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Thermoregulation Clinical Pathway – PICU and PCU

PICU/PCU Clinical Pathway for Thermoregulation

Goals and Metrics
Provider Resources
Child Requiring Thermoregulation
2026 Review of Recent Evidence

Methods to Measure Temperature

Bedside Shivering Assessment Scale (BSAS) Monitoring
 
 
 
 

Acute Neurologic Injury

Shivering prevention required

Non-neurologic Injury

Shivering prevention as clinically indicated
 
 
 
 
 
 
 
 
 
 
 
 
Targeted Temperature Management 36°C
for Cardiac Arrest
Formerly controlled normothermia
Targeted Temperature Management 36.8°C
for Non-Cardiac Arrest
Formerly controlled normothermia
Targeted Temperature Management 33°C
Formerly induced hypothermia
Hyperthermia
> 38°C
New-Onset Hypothermia
< 36°C
No history of hypothermia
Chronic Hypothermia
< 36°C
History of hypothermia

Device Selection

Never use more than 1 external device at a time
Arctic Sun
Indications Probe Requirements Features Tips
Preferred device for
  • Acute neurologic injury
  • Continuous core temperature monitoring
  • 1st probe to the device (esophageal preferred—confirm placement with X-ray: probe in lower third of esophagus behind level of heart)
  • 2nd probe to the monitor (required for TTM 33°C)
  • Device-controlled
  • Device auto adjusts temperature based on feedback from the measured core temperature
  • Warms or cools with pads applied to child’s skin
  • Temperature probe connects to device to help maintain tight temperature control
  • Controlled rate of re-warming when indicated
  • Preferred method of thermoregulation for children with acute neurologic injury if available
  • Device has preset modes based on targeted temperature and once temperature is selected, no adjustments are needed
  • Pads are single use, can be used up to 5 days and may remain on child while transporting off unit, except to OR or IR
  • Pads may remain on for X-ray, CT and MRI. Remove pads for OR and IR.
  • Placement and size of pads varies based on child size
  • Contraindications: signs of ulceration, burns, hives, or rash
Blanketrol
Indications Probe Requirements Features Tips
  • Hyperthermia
  • or
  • Acute hypothermia
  • or
  • Acute on chronic hypothermia
  • 2nd line for acute neurologic injury
  • Continuous core temperature monitoring
  • 1st probe to the device (esophageal preferred—confirm placement with X-ray: probe in lower third of esophagus behind level of heart)
  • 2nd probe to the monitor
    (required for TTM 33°C)
  • Device-controlled
  • Device auto adjusts temperature based on feedback from the measured core temperature
  • Warms or cools with blanket from above and/or below
  • Temperature probe connects to device to help maintain tight temperature control
  • Automatic mode should be used to rapidly decrease temperature
    • e.g., reduce fever or induce hypothermia
  • Manual mode used only for rewarming when patient’s core temperature is < 30°C
  • Guidelines for adjusting Blanketrol temperature and modes:
Thermoflect Blanket
Indications Probe Requirements Features Tips
  • Acute mild hypothermia 35–36°C without acute neurologic injury
  • or
  • Chronic hypothermia with baseline hypothalamic temperature dysregulation
  • Acute hypothermia: continuous core temperature monitoring
  • Probe to the monitor
  • Chronic hypothermia: minimum intermittent monitoring
  • Passive rewarming using child’s own body heat
  • Low risk of overheating
  • Tuck in around child
  • Does not matter which side is up
Bair Hugger
Indications Probe Requirements Features Tips
  • Temperature > 34°C
  • and
  • Awake at neurologic baseline
    • e.g., post-operative, or baseline hypothalamic temperature dysregulation and able to communicate discomfort
  • Continuous core temperature monitoring
  • Probe to the monitor
  • Provider-controlled
  • There is no feedback mechanism to help control the child’s temperature
  • Risk of overheating as device does not decrease heat as child’s temp increases
  • Warms with a cover from above only
  • Temperature probe does not connect to device
  • Plastic side should be facing up
  • Airflow towards child