Going to push back on this one. Elevated temperatures to the degree that cause brain injury are exceedingly rare except in the cases of environmental factors that prevent heat loss. We're talking about temps over 107 for extended periods of time before a person is likely to suffer neurologic impairment.
@longhaul3's example is one of those rare cases
because of the established brain injury and the impaired temperature regulation related to the neuro storming. But in otherwise intact normal brains, I would not consider hyperthermia the larger risk over the ongoing hemolysis. Fevers are super uncomfortable for sure, but ultimately unlikely to be of significant harm.
My practice in the Pediatric ICU for active cooling measures has changed over time, but now focuses only on situations in which trying to manage the metabolic demands of fever leads to significant improvement - the patient in septic shock on pressors, the child with heart failure who can't compensate, the traumatic brain injury. But otherwise, for the awake kid is going to be more miserable with ice packs in their arm pts than just rigoring through the fever.
