In my practice I see quite a few patients with severe traumatic brain injury. Previously in this blog we talked about decompressive craniectomy as a treatment option for head injured patients. Another aspect of daily management of these patients that has significant impact on recovery is fever control. There is no doubt that high fever worsens neurological outcome in patients with brain injury. Yet, cooling those patients to subnormal temperatures (32-33 degrees C) was not shown to be beneficial. I believe there are too many confounding factors in trauma patients making them poor candidates for cooling.
How do we maintain euthermia (normal temperature) in these patients? I have tried multiple modalities in my practice: ice packs, Tylenol, cooling blankets, fans, gastric/bladder lavages. High fever in neurological patients is often hard to control. None of the options mentioned above work consistently well. The newer fever control modality that I have tried is endovascular cooling. Inserting a special cooling catheter (see picture above) with a cold saline circulating thru 3 or more coaxial balloons into a central vein makes cooling these patient much more consistent and controlled.  This is only one of the few new (intravascular or external) cooling devices available. It would be interesting to see if anybody has more experience with any other devices or techniques.