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Specific Start-Up Time and Staging of Target Temperature Management

2019.04.26 / Friday

Specific Start-Up Time and Staging of Target Temperature Management

 

TTM


At present, target temperature management is most widely used in two types of patients; one is cardiac patients (cardiac arrest);

One group is patients with brain injury (acute ischemic stroke, cerebral hemorrhage, or traumatic brain injury).

 

For patients with cardiac arrest, it is recommended to start TTM within 8 hours after ROSC (spontaneous respiratory circulation recovery after cardiopulmonary resuscitation). Although some research data show that patients may still benefit from the application of TTM after 8 hours, but a large number of data show that the longer the delay in starting TTM, the less the benefit.

For patients with acute ischemic stroke, cerebral hemorrhage or craniocerebral trauma, the TTM should be opened earlier, with the best prescription within 6-72 hours to maximize the benefits of patients.

In addition, TTM opening time can also be determined according to the risk of secondary nerve injury.

 

Target temperature management can be divided into three periods, namely induction period, maintenance period and rewarming period.

 

TTM induction period refers to the period during which the patient's core body temperature is reduced to the target temperature through device assistance. The optimal induction period is usually 2-4 hours.

 

TTM maintenance period refers to the time when the patient's core body temperature remains stable at a certain target temperature, and the recommended target temperature maintenance period is more than 24 hours. The maintenance period varies among different types of patients:

For patients with OHCA (out-of-hospital cardiac arrest), the optimal maintenance period is often at least 24 hours;

For patients with traumatic craniocerebral trauma, the optimal maintenance period is often at least 48 hours;

For patients with acute ischemic stroke and heat stroke, it is often recommended within 24-72 hours.

For patients with cerebral hemorrhage, it is recommended to maintain 8-10 hours;

In addition to the above examples, doctors can also determine the duration of maintenance based on the patient's pathological and physiological state, as well as the dose and effect of treatment.

 

TTM rewarming period must be slow and precise, and needs on the basis of diseases in the 6-72 hours slow increases core body temperature to the patients with physical body temperature, the process need to use the medical temperature probe to monitor body temperature, and, within 72 hours after rewarming success are need to control the core body temperature 37.5 .


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