Controlled normothermia in neurologic intensive care.

Preclinical studies of cerebral ischemia and trauma find increased brain tissue injury and worsened functional outcomes if the brain temperature exceeds 39 degrees C. Several retrospective studies of patients with new-onset stroke, intracerebral hemorrhage, or subarachnoid hemorrhage support these observations. However, fever is very common among these patients early after the onset of their disease, particularly if they are in the ICU for a week or more, and brain temperatures are likely to be as much as 2 degrees C higher than rectal temperatures. Finally, intravascular temperature modulation has been shown to be more effective for preventing fever than conventional methods, such as antipyretic medications or surface-cooling techniques. Further study is needed to establish if such better control of temperature will lead to improved outcomes.