Childs Charmaine, Lunn Kueh Wern
Crit Care. 2013 Apr 22;17(2):222. doi: 10.1186/cc11892.
Surrogate or 'proxy' measures of brain temperature are used in the routine management of patients with brain damage. The prevailing view is that the brain is 'hotter' than the body. The polarity and magnitude of temperature differences between brain and body, however, remains unclear after severe traumatic brain injury (TBI). The focus of this systematic review is on the adult patient admitted to intensive/neurocritical care with a diagnosis of severe TBI (Glasgow Coma Scale score of less than 8). The review considered studies that measured brain temperature and core body temperature. Articles published in English from the years 1980 to 2012 were searched in databases, CINAHL, PubMed, Scopus, Web of Science, Science Direct, Ovid SP, Mednar and ProQuest Dissertations & Theses Database. For the review, publications of randomised controlled trials, non-randomised controlled trials, before and after studies, cohort studies, case-control studies and descriptive studies were considered for inclusion. Of 2,391 records identified via the search strategies, 37 were retrieved for detailed examination (including two via hand searching). Fifteen were reviewed and assessed for methodological quality. Eleven studies were included in the systematic review providing 15 brain-core body temperature comparisons. The direction of mean brain-body temperature differences was positive (brain higher than body temperature) and negative (brain lower than body temperature). Hypothermia is associated with large brain-body temperature differences. Brain temperature cannot be predicted reliably from core body temperature. Concurrent monitoring of brain and body temperature is recommended in patients where risk of temperature-related neuronal damage is a cause for clinical concern and when deliberate induction of below-normal body temperature is instituted.
脑温的替代或“代理”测量方法被用于脑损伤患者的常规管理中。普遍观点认为大脑比身体“更热”。然而，在严重创伤性脑损伤（TBI）后，大脑与身体之间温度差异的极性和大小仍不明确。本系统评价的重点是入住重症/神经重症监护病房、诊断为重度TBI（格拉斯哥昏迷量表评分低于8分）的成年患者。该评价纳入了测量脑温和核心体温的研究。在CINAHL、PubMed、Scopus、科学网、Science Direct、Ovid SP、Mednar和ProQuest学位论文数据库中检索了1980年至2012年发表的英文文章。对于该评价，考虑纳入随机对照试验、非随机对照试验、前后对照研究、队列研究、病例对照研究和描述性研究的出版物。通过检索策略识别出2391条记录，其中37条被检索出来进行详细审查（包括通过手工检索的两条）。对15条进行了审查并评估其方法学质量。11项研究被纳入系统评价，提供了15次脑温与核心体温的比较。平均脑温与体温差异的方向为正向（脑温高于体温）和负向（脑温低于体温）。体温过低与较大的脑温与体温差异相关。无法根据核心体温可靠地预测脑温。对于温度相关神经元损伤风险引起临床关注的患者以及进行低于正常体温的诱导时，建议同时监测脑温和体温。
