title: Keep the brain cool--endovascular cooling in patients with severe traumatic brain injury: a case series study.
abstract: BACKGROUND
  As brain temperature is reported to be extensively higher than core body temperature in traumatic brain injury (TBI) patients, posttraumatic hyperthermia is of particular relevance in the injured brain.
  
  
  OBJECTIVE
  To study the influence of prophylactic normothermia on brain temperature and the temperature gradient between brain and core body in patients with severe TBI using an intravascular cooling system and to assess the relationship between brain temperature and intracranial pressure (ICP) under endovascular temperature control.
  
  
  METHODS
  Prospective case series study conducted in the neurologic intensive care unit of a tertiary care university hospital. Seven patients with severe TBI with a Glasgow Coma Scale score of 8 or less were consecutively enrolled. Prophylactic normothermia, defined as a target temperature of 36.5°C, was maintained using an intravascular cooling system. Simultaneous measurements of brain and urinary bladder temperature and ICP were taken over a 72-hour period.
  
  
  RESULTS
  The mean bladder temperature in normothermic patients was 36.3 ± 0.4°C, and the mean brain temperature was determined as 36.4 ± 0.5°C. The mean temperature difference between brain and bladder was 0.1°C. We found a significant direct correlation between brain and bladder temperature (r = 0.95). In 52.4% of all measurements, brain temperature was higher than core body temperature. The mean ICP was 18 ± 8 mm Hg.
  
  
  CONCLUSIONS
  Intravascular temperature management stabilizes both brain and body core temperature; prophylactic normothermia reduces the otherwise extreme increase of intracerebral temperature in patients with severe TBI. The intravascular cooling management proved to be an efficacious and feasible method to control brain temperature and to avoid hyperthermia in the injured brain. We could not find a statistically significant correlation between brain temperature and ICP.
authors.affiliation: Department of Neurology, Neurologic Intensive Care Unit, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Marlene
authors.initials: M
authors.lastname: Fischer
authors.forename: Peter
authors.initials: P
authors.lastname: Lackner
authors.forename: Ronny
authors.initials: R
authors.lastname: Beer
authors.forename: Raimund
authors.initials: R
authors.lastname: Helbok
authors.forename: Stephanie
authors.initials: S
authors.lastname: Klien
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Bettina
authors.initials: B
authors.lastname: Pfausler
authors.forename: Erich
authors.initials: E
authors.lastname: Schmutzhard
authors.forename: Gregor
authors.initials: G
authors.lastname: Broessner
mesh_terms: D000328:Adult; D000368:Aged; D001831:Body Temperature / Q000502:physiology*; D001921:Brain / Q000473:pathology / Q000502:physiology*; D001930:Brain Injuries / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D003080:Cold Temperature; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index