Therapeutic hypothermia: Difference between revisions
| Line 15: | Line 15: | ||
*Significant trauma (especially intra-abdominal) | *Significant trauma (especially intra-abdominal) | ||
==Sedation== | ==Sedation and Paralytics== | ||
Should administer one or more of the following: | Should administer one or more of the following: | ||
*Fentanyl Injection 50 mcg IV every hour as needed for pain. | *Fentanyl Injection 50 mcg IV every hour as needed for pain. | ||
| Line 24: | Line 24: | ||
*Pancuronium IV infusion | *Pancuronium IV infusion | ||
**Initiate before initiating cooling. Dosing recommendations: 0.1 mg/kg loading dose followed by a continuous infusion of 0.33-2 mcg/kg/minute. | **Initiate before initiating cooling. Dosing recommendations: 0.1 mg/kg loading dose followed by a continuous infusion of 0.33-2 mcg/kg/minute. | ||
**Do not use in patients with renal and/or hepatic insufficiency. | **Do not use in patients with renal and/or hepatic insufficiency. | ||
Prevention of shivering is important to avoid warming and needless oxygen consumption | |||
*May require train of four monitor with goal of 1-2/4 twitches with neuromuscular blockade | |||
*Lower doses of NMB work against shivering | |||
*Higher doses of NMB used to paralyze the diaphragm in these scenarios: | |||
**Need to decrease O2 consumption | |||
**Decrease plateau pressures | |||
**Hypoxemia is present | |||
==Management== | ==Management== | ||
Revision as of 16:56, 15 September 2014
Background
- Determination of Neurologic Prognosis is unreliable before at least 72 hours after ROSC. Do not neuroprognosticate until 72 hours post rewarming.
Exclusion/Contraindications
- >12hrs since ROSC
- Glasgow Motor score >5
- Minimal pre-morbid cognitive status
- Other reason for coma
- intracranial pathology (i.e. intracranial hemorrhage, ischemic stroke)
- subarachnoid hemorrhage
- sedation
- Sepsis as etiology for arrest
- DNR/DNI status
- Uncontrollable bleeding
- Significant trauma (especially intra-abdominal)
Sedation and Paralytics
Should administer one or more of the following:
- Fentanyl Injection 50 mcg IV every hour as needed for pain.
- Fentanyl IV infusion NSS
- Propofol IV infusion
- Lorazepam IV infusion
- Lorazepam Injection 1 mg IV every 2 hours as needed for agitation.
- Pancuronium IV infusion
- Initiate before initiating cooling. Dosing recommendations: 0.1 mg/kg loading dose followed by a continuous infusion of 0.33-2 mcg/kg/minute.
- Do not use in patients with renal and/or hepatic insufficiency.
Prevention of shivering is important to avoid warming and needless oxygen consumption
- May require train of four monitor with goal of 1-2/4 twitches with neuromuscular blockade
- Lower doses of NMB work against shivering
- Higher doses of NMB used to paralyze the diaphragm in these scenarios:
- Need to decrease O2 consumption
- Decrease plateau pressures
- Hypoxemia is present
Management
- Consider head CT
Cooling
- Cool to 32-34º C as soon as possible (within 4 hours)
- Initiate rewarming 24 hrs after target temperature was reached
Disposition
- ICU admission
See Also
Source
- University of Pennsylvania Targeted Temperature Management Protocol