The Importance of Brain Temperature in Patients after Severe Head Injury: Relationship to Intracranial Pressure, Cerebral Perfusion Pressure, Cerebral Blood Flow, and Outcome

Soukup, Jens; Zauner, Alois; Doppenberg, Egon M.R.; Menzel, M.; Gilman, Charlotte; Young, Harold F.; Bullock, R. E.

doi:10.1089/089771502753754046

Cited by 147 publications

(105 citation statements)

References 58 publications

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“…A review of this mixed evidence suggests that following acute neurological disease and injury, the human brain is at a higher temperature than body tissues [20]. However, variations in the patients' thermal state appear to have an impact on the brain-body temperature gradient; the greatest difference occurring during hypothermia with average brain temperature over 1°C lower than core body temperature [21]. These findings are consistent with models of heat transfer from brain to body core during hypothermia [22].…”

supporting

confidence: 52%

Differences between brain and rectal temperatures during routine critical care of patients with severe traumatic brain injury*

Childs

Vail

Protheroe³

et al. 2005

Anaesthesia

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SummaryTheoretical models suggest that small differences only exist between brain and body temperature in health. Once the brain is injured, brain temperature is generally regarded to rise above body temperature. However, since reports of the magnitude of the temperature gradient between brain and body vary, it is still not clear whether conventional body temperature monitoring accurately predicts brain temperature at all times. In this prospective, descriptive study, 20 adults with severe primary brain trauma were studied during their stay in the neurointensive care unit. Brain temperature ranged from 33.4 to 39.9°C. Comparisons between paired brain and rectal temperature measurements revealed no evidence of a systematic difference [mean difference )0.04°C (range )0.13 to 0.05°C, 95% CI), p = 0.39]. Contrary to popular belief, brain temperature did not exceed systemic temperature in this relatively homogeneous patient series. The mean values masked inconsistent and unpredictable individual brain-rectal temperature differences (range 1.8 to )2.9°C) and reversal of the brain-body temperature gradient occurred in some patients. Brain temperature could not be predicted from body temperature at all times. Brain temperature is seldom measured during routine neurointensive care but there is a long-held assumption that since the temperatures of healthy internal organs differ only slightly [1], temperature measurements of the rectum, bladder, pulmonary artery and tympanum can be used as surrogates for brain temperature. Using these conventional body sites, temperatures greater than 38.5°C are commonly encountered during neurocritical care [2,3] and cause concern. In animal models of cerebral ischaemia [4][5][6][7] and trauma [8,9] a rise in body core temperature in excess of 38°C is associated with increased neuronal damage. In stroke patients a rise in body temperature independently predicts poor outcome [10] and increased mortality [11][12][13][14] but when the human brain is injured by trauma, the evidence for a relationship between raised body temperature and worse neurological outcome is not as clear [15,16]. However, it is assumed that the deleterious metabolic, inflammatory and biochemical mechanisms associated with raised body temperature in animal models of stroke and trauma may operate similarly in the brain injured human [17]. This assumption underpins current opinion that even a small increase in body temperature (1-2°C) above normal (37°C) accelerates ischaemic damage and increases the size of the primary brain lesion [9,18] and should therefore be prevented [13].Little is known about human brain temperature, but theoretical models suggest that during normothermia the temperature of the brain is close to that of internal carotid arterial blood before the blood enters the circle of Willis [19]. In man, direct measurement of brain temperature Anaesthesia, 2005, 60, pages 759-765

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supporting

confidence: 52%

Differences between brain and rectal temperatures during routine critical care of patients with severe traumatic brain injury*

Childs

Vail

Protheroe³

et al. 2005

Anaesthesia

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“…Alternatively, this inversion of the brain and bladder temperatures may have resulted from ischemia induced by low CBF, decreased cerebral metabolic demand, or changes in hypothalamic regulation due to pharmacological treatment (sedation, paracetamol) during hypothermia. 17) This study found that the difference between brain and bladder temperatures in the SDH group was significantly lower than that in the DAI group, possibly because the brain temperature in the DAI group was increased by the higher cerebral metabolism and CBF induced by DAI. In addition, the brain temperature in the SDH group may have been influenced by environmental factors.…”

Section: E Suehiro Et Almentioning

confidence: 59%

“…Some studies have looked at the differences between brain temperature and core temperature in a clinical setting, since the introduction of technology for direct measurement of brain temperature. 5,12,17,20) Brain temperature was much higher than rectal temperature if CPP was reduced to between 50 and 20 mmHg, indicating impaired CBF. 13) Furthermore, this difference decreased significantly as CPP was reduced to below 20 mmHg, indicating irreversible impairment of CBF.…”

Section: E Suehiro Et Almentioning

confidence: 99%

“…Although we were unable to measure CBF in this study, the brain temperature and the difference between brain and core temperature are both largely dependent on CBF. 17) Therefore, the increased temperature difference reflects the higher SjO 2 resulting from increased CBF. These findings suggest that measurement of brain temperature is a good indicator of Differences Between Brain and Core Temperature in Head Injury CBF and cerebral metabolism, and can be used easily at the bedside.…”

Section: E Suehiro Et Almentioning

confidence: 99%

“…Furthermore, the difference between brain and rectal temperature is correlated with CBF and outcome. 17) Decompressive craniectomy is frequently performed for relief of medically refractory intracranial pressure (ICP) caused by severe brain edema, and has large effects on regional blood flow, metabolism, and heat ex-…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Significance of Differences Between Brain Temperature and Core Temperature (Delta T) During Mild Hypothermia in Patients With Diffuse Axonal Injury

Suehiro

Fujisawa

Koizumi

et al. 2011

Neurol. Med. Chir.(Tokyo)

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The differences between brain and bladder temperature (delta T), and the relationship of delta T to cerebral perfusion pressure (CPP) and jugular venous oxygen saturation (SjO 2 ) were studied during hypothermia in 11 patients with severe traumatic brain injury, of whom 5 underwent conservative treatment for diffuse axonal injury (DAI) (DAI group) and 6 who underwent decompressive craniectomy for hematoma (SDH group). All patients underwent hypothermia treatment. Brain temperature was monitored via an intraparenchymal catheter. Bladder temperature was used as the core temperature. SjO 2 was measured continuously. The outcome of all patients was evaluated at discharge using the Glasgow Outcome Scale. Delta T in the SDH group was significantly lower than that in the DAI group. No relationship was found between delta T and CPP during the investigation period. A significant correlation between delta T and SjO 2 was seen in the DAI group, but not in the SDH group. Decompressive craniectomy affects the brain temperature through external environmental factors. Measurement of brain temperature may be a reliable indicator of cerebral blood flow and brain metabolism in patients with DAI and closed cranium during hypothermia. Further experience is required to test this proposal.

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Neuroprotective effects of deep hypothermia in refractory status epilepticus

Niquet

Gezalian

Baldwin

et al. 2015

Ann Clin Transl Neurol

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ObjectivePharmacoresistance develops quickly during repetitive seizures, and refractory status epilepticus (RSE) remains a therapeutic challenge. The outcome of RSE is poor, with high mortality and morbidity. New treatments are needed. Deep hypothermia (20°C) is used clinically during reconstructive cardiac surgery and neurosurgery, and has proved safe and effective in those indications. We tested the hypothesis that deep hypothermia reduces RSE and its long‐term consequences.MethodsWe used a model of SE induced by lithium and pilocarpine and refractory to midazolam. Several EEG measures were recorded in both hypothermic (n = 17) and normothermic (n = 20) animals. Neuronal injury (by Fluoro‐Jade B), cell‐mediated inflammation, and breakdown of the blood–brain barrier (BBB) (by immunohistochemistry) were studied 48 h following SE onset.ResultsNormothermic rats in RSE seized for 4.1 ± 1.1 h, and at 48 h they displayed extensive neuronal injury in many brain regions, including hippocampus, dentate gyrus, amygdala, entorhinal and pyriform cortices, thalamus, caudate/putamen, and the frontoparietal neocortex. Deep hypothermia (20°C) of 30 min duration terminated RSE within 12 min of initiation of hypothermia, reduced EEG power and seizure activity upon rewarming, and eliminated SE‐induced neuronal injury in most animals. Normothermic rats showed widespread breakdown of the BBB, and extensive macrophage infiltration in areas of neuronal injury, which were completely absent in animals treated with hypothermia.InterpretationThese results suggest that deep hypothermia may open a new therapeutic avenue for the treatment of RSE and for the prevention of its long‐term consequences.

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The Importance of Brain Temperature in Patients after Severe Head Injury: Relationship to Intracranial Pressure, Cerebral Perfusion Pressure, Cerebral Blood Flow, and Outcome

Cited by 147 publications

References 58 publications

Differences between brain and rectal temperatures during routine critical care of patients with severe traumatic brain injury*

Differences between brain and rectal temperatures during routine critical care of patients with severe traumatic brain injury*

Significance of Differences Between Brain Temperature and Core Temperature (Delta T) During Mild Hypothermia in Patients With Diffuse Axonal Injury

Neuroprotective effects of deep hypothermia in refractory status epilepticus

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