PICU/PCU Clinical Pathway for Thermoregulation

Related Order Sets
  • Cooling Blanket Order Set
  • TBI Order Set
Targeted Temperature Management 33°C
(Formerly induced hypothermia)
Febrile Patient
Definition: > 38°C
Patient with
Acute Hypothermia

Definition: < 36°C

Temperature Measurement

A core temperature is the GOLD STANDARD

Core temperature is measured internally and is more reliable than a surface temperature and therefore should be considered the patient’s true temperature:

  • Esophageal
  • Bladder
  • Rectal
  • Oral

Surface temperature is altered by critical illness, vasopressors and cooling devices:

  • Axillary
  • Surface probe
Which Device to Use
Cincinnati Sub-zero Blanketrol® III Bair Hugger™Bair Hugger Manual Thermoflect® BlanketThermoflect Blanket Manual
  1. Neurologic Injury
  2. Patients < 36°C and not at their neurologic baseline and/or sedated/intubated
  • Patients > 34°C and awake patient at neurologic baseline (e.g., post-operative patient or patient with baseline hypothalamic temperature dysregulation)
  1. Acute mild hypothermic patient 35-36°C without acute neurologic injury where hypothermia is not being used as a treatment
  2. Chronic hypothermic patient with baseline hypothalamic temperature dysregulation
  • Device-controlled
  • Warms or cools from above and/or below
  • Temperature probe connects to device to help maintain tight temperature control
Quick Tips
  • Automatic mode should be used to rapidly decrease temperature (i.e. reduce fever or induce hypothermia)
    • When goal temperature is reached, switch device to gradient 10 smart mode for patient comfort.
  • CSZ blanket can be used several ways:
    • Beneath patient
    • On top of patient
    • Both
  • Note
    As there are limited devices, anticipated needs allow for ordering of additional supplies. The cooling blanket component is available in Pyxis supply machines.
  • Person-controlled
  • Warms from above only
  • Temperature probe does not connect to device
  • Requires continuous temperature monitoring
  • There is no feedback mechanism to help control the patient’s temperature (i.e., the Bair Hugger will not decrease from high to medium heat as the patient’s temperature increases)
Quick Tips
  • Plastic side should be facing up
  • Air towards patient
  • Passive rewarming using patient’s own body heat
  • Is not a device, but blanket
  • Requires continuous or frequent temperature monitoring depending on clinical situation
  • Low risk of overheating
Quick Tips
  • Tuck in around patient
  • Does not matter which side is up
Posted: July 2015
Revised: June 2022
Authors: A. Topjian, MD; L. Hutchins, RN; M. Snyder, RN; K. Lourie, RN; K. Agarwal, RN; J. Fowler, MD