Fever is common in neurocritical care patients and is associated with poor outcome. Targeted temperature management (TTM), i.e. therapeutic hypothermia or controlled normothermia, after acute brain injury has been studied as a neuroprotectant for several decades. In contrast to pharmacological agents with specific targets TTM affects multiple pathophysiological mechanisms and is primarily thought to attenuate secondary brain injury. Most promising results have been obtained from experimental studies on cerebral ischemia or traumatic brain injury showing beneficial effects of hypothermia on structural and functional outcome. A positive influence of hypothermia has been observed in animal models of spontaneous intracerebral hemorrhage (ICH) improving, among others, perihematomal edema, blood-brain barrier integrity, inflammation and thrombin-induced injury. However, results regarding functional outcome are conflicting. Little data is available on the effect of TTM in humans. Single-center observational studies have shown reduced perihematomal edema under mild hypothermia and an association with favorable outcome. Thus, results from ongoing, prospective randomized-controlled trials are highly anticipated.
