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Target temperature management in critically ill patients

par Annoni, Filippo ;Peluso, Lorenzo ;Taccone, Fabio Silvio
Référence Textbook of Critical Care, Elsevier, page (240.e3-245.e3)
Publication Publié, 2023-01

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Résumé :

In critically ill patients with acute brain injury, target temperature management (TTM) with different levels of temperature (i.e., between 33°C and 36°C) has been considered one of the effective interventions to reduce the extension of secondary brain damage. Despite several experimental findings supporting this hypothesis, the role of TTM remains controversial in humans. TTM at 33°C for 72 hours is recommended in newborns suffering from hypoxic-ischemic encephalopathy; in cardiac arrest occurring in pediatric patients, the data are scarce and inconclusive, whereas in adult patients, recent studies have shown that TTM at 33°C is not beneficial in all cases but possibly in some subgroups. There is no role for hypothermia in other forms of brain injury, whereas maintaining normothermia (i.e., around 37°C) appears to be the “standard of care,” at least in the most severe patients. The use of TTM in other forms of critical illness remains unclear and should be discouraged as routine intervention.