Temperature control in acute brain injury

PURPOSE: Temperature is a key determinant of cerebral vulnerability after acute brain injury and a physiological variable that can be continuously monitored and actively controlled in the intensive care unit. Its therapeutic role has evolved from hypothermia-centred strategies toward early recognition of fever and controlled normothermia. This review examines the physiological rationale, clinical evidence, and contemporary practice of temperature management in neurocritical care. METHODS: We synthesised evidence from major randomised trials, observational studies, and international consensus recommendations across traumatic brain injury, acute vascular brain injury, and post-cardiac arrest encephalopathy, together with current monitoring and implementation approaches. RESULTS: Fever is consistently associated with worse neurological outcomes. In traumatic brain injury, hypothermia reduces intracranial pressure but does not improve functional outcome when used prophylactically and is reserved for refractory intracranial hypertension. In acute vascular brain injury, neutral trials and feasibility constraints have shifted practice toward early detection and treatment of fever rather than hypothermia. In post-cardiac arrest care, contemporary guidelines recommend protocolised temperature control with selection and maintenance of a constant target between 32°C and 37.5°C and active prevention of fever, rather than mandatory hypothermia. CONCLUSIONS: Temperature control is a fundamental component of care aimed at protecting the injured brain through continuous monitoring, early detection of fever, and prevention of temperature-related harm.