Rewarming: facts and myths from the neurological perspectives

Schmutzhard, Erich; Fischer, Marlene; Dietmann, Anelia; Helbok, Raimund; Broessner, Gregor

doi:10.1186/cc11282

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…26 Gradual rewarming by 0.5C°/h was used throughout all periods as it is currently recommended for patients with both intended and unintended hypothermia to avoid complications such as shock, seizures, and arrhythmias. 27–29 Thus, we chose a threshold of <20% incidence of admission hypothermia for the primary outcome measure to account for a potentially irreducible number of patients that would not achieve normothermia (if originally hypothermic) due to short transport times. The threshold proved to be a conservative estimate, however, as maintenance of normothermia and achieving normothermia in initially hypothermic patients both improved throughout the study regardless of the length of transport.…”

Section: Discussionmentioning

confidence: 99%

“…Rewarming rates have also been informed by observation of hypothermia in adults and pediatric patients and more recently by the research protocols of therapeutic hypothermia in neonates with encephalopathy. 27–29 A faster rewarming rate (>0.5°C/h) has been suggested to have no increased risk in poor neonatal outcomes and may actually decrease the incidence of respiratory distress syndrome in the ELBW population. 26 Such a change may ameliorate the increased risk for morbidity and mortality that VLBW/ELBW neonates requiring interfacility transport have compared with their inborn cohorts.…”

Section: Discussionmentioning

confidence: 99%

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Improving Thermal Support in Very and Extremely Low Birth Weight Infants during Interfacility Transport

McNellis

Leonard

Thornton

et al. 2019

Pediatric Quality &Amp; Safety

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Introduction: Review of very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates transported by our specialized pediatric/neonatal transport team revealed hypothermia in up to 52% of admissions. This project aimed to decrease the incidence of hypothermia in VLBW and ELBW neonates requiring transport between facilities from 52% to <20% over 1 year. Methods: In response to gaps in knowledge and barriers to care revealed by a survey administered to transport personnel, we used a standard quality improvement plan-do-study-act model to introduce new equipment and a comprehensive thermoregulation protocol via standardized education. The primary outcome measure was the incidence of hypothermia (axillary temperature < 36.5°C) in transported VLBW and ELBW neonates. The process measure was compliance with the protocol. The balancing measures were unintended hyperthermia and transport team ground time. Transport personnel were updated on progress via meetings and run charts. Results: We reduced the incidence of hypothermia to 17% in 1 year. Compliance with the protocol improved from 60% to 76%. There was no increase in unintended hyperthermia (5% preintervention, 4% intervention, 7% surveillance, P = 0.76) or transport team ground time (in hours) (1.2 ± 0.9 preintervention versus 1.3 ± 0.8 intervention versus 1.2 ± 0.7 surveillance, P = 0.2). Conclusions: Quality improvement methods were used to develop an evidence-based, standardized approach to thermal support in VLBW and ELBW neonates undergoing transport between facilities. Following the implementation of this approach, we achieved the desired percent decrease in the incidence of hypothermia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improving Thermal Support in Very and Extremely Low Birth Weight Infants during Interfacility Transport

McNellis

Leonard

Thornton

et al. 2019

Pediatric Quality &Amp; Safety

View full text Add to dashboard Cite

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Targeted Temperature Management Protocol in a Pediatric Intensive Care Unit: A Quality Improvement Project

Prendergast

Allen

Mills

et al. 2021

Critical Care Nurse

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Background In patients with acute neurological injury, abrupt temperature change exacerbates increased intracranial pressures and negatively affects perfusion pressure and cerebral blood flow. Critical care nurses must provide coordinated and effective interventions to maintain normothermia without precipitating shivering immediately after acute neurological injury in pediatric patients. Objective To improve hyperthermia management in a 40-bed pediatric intensive care unit, an interdisciplinary pediatric critical care team developed, implemented, and evaluated a targeted temperature management protocol. Methods The project was guided by the organization’s plan-do-study-act quality improvement process. Quality improvement was assessed retrospectively using electronic medical records of patients meeting eligibility criteria. Samples of pediatric patients who received temperature interventions were compared before and after protocol implementation. The protocol included environmental, pharmacological, and body surface cooling device interventions, as well as use of a bedside shivering assessment scale and stepwise interventions to prevent and control shivering. Results Before implementation of the targeted temperature management protocol, 64% of patients had documented temperatures higher than 37.5 °C, and body surface cooling devices were used in 10% of patients. After protocol implementation, more than 80% of patients had documented temperatures higher than 37.5 °C, and body surface cooling devices were used in 62% of patients. Four patients (6%) before and 5 patients (31%) after protocol implementation were treated with body surface cooling without requiring use of neuromuscular blockade. Conclusions Creation and implementation of a targeted temperature management protocol increased nurses’ documented use of body surface cooling to manage hyperthermia in pediatric intensive care unit patients with acute neurological injury.

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Rewarming: facts and myths from the neurological perspectives

Cited by 2 publications

References 23 publications

Improving Thermal Support in Very and Extremely Low Birth Weight Infants during Interfacility Transport

Improving Thermal Support in Very and Extremely Low Birth Weight Infants during Interfacility Transport

Targeted Temperature Management Protocol in a Pediatric Intensive Care Unit: A Quality Improvement Project

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