Consensus Background and Status of Target Temperature Management (TTM)
Targeted temperature management (TTM) is the process that core body temperature is rapidly reduced to the target temperature by using physical and chemical (drug) methods, and slowly returns to normal physiological temperature after maintaining the target temperature for a certain period of time, and avoids temperature rebound.
Since 2002, TTM has gradually become one of the important treatment strategies for coma patients after resuscitation after cardiac arrest, and has been widely used in the treatment of various adult acute critical brain injuries.
TTM has the function of protecting brain nerve function, and its action mechanism mainly includes the following aspects:
1. Reduce brain metabolism, reduce intracranial pressure, reduce cerebral edema;
2. Reduces apoptosis and necrosis of brain cells from the initial stage;
3. Reduce the production of local lactic acid, reduce the release of excitatory toxic substances;
4. Reduce the inflammation of brain tissue and systemic inflammation;
5. Reduce the generation of oxygen free radicals;
6. Decreased vascular permeability, decreased exudation, and inhibited vascular edema.
In foreign countries, TTM has been widely used in patients with severe acute brain injury caused by various reasons to improve neurological outcome, while there is no relevant guidance or consensus to guide the application of TTM in China.
As one of the intervention means, TTM has potential value for reducing and controlling secondary nerve injury in patients with acute brain injury, but temperature should not be stressed alone.
TTM treatment should be combined with other treatments, such as hemodynamic monitoring, real-time temperature monitoring of skin and body cavity using medical temperature probe, analgesia and sedation, etc.
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