Reconsidering the role of hypothermia in management of severe traumatic brain injury

• The role of hypothermia in the management of severe traumatic brain injury remains controversial.
• Recent trials not only failed to demonstrate benefit but also revealed a tendency towards clinical harm.
• The time may have come to reconsider the role of hypothermia in the management of severe traumatic brain injury.

Over the past two decades there has been considerable interest in the use of hypothermia in the management of severe traumatic brain injury. However despite promising experimental evidence, results from clinical studies have failed to demonstrate benefit. Indeed recent studies have shown a tendency to worse outcomes in those patients randomised to therapeutic hypothermia. In this narrative review the pathophysiological rationale behind hypothermia and the clinical evidence for efficacy are examined. There would still appear to be a role for hypothermia in the management of intractable intracranial hypertension. However optimising therapeutic time frames and better management of strategies for complications will be required if experimental evidence for neuroprotection is to be translated into clinical benefit.