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Neurocritical Care
Published in: Neurocritical Care 3/2017

01-12-2017 | Original Article

The Implementation of Targeted Temperature Management: An Evidence-Based Guideline from the Neurocritical Care Society

Authors: Lori Kennedy Madden, Michelle Hill, Teresa L. May, Theresa Human, Mary McKenna Guanci, Judith Jacobi, Melissa V. Moreda, Neeraj Badjatia

Published in: Neurocritical Care | Issue 3/2017

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Abstract

Background

Targeted temperature management (TTM) is often used in neurocritical care to minimize secondary neurologic injury and improve outcomes. TTM encompasses therapeutic hypothermia, controlled normothermia, and treatment of fever. TTM is best supported by evidence from neonatal hypoxic-ischemic encephalopathy and out-of-hospital cardiac arrest, although it has also been explored in ischemic stroke, traumatic brain injury, and intracranial hemorrhage patients. Critical care clinicians using TTM must select appropriate cooling techniques, provide a reasonable rate of cooling, manage shivering, and ensure adequate patient monitoring among other challenges.

Methods

The Neurocritical Care Society recruited experts in neurocritical care, nursing, and pharmacotherapy to form a writing Committee in 2015. The group generated a set of 16 clinical questions relevant to TTM using the PICO format. With the assistance of a research librarian, the Committee undertook a comprehensive literature search with no back date through November 2016 with additional references up to March 2017.

Results

The Committee utilized GRADE methodology to adjudicate the quality of evidence as high, moderate, low, or very low based on their confidence that the estimate of effect approximated the true effect. They generated recommendations regarding the implementation of TTM based on this systematic review only after considering the quality of evidence, relative risks and benefits, patient values and preferences, and resource allocation.

Conclusion

This guideline is intended for neurocritical care clinicians who have chosen to use TTM in patient care; it is not meant to provide guidance regarding the clinical indications for TTM itself. While there are areas of TTM practice where clear evidence guides strong recommendations, many of the recommendations are conditional, and must be contextualized to individual patient and system needs.
Appendix
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Metadata
Title
The Implementation of Targeted Temperature Management: An Evidence-Based Guideline from the Neurocritical Care Society
Authors
Lori Kennedy Madden
Michelle Hill
Teresa L. May
Theresa Human
Mary McKenna Guanci
Judith Jacobi
Melissa V. Moreda
Neeraj Badjatia
Publication date
01-12-2017
Publisher
Springer US
Published in
Neurocritical Care / Issue 3/2017
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-017-0469-5

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