Methods of cooling: practical aspects of therapeutic temperature management.
OBJECTIVE
To review traditional and newer means of inducing, maintaining, and withdrawing therapeutic hypothermia and normothermia. To suggest treatment algorithms for temperature modulation and review neuromonitoring options.


METHODS
A review of current literature describing methods of performing therapeutic temperature management and neuromonitoring during the cooling, maintenance, and decooling periods. Algorithms for performing therapeutic temperature management are suggested.


RESULTS
Temperature management can be safely and effectively performed using traditional or newer modalities. Although traditional means of cooling are feasible and efficacious, modern devices utilizing feedback loops to maintain steady body temperature and prevent overcooling have advantages in ease of application, patient safety, maintenance of target temperature, and control of decooling. Neuromonitoring options should be adapted to an individual patient and situation.


CONCLUSIONS
Intensivists should be familiar with techniques to induce, maintain, and withdraw therapeutic temperature management, and select the most appropriate method for a given patient and situation.
Seder
David B
DB
Division of Pulmonary and Critical Care Medicine, Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA. sederd@mmc.org
Van der Kloot
Thomas E
TE
D000465:Algorithms; D001833:Body Temperature Regulation / Q000502:physiology; D001930:Brain Injuries / Q000628:therapy; D002560:Cerebrovascular Circulation / Q000502:physiology; D002985:Clinical Protocols; D016292:Procedural Sedation / Q000379:methods; D003422:Critical Care / Q000379:methods*; D003663:Decision Trees; D004734:Energy Metabolism; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D007442:Intubation, Intratracheal; D008991:Monitoring, Physiologic / Q000379:methods; D018579:Patient Selection; D012640:Seizures / Q000209:etiology; D012720:Severity of Illness Index; D012768:Shivering / Q000187:drug effects / Q000502:physiology