***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Context Elevated temperature worsens injury in experimental focal and global ischemia and brain trauma . Fever is common in patients with acute neurologic illness and independently predicts poor outcome . Conventional means of treating fever are not very effective in this population . Objective To study the effectiveness of a catheter-based heat exchange system in reducing elevated temperatures in critically ill neurologic and neurosurgical patients . Design , Intervention , Setting , and Population This was a prospect i ve r and omized , nonblinded trial that compared conventional treatment of fever ( acetaminophen and cooling blankets ) with conventional treatment plus an intravascular catheter-based heat exchange system ( Alsius , Irvine , CA ) . Patients admitted to one of 13 neurologic intensive care units in academic medical centers were eligible if they a ) suffered subarachnoid hemorrhage , intracerebral hemorrhage , ischemic infa rct ion , or traumatic brain injury ; b ) had a temperature > 38 ° C on two occasions or for > 4 continuous hrs ; and c ) required central venous access . Main Outcome MeasureThe fever burden ( area under the curve > 38 ° C ) for 72 hrs was compared in an intention to treat analysis . Safety of the catheter system was monitored . Results A total of 296 patients were enrolled over 20 months . Forty-one percent had subarachnoid hemorrhage , 24 % had traumatic brain injury , 23 % had intracerebral hemorrhage , and 13 % had ischemic stroke . The groups were matched in terms of age , body mass index , sex , and Glasgow Coma Scale score distribution . Fever burden was 7.92 vs. 2.87 ° C-hrs in the conventional group and catheter groups , respectively ( 64 % reduction , p < .01 ) . There was no higher rate of infection or the use of sedatives , narcotics , or antibiotics in the catheter group . The catheter did not significantly increase risk to the patient beyond that of a central catheter . Conclusions The addition of this catheter-based cooling system to conventional management significantly improves fever reduction in neurologic intensive care unit patients BACKGROUND Pyrexia is common after brain injury ; it is generally believed to affect outcome adversely and the usual clinical methods of reducing temperature are not effective . The normal physiological mechanisms of brain cooling are heat loss from the upper airways and through the skull , and these can produce selective brain cooling . METHODS Air at room temperature and humidity was continuously administered to 15 brain-injured , intubated and mechanically ventilated patients via a sponge-tipped oxygen catheter in each nostril at a combined rate of 115 ml kg(-1 ) min(-1 ) . Brain temperature was measured using a pressure-temperature Camino catheter which is design ed to site the thermistor 1 cm into the parenchyma in the frontal lobe . Oesophageal temperature was measured using an oesophageal stethoscope with a thermistor . After establishing baseline for 30 min , patients were r and omized to receive airflow or no airflow for 6 h and then crossed over for a further 6 h. RESULTS Airflow replicating normal resting minute volume did not produce clinical ly relevant or statistically significant reductions in brain temperature [ 0.13 ( SD 0.55 ) degrees C ; 95 % CI , 0.43 - 0.17 degrees C ] . However , we serendipitously found some evidence of selective brain cooling via the skull , but this needs further substantiation . CONCLUSIONS A flow of humidified air at room temperature through the upper respiratory tracts of intubated brain-injured patients did not produce clinical ly relevant or statistically significant reductions in brain temperature measured in the frontal lobe Background Temperature management is used with increased frequency as a tool to mitigate neurological injury . Although frequently used , little is known about the optimal cooling methods for inducing and maintaining controlled normo- and hypothermia in the intensive care unit ( ICU ) . In this study we compared the efficacy of several commercially available cooling devices for temperature management in ICU patients with various types of neurological injury . Methods Fifty adult ICU patients with an indication for controlled mild hypothermia or strict normothermia were prospect ively enrolled . Ten patients in each group were assigned in consecutive order to conventional cooling ( that is , rapid infusion of 30 ml/kg cold fluids , ice and /or coldpacks ) , cooling with water circulating blankets , air circulating blankets , water circulating gel-coated pads and an intravascular heat exchange system . In all patients the speed of cooling ( expressed as ° C/h ) was measured . After the target temperature was reached , we measured the percentage of time the patient 's temperature was 0.2 ° C below or above the target range . Rates of temperature decline over time were analyzed with one-way analysis of variance . Differences between groups were analyzed with one-way analysis of variance , with Bonferroni correction for multiple comparisons . A p < 0.05 was considered statistically significant . Results Temperature decline was significantly higher with the water-circulating blankets ( 1.33 ± 0.63 ° C/h ) , gel-pads ( 1.04 ± 0.14 ° C/h ) and intravascular cooling ( 1.46 ± 0.42 ° C/h ) compared to conventional cooling ( 0.31 ± 0.23 ° C/h ) and the air-circulating blankets ( 0.18 ± 0.2 ° C/h ) ( p < 0.01 ) . After the target temperature was reached , the intravascular cooling device was 11.2 ± 18.7 % of the time out of range , which was significantly less compared to all other methods . Conclusion Cooling with water-circulating blankets , gel-pads and intravascular cooling is more efficient compared to conventional cooling and air-circulating blankets . The intravascular cooling system is most reliable to maintain a stable temperature OBJECT Hypothermia is by far the most potent neuroprotectant . Nevertheless , timely and safe delivery of hypothermia remains a clinical challenge . To maximize neuroprotection yet minimize systemic complications , ultra-early delivery of selective cerebral hypothermia by Emergency Medical Service ( EMS ) personnel in the field would be advantageous . The authors ( W.E. and H.W. ) have developed a cooling helmet by using National Aeronautics and Space Administration spinoff technology . In this study its effectiveness in lowering brain temperature in patients with severe stroke or head injury is examined . METHODS Patients were r and omly assigned to groups receiving either the cooling helmet or no cooling , and brain temperatures ( 0.8 cm below the cortical surface ) were continuously monitored for a mean of 48 to 72 hours with a Neurotrend sensor and then compared with the patients ' core temperatures . There were eight patients in the study group and six in the control group . The mean change in temperature ( brain-body temperature ) calculated from 277 data hours in the study group was -1.6 degrees C compared with a mean change in temperature of + 0.22 degrees C calculated from 309 data hours in the control group . This was statistically significant ( p < 0.0001 ) . On average , 1.84 degrees C of brain temperature reduction ( range 0.9 - 2.4 degrees C ) was observed within 1 hour of helmet application . It took a mean of 3.4 hours ( range 2 - 6 hours ) to achieve a brain temperature lower than 34 degrees C and 6.67 hours ( range 1 - 12 hours ) before systemic hypothermia ( < 36 degrees C ) occurred . Use of the helmet result ed in no significant complications . There was , however , one episode of asymptomatic bradycardia ( heart rate < 40 ) that responded to a 0.5 degrees C body temperature increase . CONCLUSIONS This helmet delivers initial rapid and selective brain cooling and maintains a significant temperature gradient between the core and brain temperatures throughout the hypothermic period to provide sufficient regional hypothermia yet minimize systemic complications . It results in delayed systemic hypothermia , creating a safe window for possible ultra-early delivery of regional hypothermia by EMS personnel in the field BACKGROUND Cerebral hypothermia can improve outcome of experimental perinatal hypoxia-ischaemia . We did a multicentre r and omised controlled trial to find out if delayed head cooling can improve neurodevelopmental outcome in babies with neonatal encephalopathy . METHODS 234 term infants with moderate to severe neonatal encephalopathy and abnormal amplitude integrated electroencephalography ( aEEG ) were r and omly assigned to either head cooling for 72 h , within 6 h of birth , with rectal temperature maintained at 34 - 35 degrees C ( n=116 ) , or conventional care ( n=118 ) . Primary outcome was death or severe disability at 18 months . Analysis was by intention to treat . We examined in two predefined subgroup analyses the effect of hypothermia in babies with the most severe aEEG changes before r and omisation -- ie , severe loss of background amplitude , and seizures-- and those with less severe changes . FINDINGS In 16 babies , follow-up data were not available . Thus in 218 infants ( 93 % ) , 73/110 ( 66 % ) allocated conventional care and 59/108 ( 55 % ) assigned head cooling died or had severe disability at 18 months ( odds ratio 0.61 ; 95 % CI 0.34 - 1.09 , p=0.1 ) . After adjustment for the severity of aEEG changes with a logistic regression model , the odds ratio for hypothermia treatment was 0.57 ( 0.32 - 1.01 , p=0.05 ) . No difference was noted in the frequency of clinical ly important complications . Predefined subgroup analysis suggested that head cooling had no effect in infants with the most severe aEEG changes ( n=46 , 1.8 ; 0.49 - 6.4 , p=0.51 ) , but was beneficial in infants with less severe aEEG changes ( n=172 , 0.42 ; 0.22 - 0.80 , p=0.009 ) . INTERPRETATION These data suggest that although induced head cooling is not protective in a mixed population of infants with neonatal encephalopathy , it could safely improve survival without severe neurodevelopmental disability in infants with less severe aEEG changes Introduction Aim of this r and omized prospect i ve clinical trial is to compare two methods of antipyretics and evaluate their efficacy in controlling fever during the acute phase of brain damage . Methods Twenty-two febrile comatose patients : 12 severe traumatic brain injury and 10 subarachnoid hemorrhage divided in 2 groups : Diclofenac low-dose infusion ( 10 patients ) and extemporaneous boluses of NSAIDs ( CTRL , 12 patients ) . The primary outcome measure was length of time with temperature > 38 ° C . Secondary outcome measures were : 1 ) to assess the effects of each antipyretic strategy on intracranial pressure ( ICP ) , cerebral perfusion pressure ( CPP ) , mean arterial pressure ( MAP ) and heart rate ; 2 ) to monitor adverse effects of each antipyretic strategy . The baseline characteristics in the two treatment groups were similar . Results Primary findings : percentage of time per patient with temperature > 38 ° C was significantly lower ( P < 0.0001 ) in the DCF group , 4 % ( 0–22 % ) , vs. 34 % ( 8–56 % ) in CTRL group . In addition , mean T ° , max T ° were lower in DCF than in CTRL ( P < 0.05 ) . Secondary findings : CPP and MAP were significantly higher in DCF group ( P < 0.05 ) while ICP was not different ( NS ) . However , if ICP pre r and omization was < 25 mmHg , CTRL suffered a worst ICP ( 24 ± 11 vs. 16 ± 7 P = 0.01 ) , MAP ( 89 ± 10 vs. 104 ± 10 P = 0.01 ) and CPP ( 75 ± 10 vs. 94 ± 17 P = 0.01 ) compared to DCF . No differences between the two treatment were recorded when ICP ≥ 25 mmHg before r and omization . There was no gastrointestinal or intracranial bleeding . Conclusions Low dose DCF infusion is a potential useful strategy for a successful control temperature better than intermittent NSAIDs dosing , minimizing potentially brain-damaging effects of fever BACKGROUND Heat loss from the upper airways and through the skull are physiological mechanisms of brain cooling which have not been fully explored clinical ly . METHODS This r and omized , crossover , factorial trial in 12 brain-injured , orally intubated patients investigated the effect of enhanced nasal airflow ( high flow unhumidified air with 20 p.p.m . nitric oxide gas ) and bilateral head fanning on frontal lobe brain temperature and selective brain cooling . After a 30 min baseline , each patient received the four possible combinations of the interventions --airflow , fanning , both together , no intervention -- in r and omized order . Each combination was delivered for 30 min and followed by a 30 min washout , the last 5 min of which provided the baseline for the next intervention . RESULTS The difference in mean brain temperature over the last 5 min of the preceding washout minus the mean over the last 5 min of intervention , was 0.15 degrees C with nasal airflow ( P=0.001 , 95 % CI 0.06 - 0.23 degrees C ) and 
    Output:
    
There is no evidence that interventions aim ed at reducing body temperature to between 35 degrees C and 37.5 degrees C in the first week after TBI improves patient outcomes .