The Brain and Hypothermia—From Aristotle to Targeted Temperature Management

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The critical importance of temperature regulation to “neurologic” well-being has some of its earliest roots in the writings of Aristotle in the fourth century BC, who stated “…man’s superior intelligence depends on the fact that his larger brain is capable of keeping the heart cool enough for optimal mental activity (1).” Given that Aristotle professed that the heart was the center of nervous function, he appears to have recognized the importance of temperature control and fever prevention in neurocritical care, except he had the organs confused! Almost 2,100 years later, another chapter in the origins of therapeutic hypothermia (TH) and its potential in neurocritical care and resuscitation is discovered in the writings of Baron Dominique-Jean Larrey, surgeon to Napoleon Bonaparte, who suggested in the early 1800s that hypothermia was beneficial to victims of traumatic exsanguination given that the soldiers located farthest from the campfire survived the longest (2). Shortly thereafter, the neurosurgeon Phelps (3) wrote in his 1897 treatise, “Traumatic Injuries of the Brain and its Membranes,” that the application of the “ice cap” was beneficial in traumatic brain injury (TBI)—second in efficacy only to trephination.
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