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Methods of cooling: Practical aspects of therapeutic temperature management

Seder, David B. MD; Van der Kloot, Thomas E. MD

doi: 10.1097/CCM.0b013e3181aa5bad

Objectives: To review traditional and newer means of inducing, maintaining, and withdrawing therapeutic hypothermia and normothermia. To suggest treatment algorithms for temperature modulation and review neuromonitoring options.

Design: A review of current literature describing methods of performing therapeutic temperature management and neuromonitoring during the cooling, maintenance, and decooling periods. Algorithms for performing therapeutic temperature management are suggested.

Results: Temperature management can be safely and effectively performed using traditional or newer modalities. Although traditional means of cooling are feasible and efficacious, modern devices utilizing feedback loops to maintain steady body temperature and prevent overcooling have advantages in ease of application, patient safety, maintenance of target temperature, and control of decooling. Neuromonitoring options should be adapted to an individual patient and situation.

Conclusions: Intensivists should be familiar with techniques to induce, maintain, and withdraw therapeutic temperature management, and select the most appropriate method for a given patient and situation.

From the Division of Pulmonary and Critical Care Medicine and Neuroscience Institute, Maine Medical Center, and Tufts University School of Medicine, Portland, ME (DBS); and University of Vermont College of Medicine, Burlington, VT (TEVdK).

The authors have not disclosed any potential conflicts of interest.

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© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins