The use of targeted temperature management for elevated intracranial pressure

The use of hypothermia for treatment of intracranial hypertension is controversial, despite no other medical therapy demonstrating consistent improvements in morbidity or mortality. Much of this may be the result of negative results from randomized controlled trials. However, the patients selected for these trials may have obscured the results in the populations most likely to benefit. Further, brain injury does not behave uniformly, not even within a diagnosis. Therefore, therapies may have more benefit in some diseases, less in others. This review focuses on the effect on outcome of intracranial hypertension in common disease processes in the neurocritical care unit, and identifies who is most likely to benefit from the use of hypothermia.