Target temperature management in traumatic brain injury with a focus on adverse events, recognition, and prevention

Oct 5, 2026

Targeted temperature management is reviewed for traumatic brain injury, emphasizing adverse events that may emerge during induction, maintenance, and rewarming. The review explains the rationale for hypothermia-based neuroprotection, summarizes why outcomes have remained uncertain in randomized controlled studies, and contrasts established benefits in cardiac arrest care with limited or inconsistent evidence in TBI. It highlights complications and risks, including pneumonia-associated mortality signals, and outlines prevention and response considerations to improve safety while supporting neurological recovery.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages232

Reading Time9 h 45 min

AccessFree to download

Introduction

Why did TH and TTM not demonstrate neuroprotection in TBI patients?

Key messages

Acute and Critical Care 2022 November 37(4):483-490 [https://doi.org/10.4266/acc.2022.01291](https://doi.org/10.4266/acc.2022.01291) | pISSN 2586-6052 | eISSN 2586-6060 Target temperature management in traumatic brain injury with a focus on adverse events, recognition, and prevention Kwang Wook Jo Department of Neurosurgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Traumatic brain injury (TBI) is a critical cause of disability and death worldwide. Many studies have been conducted aimed at achieving favorable neurologic outcomes by reducing secondary brain injury in TBI patients. However, ground-breaking outcomes are still insufficient so far. Because mild-to-moderate hypothermia (32°C–35°C) has been confirmed to help neurological recovery for recovered patients after circulatory arrest, it has been recognized as a major neuroprotective treatment plan for TBI patients. Thereafter, many clinical studies about the effect of therapeutic hypothermia (TH) on severe TBI have been conducted. However, efficacy and safety have not been demonstrated in many large-scale randomized controlled studies. Rather, some studies have demonstrated an increase in mortality rate due to complications such as pneumonia, so it is not highly recommended for severe TBI patients. Recently, some studies have shown results suggesting TH may help reperfusion/ischemic injury prevention after surgery in the case of mass lesions, such as acute subdural hematoma, and it has also been shown to be effective in intracranial pressure control. In conclusion, TH is still at the center of neuroprotective therapeutic studies regarding TBI. If proper measures can be taken to mitigate the many adverse events that may occur during the course of treatment, more positive efficacy can be confirmed. In this review, we look into adverse events that may occur during the process of the induction, maintenance, and rewarming of targeted temperature management and consider ways to prevent and address them. Key Words: intracranial pressure; ischemia; reperfusion; targeted temperature management; therapeutic hypothermia; traumatic brain injury INTRODUCTION In adult out-of-hospital cardiac arrest survivors with ventricular tachycardia or fibrillation, when TH (32°C–34°C for 12–24 hours) is applied after resuscitation, it is well-known to improve neurologic outcomes by reducing reperfusion injury (hypoxic-ischemic cascade), and it is therefore recommended. Based on this situation, many studies have been conducted to confirm the effects of therapeutic hypothermia (TH) or targeted temperature management (TTM) on severe traumatic brain injury (TBI) treatment. The efficacy of TH has not been demonstrated so far to improve neurological outcomes in Review Article Received: October 9, 2022 Accepted: November 3, 2022 Corresponding author Kwang Wook Jo Department of Neurosurgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon 14647, Korea Tel: +82-32-340-7039 Fax: +82-32-340-7391 [E-mail: jkw94@naver.com](E-mail: jkw94@naver.com) Copyright ©2022 The Korean Society of Critical Care Medicine This is an Open Access article distributed under the terms of Creative Attributions Non-Commercial License ([https://creativecom](https://creativecom)[mons.org/li-censes/by-nc/4.0/](mons.org/li-censes/by-nc/4.0/)) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. [https://www.accjournal.org](https://www.accjournal.org) 483 Jo KW Temperature management in traumatic brain injury patients with TBI in multicenter randomized controlled study (RCT) [1-4] . For this reason, early (within 2.5 hours), shortterm (48 hours post-injury), and prophylactic hypothermia are not recommended to improve outcomes in patients with diffuse injury in the Guidelines for the Mana

FAQs

What is the main focus of targeted temperature management in traumatic brain injury in this review?

The review focuses on adverse events that can occur during induction, maintenance, and rewarming of targeted temperature management, and discusses recognition, prevention, and management approaches.

Why has therapeutic hypothermia not clearly demonstrated neuroprotection in traumatic brain injury?

The exact mechanism is not fully known, and the review notes that the brain’s pathological environment in TBI differs from conditions like out-of-hospital cardiac arrest where TH has shown better outcomes.

What adverse-event risks are highlighted for severe traumatic brain injury when using therapeutic hypothermia?

The review reports that some studies have shown increased mortality associated with complications such as pneumonia, which limits strong recommendations for severe TBI.

Oct 5, 2026

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