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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