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Review
. 2024 May 20;28(1):170.
doi: 10.1186/s13054-024-04951-x.

Targeted temperature control following traumatic brain injury: ESICM/NACCS best practice consensus recommendations

Andrea Lavinio  1   2 , Jonathan P Coles  3   4 , Chiara Robba  5 , Marcel Aries  6   7 , Pierre Bouzat  8 , Dara Chean  9 , Shirin Frisvold  10   11 , Laura Galarza  12 , Raimund Helbok  13   14 , Jeroen Hermanides  15 , Mathieu van der Jagt  16 , David K Menon  3   4 , Geert Meyfroidt  17 , Jean-Francois Payen  8 , Daniele Poole  18 , Frank Rasulo  19 , Jonathan Rhodes  20 , Emily Sidlow  21 , Luzius A Steiner  22 , Fabio Silvio Taccone  23   24 , Riikka Takala  25   26
Affiliations
Review

Targeted temperature control following traumatic brain injury: ESICM/NACCS best practice consensus recommendations

Andrea Lavinio et al. Crit Care. .

Abstract

Aims and scope: The aim of this panel was to develop consensus recommendations on targeted temperature control (TTC) in patients with severe traumatic brain injury (TBI) and in patients with moderate TBI who deteriorate and require admission to the intensive care unit 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 based on a systematic literature review was completed ahead of the meeting, before the group convened to explore the level of consensus on TTC 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 TTC 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 (36.0-37.5 °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 ICP management protocol. Temperature control 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 TTC delivery for patients following TBI, and to highlight areas of need for further research to improve clinical guidelines in this setting.

Keywords: Fever; Intracranial pressure; Normothermia; Targeted temperature control; Traumatic brain injury.

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Conflict of interest statement

AL received consultancy and speaker fees from Beckton, Dickinson and Company (“BD”) for Chairing the Delphi panel and for contributing to the writing of the article. RH received speaker fees from BD and Zoll.

Figures

Fig. 1
Fig. 1
Summary of the Delphi process. ESAIC European Society of Anaesthesiology and Intensive Care, ESICM European Society of Intensive Care Medicine, NACCS Neuro Anaesthesia and Critical Care Society
Fig. 2
Fig. 2
Intracranial pressure management algorithm for severe TBI edited from SIBICC 2019 [28]. * Including TTC in tiers 1 and 2 is the suggested addition from the TTC-TBI group to the original SIBICC tiers (green bars). *When possible, the lowest tier should be used. It is not necessary to use all modalities in a previous tier before moving to the next tier. Consider repeat CT and surgical options for space occupying lesions. CPP cerebral perfusion pressure, CT computed tomography, EEG electroencephalography, Hb haemoglobin, kPa kilopascal, mmHg milimetre of mercury, PaCO2 arterial partial pressure of carbon dioxide, SpO2 arterial oxygen saturation
See this image and copyright information in PMC

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