Targeted Temperature Management following Traumatic Brain Injury: ESICM / NACCS Consensus Recommendations Guidelines

Abstract

Background The aim of this panel was to develop consensus recommendations and guidance on targeted temperature management (TTM) in patients with severe traumatic brain injury (TBI) and in patients with moderate TBI who deteriorate and require admission to the intensive care unit (ICU) for intracranial pressure (ICP) management. Methods A group of 18 international neuro-intensive care experts in the acute management of TBI participated in a modified Delphi process. An online anonymised survey was completed ahead of the meeting, before the group convened to explore the level of consensus on TTM following TBI. Outputs from the meeting were combined into a further anonymous online survey round to finalise recommendations. Thresholds of ≥ 16 out of 18 panel members in agreement (≥ 88%) for strong consensus and ≥ 14 out of 18 (≥ 78%) for moderate consensus were prospectively set for all statements. Results Strong consensus was reached on TTM being essential for high-quality TBI care. It was recommended that temperature should be monitored continuously, and that fever should be promptly identified and managed in patients perceived to be at risk of secondary brain injury. Controlled normothermia (36.0°C–37.5°C) was strongly recommended as a therapeutic option to be considered in tier 1 and 2 of the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC) ICP management protocol. Temperature management targets should be individualised based on the perceived risk of secondary brain injury and fever aetiology. Conclusions Based on a modified Delphi expert consensus process, this report aims to inform on best practices for TTM delivery for patients following TBI, and to highlight areas of need for further research to improve clinical guidelines in this setting.