Implementation of Targeted Temperature Management

We suggest at least 24 h of cooling in out-of-hospital cardiac arrest (OHCA) patients. ( Conditional , Moderate )

We suggest longer duration targeted temperature management (TTM) for severe traumatic brain injury (TBI) patients should increased intracranial pressure (ICP) control be the goal. ( Conditional , Low )

We advise against longer (>72 h) or deeper (<32.0 °C) hypothermia in neonates with hypoxic-ischemic encephalopathy (HIE). ( Conditional , Moderate )

We cannot recommend any specific timing of TTM initiation (prophylactic or symptom-based), due to equivocal evidence about its impact on length of stay, ICP burden, and neurologic outcome.
We recommend using controlled normothermia to reduce fever burden in patients with fever refractory to conventional therapy. ( Strong , Moderate )

We recommend using intranasal, surface, or intravascular temperature-modulating devices and/or cold saline infusions over air cooling blankets, cooling fans, or cooling packs to achieve faster time to target temperature, improve the likelihood of achieving target temperature, and lessen the likelihood of overshoot. ( Strong , High )

We recommend using surface cooling devices over passive air cooling and/or ice packs to increase the likelihood of achieving target temperature in neonatal patients with hypoxic-ischemic encephalopathy. ( Strong , High )

To maintain constant patient temperature, we recommend using intravascular catheters, or gel pads if such catheters are not available. ( Strong , High )

To minimize temperature variability in neonates with HIE, we suggest using a servo-controlled body wrap over conventional measures. ( Conditional , Low )

To minimize overshoot, we recommend gel pads over conventional measures. ( Strong , Moderate )

To minimize overshoot, we suggest using temperature modulating devices with servo-controls and gradient temperature changes. ( Conditional , Low )

We suggest using an esophageal temperature probe during all phases of TTM. If an esophageal probe is not appropriate or available, we suggest using a bladder temperature probe. ( Conditional , Low )