocerebral injury surgery is more prominent in children (Lin et al. ). At present, clinical nursing for fever in such children mainly relies on conventional symptomatic interventions, including physical cooling (such as warm water sponge bath, ice pack cold compress) and drug cooling (such as application of ibuprofen and acetaminophen) (Lotakis et al. ). However, these measures lack precise prediction of high-risk factors for fever and individualized intervention design. Moreover, the clinical identification of core influencing factors for the occurrence of fever is not comprehensive enough, and the timing of intervention is not accurately grasped, resulting in poor cooling effect in some children, prolonged duration of fever, and impact on the overall rehabilitation process (Cavazzoni and Boakye ; Lewis et al. ). In addition, among existing clinical studies, systematic research on the epidemiological characteristics, screening of associated factors, and effects of targeted nursing interventions for persistent hyperthermia in children after craniocerebral injury surgery is relatively scarce, lacking unified nursing standards and evidence-based basis, which makes it difficult to effectively guide the standardized development of clinical nursing practice. Based on this, this study aims to systematically analyze the current situation of persistent hyperthermia in children after craniocerebral injury surgery and clarify its key associated factors, so as to provide a basis for optimizing clinical treatment and nursing plans. This study was reviewed and approved by the Medical Ethics Committee of our hospital (Approval No.: 202601073–1), and the research implementation strictly followed the Declaration of Helsinki and relevant ethical norms for pediatric clinical research. All guardians of children voluntarily signed written informed consent forms after fully understanding the research purpose, methods, potential risks, and benefits. During the research process, attention was paid to protecting the privacy of children; all clinical data were anonymized and only used for statistical analysis in this study.