Report of a Consensus Meeting on Human Brain Temperature After Severe Traumatic Brain Injury: Its Measurement and Management During Pyrexia

Abstract

Temperature disturbances are common in patients with severe traumatic brain injury. The possibility of an adaptive, potentially beneficial role for fever in patients with severe brain trauma has been dismissed, but without good justification. Fever might, in some patients, confer benefit. A cadre of clinicians and scientists met to debate the clinically relevant, but often controversial issue about whether raised brain temperature after human traumatic brain injury (TBI) should be regarded as “good or bad” for outcome. The objective was to produce a consensus document of views about current temperature measurement and pyrexia treatment. Lectures were delivered by invited speakers with National and International publication track records in thermoregulation, neuroscience, epidemiology, measurement standards and neurocritical care. Summaries of the lectures and workshop discussions were produced from transcriptions of the lectures and workshop discussions. At the close of meeting, there was agreement on four key issues relevant to modern temperature measurement and management and for undergirding of an evidence-based practice, culminating in a consensus statement. There is no robust scientific data to support the use of hypothermia in patients whose intracranial pressure is controllable using standard therapy. A randomized clinical trial is justified to establish if body cooling for control of pyrexia (to normothermia) vs moderate pyrexia leads to a better patient outcome for TBI patients.

The Modeling of Shock-Wave Pressures, Energies, and Temperatures Within the Human Brain Due to Improvised Explosive Devices (IEDs) Using the Transport and Burgers' Equations

“…Since Equation (228) has been obtained via the Riemann integral, where the mid-point is x = L 2 for the range 0 ≤ x ≤ L, then, with n = 1, the solution yields a maximum energy of 1.406 × 10 8 J and a temperature of 37.055 • C. This latter figure appears reasonably consistent with observed temperature fluctuations for a normal and un-inflicted human brain in its resting state [19]. The sinusoidal temperature profile of this is illustrated in Figure 17A.…”

“…From each of the Equations (19) and (20) in Paper 1, the resulting second-order Burgers' equation is obtained as expressed in Equation (16). When γ ∼ = 0, Equation (16) reduces to the firstorder Burgers' equation.…”

Fever Management Practices of Neuroscience Nurses

“…Fever is thought to induce secondary brain injury, which is associated with worse outcomes and higher mortality rates (Reith et al, 1996;Stocchetti et al, 2002;Thompson, Tkacs, Saatman, Raghupathi, & Mcintosh, 2003). Research specific to ischemic stroke supports this inference (Castillo, Davalos, Marrugat, & Noya, 1998;Reith et al, 1996;Saini, Saqqur, Kamruzzaaman, Lees, & Shuaib, 2009); however, questions have emerged in recent literature about the evidence for treatment of fever in all persons with traumatic brain injury (TBI; Childs et al, 2010). Currently available clinical practice guidelines (CPGs) support the use of interventional therapies to maintain normothermia for ischemic stroke and subarachnoid hemorrhage (SAH), but the American Association of Neurological Surgeons/Brain Trauma Foundation (AANS/BTF) TBI guidelines fail to mention fever management entirely (Connolly et al, 2012;Jaunch et al, 2013;Morgenstern et al, 2010;O'Grady et al, 2008).…”

Infra-red Thermal Imaging of the Inner Canthus: Correlates with the Temperature of the Injured Human Brain

“…It is generally assumed that body temperature is a reliable 'surrogate' for brain temperature but proxy measures for brain temperature are often unreliable [5]. Direct monitoring is safe and recommended during neurocritical care [6]. However, it is customary to revert to body measurement sites (rectum, tympanum, oral, tympanic) once the patient leaves the intensive care unit (ICU).…”