Aggressive Fever Control With Intravenous Ibuprofen After Non-traumatic Brain Hemorrhage

• Fever Burden [ Time Frame: Up to14 days ] [ Designated as safety issue: No ]
  Reduction in fever burden (degrees C x hours) with intravenous ibuprofen infusion as compared to oral acetaminophen over duration of treatment. Fever burden is calculated hourly by subtracting each patient's recorded temperature (from either a bladder or esophageal temperature probe) from 37 degrees C.
  
  

• Inflammatory Markers [ Time Frame: Up to 14 days ] [ Designated as safety issue: No ]
  Mean difference in markers of inflammation between IV ibuprofen and standard of care groups
  
  
• Cost analysis [ Time Frame: Up to 14 days ] [ Designated as safety issue: No ]
  Cost analysis of aggressive fever control (AFC) between patients randomized to either intravenous ibuprofen infusion or standard of care (oral acetaminophen).
  
  
• Bleeding Incidence [ Time Frame: Up to 14 days ] [ Designated as safety issue: Yes ]
  Incidence of bleeding (defined by a priori criteria)
  
  

This is an open-label, investigator initiated single center, randomized, prospective study. Subjects meeting enrollment criteria will be randomly assigned 1:1 to one of two groups:

1. Standard Care: Acetaminophen 650 mg via oral/nasogastric tube every 6 hours as needed for T>=38.3 C (100.9 F) for up to post bleed day 14 or discharge from the Neuro ICU, whichever comes first.
2. Ibuprofen 400 mg/100 mL NS IV over 30 minutes, followed by a continuous infusion of 2000 mg/500 mL NS at 85 mg/hour (21 mL/hour) for up to post bleed day 14 or discharge from the Neuro ICU, whichever comes first.

Patients/surrogates will be approached for consent and randomized upon admission. Therapy will only be initiated once a patient becomes febrile (>=38.3 C, 100.9 F). The use of temperature modulating devices will be permitted as per institutionally approved guidelines in those patients continuing to demonstrate a fever (T>38.3 C, 100.9 F) with either therapy.