CARE OF PATIENT ON TARGETED TEMPERATURE MANAGEMENT THERAPY IN CRITICAL CARE SETTING DEFINITION
Targeted Temperature Management (TTM) previously known as therapeutic hypothermia, is an intervention that has been shown to improve the outcome of comatose patient after cardiac arrest and traumatic brain injury (TBI) by maintaining body temperature ranged from 32℃ to 36℃ for at least 24 hours and 48 hours respectively. 1,2,3,4,5
STANDARD STATEMENT
The patient receives targeted temperature management therapy safely and effectively.
STRUCTURE / PROCESS STANDARD
1. Explain the reasons, cooling techniques and potential adverse effects of the treatment to significant other(s). N1, N2, N3
2. Prepare equipment for TTM accordingly N4.
3. Perform baseline
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Arterial line kit for continuous hemodynamic monitoring
b. Central venous catheter for drug administration
c. Ice packs
d. Cooling blanket and cooling machine filled with filtered water
e. Rectal temperature probe for continuous temperature monitoring
f. Sedation/ Neuromuscular blockade
g. Mechanical ventilator without heated humidification
N5. Baseline nursing assessment6,7,8,9
a. Baseline neurological assessment, including GCS and pupil assessment
b. Baseline vital signs (heart rate, blood pressure, SpO2, ETCO2, EEG and cardiac rhythm assessment)
c. Baseline skin assessment
d. Baseline body temperature
e. Baseline blood work: Potassium, Magnesium, Phosphate, Calcium, Glucose, ABG, PTT, INR, platelets, Amylase, AST, ALT, Bilirubin, Alkaline Phosphatase
N6. Induction phase6,7,8,9,10
Aim to reach target temperature as soon as possible. Start TTM with 2-4 hours of ROSC after cardiac arrest and reach a target rectal temperature of 32℃ to 36℃ within 4 hours after initiation of treatment. For TBI patients, aim to achieve the target rectal temperature of 32- 36℃. Inform intensive care unit doctors if target temperature is unable to achieve within 4 hours of initiation. Use the indicated cooling methods as below.
a. Apply surface water cooling