Commentary on “Brain Temperature Influences Intracranial Pressure and Cerebral Perfusion Pressure After Traumatic Brain Injury”

Excerpt

Although it is well established that fever is associated with prolonged intensive care unit stays and higher patient mortality rates [1, 2] following traumatic brain injury (TBI), it remains unclear whether fever is the driver of harm or a bystander. Elevated temperatures may act as the mechanism for cellular injury, and thus patient deterioration, or, alternatively, fever might denote the presence of a separate process responsible for both pyrexia and injury. There are multiple mechanisms by which posttraumatic fever has been proposed to intensify central nervous system cellular injury, although, in humans, only indirect evidence exists of secondary injury during fever [3]. Regardless, the standard of care is to monitor temperature and treat fever when it arises in patients with brain injury. Conventionally, core body temperature measured from the bladder or esophagus is often used as a surrogate for brain temperature. However, as it becomes increasingly feasible to directly measure brain temperature with invasive monitors, clinicians and researchers struggle to interpret and act on this new data. Although brain temperature usually correlates tightly with core temperature at 0.5–1 °C higher [4], core and brain temperatures may decouple in certain circumstances that are incompletely understood [5]. …