Thermoregulation Clinical Pathway — PICU and PCU

Targeted Temperature Management 33°C

Thermoregulation Requirement — Choose Device
Arctic Sun is the preferred device for acute neurologic injury
Arctic Sun
Choose preset program
Do not adjust
Temperature < 30°C
Temperature ≥ 30°C
Set blanket temperature,
manual 42°C
Set blanket temperature,
automatic 33°C
Temperature Goal
32 to 34°C
Maintain goal temperature for
24-72 hrs per clinical team
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
Possible Hypothermia Side Effects
Ventricular Fibrillation:
High Risk When < 30°C
Follow PALS/ACLS guidelines
Sinus Bradycardia No intervention needed if end organ perfusion maintained (normal SVO2 and 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