Thermoregulation Clinical Pathway — PICU and PCU
Targeted Temperature Management 33°C
(Formerly Induced Hypothermia)
(Formerly Induced Hypothermia)
Measure Patient
Core Temperature
Core Temperature
Use 2 core probes according to the following preferences:
Use Cooling Blanket Order Set
- Esophageal
- Foley
- Rectal
Patient Core
Temperature < 30°C
Temperature < 30°C
Patient Core
Temperature ≥ 30°C
Temperature ≥ 30°C
Set Blanket Temperature
MANUAL 42°C
MANUAL 42°C
Set Blanket Temperature
AUTOMATIC 33°C
AUTOMATIC 33°C
Core Temperature ≥ 30°C
Set Blanket Temperature
AUTOMATIC 33°C
AUTOMATIC 33°C
Core Temperature Goal
32 to 34°C
32 to 34°C
Maintenance Phase
Maintain Goal Temperature for 48 hours
Maintain Goal Temperature for 48 hours
Rewarming
Over 16 - 24 hours
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
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
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:
|
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:
|
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 |