Thermoregulation Clinical Pathway — PICU and PCU

Targeted Temperature Management 33°C
(Formerly Induced Hypothermia)
Measure Patient
Core Temperature
Use 2 core probes according to the following preferences:
  1. Esophageal
  2. Foley
  3. Rectal
Use Cooling Blanket Order Set
Patient Core
Temperature < 30°C
Patient Core
Temperature ≥ 30°C
Set Blanket Temperature
MANUAL 42°C
Set Blanket Temperature
AUTOMATIC 33°C
Core Temperature ≥ 30°C
Set Blanket Temperature
AUTOMATIC 33°C
Core Temperature Goal
32 to 34°C
Maintenance Phase
Maintain Goal Temperature for 48 hours
Rewarming
Over 16 - 24 hours
Increase Set Blanket Temperature
1°C every 6 hours in gradient 10 smart mode to goal of set temp 36°C
Targeted Temperature Management 36°C
Core Temperature Goal 36°C for up to 48 hours
HYPOTHERMIA – WHAT TO EXPECT
< 30°C HIGH RISK Ventricular Fibrillation
Sinus Bradycardia No intervention needed if end organ perfusion maintained (normal SVO2 & lactate)
Hypertension, Poor Peripheral Perfusion Blood pressure may be increased due to increased systemic vascular resistance.
Electrolyte Derangements:
  • Low Magnesium, Calcium, Phosphorous, and Potassium
Add K to fluids if making urine. Replete others as needed.
Cold Diuresis Monitor CVP and replete fluids as needed.
Hyperglycemia May need insulin
Shivering Sedate, paralyze as needed.
Increase in Bleeding Time Usually no significant bleeding complications
REWARMING – WHAT TO WATCH FOR
Vasodilation with:
  • Associated tachycardia
  • Hypotension
  • Low urine output
Replete fluids as needed
Monitor CVP and end organ perfusion
Hyperkalemia Consider decreasing supplemental potassium
Shivering Sedate and paralyze as needed
Seizures Can occur with rewarming