Skip to content


  • Meeting abstract
  • Open Access

Intracranial pressure and hypothermia

  • 1
Critical Care201216 (Suppl 2) :A23

  • Published:


  • Traumatic Brain Injury
  • Intracranial Pressure
  • Intracranial Hypertension
  • Therapeutic Hypothermia
  • Decompressive Craniectomy

Although the neuroprotective potential of hypothermia is well known and has been established experimentally, its clinical use is limited to selected indications [1], as large trials have yielded disappointing results [2]. This has been mainly attributed to the side effects of hypothermia in critically ill patients and problems with rewarming.

Intracranial hypertension is a major problem in neurocritical care and particularly in patients with subarachnoid hemorrhage (SAH) and traumatic brain injury (TBI), causing death if uncontrolled. As trials on prophylactic hypothermia, for example, for TBI have not been successful in improving outcome, its routine use can currently not be recommended. However, there are many literature reports demonstrating enormous efficacy of hypothermia to reduce elevated intracranial pressure (ICP). Mechanisms of action are thought to be the reduction of metabolism and perfusion and the reduction of edema besides others. Studies have indicated that therapeutic efficacy is sufficient for ICP control at mild hypothermia of 35°C, thus minimizing detrimental effects. In desperate clinical situations hypothermia is used to control intracranial hypertension both for TBI and SAH, but it has recently been applied only as a last resort. Other second-tier therapies and surgical maneuvers like decompressive craniectomy have been popularized instead, although their efficacy is still questioned as well. The knowledge and experience with therapeutic hypothermia has advanced in recent years and the problems of side effects and most importantly rewarming can be better addressed [3]. The latter has been a tremendous problem in patients with uncontrollable ICP, as despite its initial efficacy ICP problems recurred, if hypothermia was stopped prematurely. This goes in line with a recent metaanalysis that stressed the importance of prolonged hypothermia (48 hours to 5 days) and of slow rewarming (<1°C/4 hours). As a consequence the Eurotherm3235Trial was initiated to investigate the effect of hypothermia particularly for intracranial pressure reduction [4]. It has to be awaited whether this will foster the use of hypothermia to treat elevated ICP or whether we will stick with the policy of controlled normothermia.

Authors’ Affiliations

Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria


  1. Rivera-Lara L, Zhang J, Muehlschlegel S: Therapeutic hypothermia for acute neurological injuries. Neurotherapeutics 2012, 9: 73-86. 10.1007/s13311-011-0092-7PubMed CentralView ArticlePubMedGoogle Scholar
  2. Clifton GL, Miller ER, Choi SC, Levin HS, McCauley S, Smith KR Jr, Muizelaar JP, Wagner FC Jr, Marion DW, Luerssen TG, Chesnut RM, Schwartz M: Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 2001, 344: 556-563. 10.1056/NEJM200102223440803View ArticlePubMedGoogle Scholar
  3. Polderman KH, Herold I: Therapeutic hypothermia and controlled normothermia in the intensive care unit: practical considerations, side effects, and cooling methods. Crit Care Med 2009, 37: 1101-1120. 10.1097/CCM.0b013e3181962ad5View ArticlePubMedGoogle Scholar
  4. Andrews PJ, Sinclair HL, Battison CG, et al.: European society of intensive care medicine study of therapeutic hypothermia (32°-35°C) for intracranial pressure reduction after traumatic brain injury (the Eurotherm3235 Trial). Trials 2011, 12: 12-18. 10.1186/1745-6215-12-S1-A12View ArticleGoogle Scholar


© Thomé; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.