What is included in supportive therapy during targeted temperature management (TTM)?

Updated: Jul 26, 2019
  • Author: Alex Koyfman, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

Answer

A mean arterial pressure (MAP) goal of more than 80 mm Hg is preferred; hypertension is potentially additive to the neuroprotection of hypothermia

Norepinephrine can be used, starting at 0.01 mcg/kg/min and titrated to a MAP above 80 mm Hg

Practice standard neuroprotective strategies such as placing the head of the bed at 30° [5]

Obtain a 12-lead electrocardiogram (ECG) after ROSC to evaluate for the presence of ST-elevation (class I, level of evidence B) [2]

Monitor for dysrhythmia (most commonly bradycardia) associated with hypothermia

If life-threatening dysrhythmia arises and persists, or hemodynamic instability or bleeding develops, discontinue active cooling and rewarm the patient

During cooling, an ECG Osbourne or camel wave may be present; heart rate less than 40 bpm is common and is not a cause for concern in the absence of other evidence of hemodynamic instability

Check skin every 2-6 hours for thermal injury caused by cold blankets

Regularly check the patient’s temperature with a secondary temperature monitoring device when cooling

After TTM, fever should be avoided

Maintain oxygen saturation above 94%

Do not provide nutrition to the patient during the initiation, maintenance, or rewarming phases of the therapy


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