Agressive Normothermia After Severe TBI May Improve Outcomes

In-hospital mortality was significantly lower despite longer overall stays.

WASHINGTON — A normothermia/antishivering protocol improved temperature control and lowered in-hospital mortality among patients with severe traumatic brain injury, according to researchers.

Patients treated with the protocol had more consistently maintained normothermia — defined as a body temperature between 97.5° and 99.5° F — compared with controls (53% vs. 39%, P= 0.0009), Deborah Green-LaRoche, MD, of Tufts University Medical Center in Boston, said during a poster session. 

Fever is common but serious in patients with severe TBI, and is associated with worse outcomes and longer stays in the intensive care unit, but little data is available on the benefits of aggressively maintaining normothermia in this population.

“The duration and degree of temperature elevation may have a dose-dependant association with functional outcome,” the researchers said.

So Green-LaRoche and colleagues performed a retrospective study to evaluate the effect of an induced normothermia/antishivering protocol among 29 cases with severe TBI and 51 controls during two predetermined 18-month periods after the hospital intervention was instituted (June 2012 to December 2013 and June 2009 to December 2010, respectively). 

The most common reasons for TBI were car accidents, falls and being hit by cars. The normothermia/antishivering protocol utilized the Arctic Sun Temperature Management System, and consisted of wrapping a patient’s thighs and torso with a gel-like foam pad and setting the appropriate temperature via a computer console. 

Patients were also given acetominophen, meperidine (Demerol) and buspirone (Buspar) to control shivering and had a warming blanket placed over their hands and extremities.

Although stays in the intensive care unit (ICU) were longer among case patients than controls (17.3 vs. 12.3 days; P=0.03), in-hospital mortality was significantly lower (6.9% vs. 33.3%; P=0.007), the researchers found. 

While not markedly different at hospital discharge, good functional outcomes (as assessed by Rankin Scale Scores ≤2) were more common among the induced normothermia group at follow-up clinic visits.

The proportion of recorded intracranial pressures <20 mmHg was the same (85%) for the two groups.

Arctic Sun was used more consistently among cases than controls (53% vs. 40%; P=0.01). Patients in the case group were also more likely to receive buspirone and meperidine, but acetaminophen use was similar for both groups.

The small patient population and single-site study design are limitations to the current findings. “One confounding factor may be an overall more aggressive approach to treatment of the severe TBI patient during the latter time frame,” according to the researchers. 

They called for a larger multicenter study to confirm the benefits of aggressively maintaining normothermia. 


  1. Green-LaRoche DM et al. #P7.168. “Induced Normothermia in Severe Traumatic Brain Injury Patients.” Presented at: AAN 2015. Washington, DC. April 18-25, 2015.