How is controlled rewarming performed in 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

Begin rewarming of the patient 24 hours after the initiation of cooling.

  • Rewarm slowly at a rate of 0.3-0.5°C every hour

  • Rewarming will take approximately 8-12 hours

  • Remove cooling blankets (and ice if still in use)

  • One method is to set the water temperature in the cooling device to 35°C and then increase the water temperature by 0.5°C every 1-2 hours until a stable core body temperature of 36°C has been reached for 1 hour

  • Maintain the paralytic agent and sedation until the patient’s temperature reaches 36°C; if infusing, discontinue the paralytic agent first; the sedation may be discontinued at the practitioner’s discretion

  • Monitor the patient for hypotension secondary to vasodilation related to rewarming

  • Discontinue potassium infusions

  • Avoid hyperthermia

See the image below.

Targeted temperature management (therapeutic hypot Targeted temperature management (therapeutic hypothermia). Cooling pads.

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