What is the recommended approach to temperature management in severe TBI?

• A. Induced hypothermia is standard of care for all patients with severe TBI.
• B. Maintain normothermia; treat fever promptly; induced hypothermia not standard due to adverse effects; targeted temperature management may be considered in select cases.
• C. Temperature management is not important.
• D. Hyperthermia is protective in TBI.

Answer: (B)

Maintaining a stable, normal body temperature is important because fever worsens brain injury by increasing metabolic demand and can raise intracranial pressure. The best approach is to keep the patient at normothermia and treat any fever promptly. Induced hypothermia has not become standard for all severe TBI patients because large studies haven’t shown clear, consistent benefits and the cooling process brings several risks, such as infections, blood clotting problems, electrolyte disturbances, and heart rhythm issues. Targeted temperature management (cooling or warming to a specific range) may be considered in select cases, such as when there is refractory intracranial hypertension or persistent fever despite standard measures, but it isn’t routine care for every patient. In practice, use antipyretics and cooling methods as needed to maintain normothermia, with careful monitoring and escalation only in appropriate, carefully selected situations.