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TTM Guidance for Critical Care: Part 2 of 2

By CSZ Medical On May 31, 2018 10:00:00 AM

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TTM After Stroke, Intra-Cerebral Hemorrhage, and Subarachnoid Hemorrhage

The panel found very little evidence to support the use of TTM in the hypothermic range in these clinical settings. Their recommendations for this group were all in the expert opinion category.

Because fever is a common complication in these situations and associated with poorer outcomes, the panel recommended using TTM for normothermia in severe ischemic stroke.

The panel did suggest considering TTM at 35°-37° C to lower ICP in patients with spontaneous intracerebral hemorrhage. The evidence suggested that mild hypothermia may reduce edema and ICP, but does not lead to better neurological outcomes.

In comatose patients with aneurysmal subarachnoid hemorrhage, the data showed that hypothermia may lower ICP and improve neurological outcome, so the panel suggested using TTM in this setting.

TTM in Acute Bacterial Meningitis and Status Epilepticus

Again, all the recommendations for this group were given as expert opinions. The panel suggested the use of TTM at 34°-36° C to improve survival and neurological outcome in comatose patients with bacterial meningitis and intracranial hypertension. Likewise, they suggested TTM at 32°-35° C to control seizure activity in adults with refractory or super-refractory status epilepticus.

They recommended normothermia for all others in this group: comatose patients with meningitis or menignoencephalitis when fever is not tolerated, comatose patients with bacterial meningitis and no intracranial hypertension, and children with status epilepticus.

TTM After Hemodynamic Shock

The panel recommended not using TTM below 36° C for cardiogenic and septic shock, and suggested using TTM for normothermia in septic shock.

Although TTM can be an invaluable tool for a variety of clinical scenarios, the panel noted that intensivists need to be vigilant for the common complications of TTM, including hypokalemia, sepsis, pneumonia, and arrhythmia.

CSZ Medical, a Gentherm company, is pleased to be able to provide a wide range of TTM devices for use in the critical care environment. Visit us here or call us at 800-989-7373 for more information on specific product needs.

Read Part I of the blog here.

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References

  1. Cariou A, Payen JF, Asehnoune K, et al. Targeted temperature management in the ICU: guidelines from a French expert panel. Ann Intensive Care. 2017 Dec;7 (1):70. https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-017-0294-1

  2. Donnino MW, Andersen LW, Berg KM, et al. Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Circulation. 2015 Dec 22;132 (25):2448-56. http://circ.ahajournals.org/content/132/25/2448.short

  3. Stanger D, Mihajlovic V, Singer J, Desai S, El-Sayegh R, Wong GC. Effects of targeted temperature management on mortality and neurological outcome: A systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care. 2017 Nov 1:2048872617744353. http://journals.sagepub.com/doi/abs/10.1177/2048872617744353

  1. Lindsay PJ, Buell D, Scales DC. The efficacy and safety of pre-hospital cooling after out-of-hospital cardiac arrest: a systematic review and meta-analysis. Crit Care. 2018 Mar 13;22 (1):66. https://ccforum.biomedcentral.com/articles/10.1186/s13054-018-1984-2

*This article is intended for educational purposes only and is not intended as medical advice or as a substitute for the medical judgment of a physician in evaluating patients. For more information, please review the information sources referenced in this article. For more information on CSZ, please visit our website or call us at 1-800-989-7373.