EXPRESS: Practical efficiency of coupling targeted temperature management to cerebral temperature versus systemic...

BackgroundTargeted temperature management (TTM) is widely used to prevent secondary brain injury in febrile brain-injured patients, and it almost always targets systemic temperature (ST). However, because the therapeutic target is the brain, brain temperature (BT) may represent a more relevant target. We investigated whether BT-targeted TTM improved BT control compared with conventional ST-targeted TTM.MethodsBrain-TTM was a single-center, prospective, randomized controlled pathophysiology study including brain-injured patients monitored with an intracerebral pressure probe incorporating a thermal sensor. Patients with BT ≥38.5°C requiring TTM were randomized to BT-targeted or ST-targeted (bladder temperature) TTM. BT and ST were recorded every minute for 12 hours.ResultsThirty-four patients were included (17 per group). Median age was 46 years (IQR 42-53), and 68% were men. During the maintenance phase (H3-H12), the median proportion of time with BT within the target range (36.0-37.0°C) was 84% (IQR 53-99) in the BT-targeted group and 89% (IQR 63-92) in the ST-targeted group (primary outcome, p=0.89). Target attainment at H3 was similar (p=0.49). The BT-ST gradient increased from 0.11±0.07°C during induction to 0.30±0.06°C during maintenance. Per-protocol analyses were consistent.ConclusionBT-targeted TTM did not improve BT control compared with ST-targeted TTM.