Thermoregulation Clinical Pathway — PICU and PCU
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 is the preferred device for acute neurologic injury
Blanketrol
Arctic Sun
Choose preset program
Do not adjust
Choose preset program
Do not adjust
Temperature < 30°C
Temperature ≥ 30°C
Set blanket temperature,
manual 42°C
manual 42°C
Set blanket temperature,
automatic 33°C
automatic 33°C
Temperature Goal
32 to 34°C
32 to 34°C
Maintain goal temperature for
24-72 hrs per clinical team
24-72 hrs per clinical team
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 36.8°C
1°C every 6 hours in gradient 10 smart mode to goal of set temp 36.8°C
Targeted Temperature Management 36.8°C
Core temperature goal 36.8°C for up to 48 hours
Core temperature goal 36.8°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:
|
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 |