Brain temperature management in traumatic brain injury

SummaryAfter a primary traumatic brain injury (TBI), the secondary brain damage that results from ischemia and reperfusion cascades is rather complex. The benefits and the mechanisms of action in whole-body cooling and selective brain cooling after TBI have been well investigated in animal studies. Despite a significant number of positive reports, induced hypothermia is not recommended as standard care for TBI patients in clinical practice because of its uncertain results. Furthermore, some authors have recommended maintaining normothermia and avoiding hyperthermia, although a consensus regarding the effective use of hypothermia in TBI patients has not been well established. In this paper, we propose that brain hyperthermia can be avoided early by maintaining, for at least 72 hours, a temperature ranging from normothermia to mild hypothermia (36–37.5°C), which is accomplished by utilizing selective brain cooling on the craniectomy side with an ice bag or by implementing other cooling systems. This may be a promising strategy when treating patients with severe TBI. However, further prospective research is clearly indicated to delineate the risks and benefits associated with these new therapies.