Table 2.

Summary of workshop discussions and the participants’ recommendations and consensus.

Workshop objective		Discussion points		Concerns expressed		Recommendations		Consensus
To discuss future recommendations for temperature measurement in patients with severe TBI.		Do opportunities exist for improvement in measurement accuracy? What are the range of differences between brain and body temperature and how much do they vary?: see Kirk et al. (2009) What are the benefits of brain temperature monitoring?		Value of common body temperature sites (Johnston et al., 2006; axilla/skin folds/rectal/oesophageal) as surrogates for brain temperature should be questioned due to poor measurement practice No published guidelines available for standardization of depth (or positioning) of the brain temperature sensor In view of evidence that differences exist between brain and body temperature, this should be sufficient justification for direct brain temperature monitoring		Need for improved measurement reliability in thermometry practice Support for greater use of multi-modality monitoring If the objective of neuro-monitoring is to prevent secondary damage-“normal” brain rather than “damaged” brain tissue should be the focus for monitoring A possible benefit of brain temperature monitoring is the potential to “titrate” brain temperature to ICP		Standardization in temperature measurement is a key objective for the future Lack of confidence in rectal temperature as a surrogate for brain temperature is attributed to poor measurement practice notably: site and depth of thermistor insertion. Brain temperature monitoring should be encouraged as a “gold” standard if intracerebral monitoring is warranted Goal for the future: to build a body of evidence on brain temperature about absolute and trend change differences between brain and different core sites There is a need to understand the role of brain temperature as a biomarker for outcome
To discuss whether therapeutic control of temperature should be advocated as a treatment panacea or undertaken “on prescription”		What is the evidence that therapeutic control of body/brain temperature is beneficial for all neurosurgical patients?		The effect of not cooling patients with high brain temperature (i.e., >39°C) on survival of injured neurones is unknown. Treatments/ therapies to manipulate brain/body temperature to normal/below normal, levels are justified only as an adjunct therapy for those patients with refractory intracranial hypertension where clinicians are “struggling” to gain control of pressure increases within the brain.		Overwhelming support was given to a more “prescriptive” or “tailored” approach to the use of cooling interventions Patients with refractory ICP may benefit from body cooling.		The “selection” of patients for therapeutic hypothermia was a preferred approach to temperature management Whole body/internal cooling is not justifiable for temperature control per se.