Temperature Control in Acute Brain Injury: An Update

Area of Science:

• Neurology
• Critical Care Medicine
• Neuroscience

Background:

• Fever is a common complication in severe acute brain injury (SABI), worsening neurological outcomes by increasing inflammation and intracranial pressure (ICP).
• Temperature management, particularly hypothermic temperature control (HTC), is explored to mitigate these adverse effects by reducing cerebral metabolic demand and inflammation.

Purpose of the Study:

• To provide an overview of the clinical evidence for temperature control in various SABI subtypes.
• To analyze the nuanced effectiveness of HTC across different severe acute brain injury conditions.

Main Methods:

• Review of clinical evidence on temperature control in SABI.
• Analysis of outcomes related to fever and HTC in traumatic brain injury (TBI), acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), aneurysmal subarachnoid hemorrhage (aSAH), and post-cardiac arrest.
• Examination of pediatric and neonatal populations.

Main Results:

• Fever prevention is consistently beneficial across SABI types.
• HTC shows variable efficacy; inconsistent results in post-cardiac arrest and mixed findings in TBI and AIS.
• Effectiveness of HTC is also variable in ICH, aSAH, bacterial meningitis, and status epilepticus, with significant benefits noted in pediatric hypoxic-ischemic encephalopathy.

Conclusions:

• While the rationale for temperature control in SABI is strong, clinical outcomes differ significantly among subtypes.
• Fever prevention is universally recommended, but HTC application and efficacy require further research to define optimal strategies.
• Nuanced approaches to temperature management are needed for different severe acute brain injuries.