title: Targeted Temperature Management in Spontaneous Intracerebral Hemorrhage: A Systematic Review.
abstract: BACKGROUND
  Fever is common in neurocritical care patients and is associated with poor outcome. Targeted temperature management (TTM), i.e. therapeutic hypothermia or controlled normothermia, after acute brain injury has been studied as a neuroprotectant for several decades. In contrast to pharmacological agents with specific targets TTM affects multiple pathophysiological mechanisms and is primarily thought to attenuate secondary brain injury. Most promising results have been obtained from experimental studies on cerebral ischemia or traumatic brain injury showing beneficial effects of hypothermia on structural and functional outcome.
  
  
  OBJECTIVE
  The aim of this systematic review of the literature is to provide an overview on preclinical and clinical data on the use of TTM for intracerebral hemorrhage (ICH). The impact of TTM on structural changes and functional outcome after induced and spontaneous ICH will be summarized.
  
  
  CONCLUSIONS
  A positive influence of hypothermia has been observed in animal models of spontaneous ICH improving, among others, perihematomal edema, blood-brain barrier integrity, inflammation and thrombin-induced injury. However, results regarding functional outcome are conflicting. Little data is available on the effect of TTM after spontaneous ICH in humans. Single-center observational studies have shown reduced perihematomal edema under mild hypothermia and an association with favorable outcome. However, these beneficial effects on mortality and functional outcome have not been confirmed in randomized studies so far. Thus, results from ongoing, prospective randomized-controlled trials are highly anticipated.
authors.affiliation: Medical University Hamburg-Eppendorf, Department of Anesthesiology, Hamburg. Germany.
authors.forename: Marlene
authors.initials: M
authors.lastname: Fischer
authors.affiliation: Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria.
authors.forename: Alois
authors.initials: A
authors.lastname: Schiefecker
authors.affiliation: Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Lackner
authors.affiliation: Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Frank
authors.affiliation: Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria.
authors.forename: Raimund
authors.initials: R
authors.lastname: Helbok
authors.affiliation: Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria.
authors.forename: Ronny
authors.initials: R
authors.lastname: Beer
authors.affiliation: Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria.
authors.forename: Bettina
authors.initials: B
authors.lastname: Pfausler
authors.affiliation: Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria.
authors.forename: Erich
authors.initials: E
authors.lastname: Schmutzhard
authors.affiliation: Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria.
authors.forename: Gregor
authors.initials: G
authors.lastname: Broessner
mesh_terms: D000818:Animals; D002545:Brain Ischemia / Q000517:prevention & control*; D002543:Cerebral Hemorrhage / Q000473:pathology / Q000628:therapy*; D004195:Disease Models, Animal; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D064887:Observational Studies as Topic
keywords: Brain injury; TTM; hypothermia; normothermia; perihematomal edema; spontaneous intracerebral hemorrhage; targeted
  temperature management