Fever and Therapeutic Hypothermia

Fever is a common phenomenon in the critical care setting but damaging to the injured brain. Therapeutic hypothermia (TH) is the intentional cooling of a patient by artificial means for a therapeutic purpose. Targeted Temperature Management (TTM) is the practice of setting a specified goal core temperature for the management of fever, maintaining normothermia, and induction of hypothermia. This chapter discusses fever and the use of TTM and TH in the neurocritical care unit for various neurological diseases. TTM in the context of post-cardiac arrest is addressed separately in another chapter. Basic definitions and methods for cooling are described and side effects of the use of TH are also presented. While this is an intriguing therapy with enormous potential, its efficacy for various neurologic diseases remains highly debated. In summary, this chapter will provide a review of the current literature and provide context for the use of TH and TTM in neurologically injured patients.