Temperature Management in the Neurointensive Care Unit

Fever in the neurocritical care unit has a high prevalence and is associated with worse outcomes in patients with severe neurologic illness. While it is well accepted that fever is associated with worse outcomes in this patient population, it is unclear if aggressive temperature management will improve outcomes. Temperature should be monitored routinely in this high-risk population, fever worked up appropriately to identify infectious etiology, and reasonable measures taken to control elevated temperature. While infection is a common source of fever in patients with significant neurologic illness, the fever may also be exacerbated by the underlying brain injury. The clinician must decide at which point to initiate fever control measures, how aggressively to manage the fever, and which temperature to target for normothermia. Several pharmacological agents are available as first-line therapy. Depending on the degree and severity of the febrile response, advanced temperature-control devices should be added to pharmacological measures. Several types of temperature-control devices are available, including invasive (intravascular catheters) and noninvasive (external cooling pads) technologies. The clinician should utilize both pharmacologic and device-based temperature therapies to minimize the amount of time spent in a febrile state and help to mitigate the secondary brain injury brought on by fever.