What is hypothermia?
In our clinical practice in intensive care units (ICU), we prefer to use targeted temperature management therapy, shortening it as 'TTM' in the current literature, instead of incomplete or outdated expressions such as 'hypothermia' or 'therapeutic hypothermia' treatment.
TTM treatment includes the steps of lowering the body temperature of comatose patients whose spontaneous circulation has returned after CPR (SDGD) to a value between 32°C and 36°C, keeping them at this temperature, and preventing the occurrence of hyperthermia for a certain period after controlled rewarming.
Why is hypothermia treatment important?
Our knowledge about some pathologies with a high mortality rate such as sudden cardiac arrest (CA), which affects hundreds of thousands of people every year in the world and in our country, enables us to make progress in these cases with a very severe prognosis. In this sense, the adoption of current approaches in basic and advanced life support practices and the effort given to care in the post-cardiopulmonary resuscitation (CPR) period are very important. It should not be overlooked that; The last link in the chain of survival after cardiac arrest has been defined as post-resuscitative care, and the aim of the treatments here is to increase the quality of life. As it is known, neurologic survival primarily determines mortality and morbidity in cardiac arrest cases. Targeted temperature management, referred to as Targeted Temperature Management (TTM) in the literature, is at the forefront of the most important proven neuroprotective treatment strategies in post-resuscitative care.
PATIENT SELECTION IN TTM TREATMENT
Today, TTM treatment is applied in many areas such as neonatal hypoxic ischemic encephalopathy (HIE), ischemic brain injury, traumatic brain injury, hepatic coma, cardiogenic shock, sepsis, ARDS follow-up and treatment.
When should adult targeted temperature management (TTM) be started?
TTM should be initiated as soon as possible to minimize reperfusion injury following return of spontaneous circulation (ROS) after cardiac arrest. In our country, SUT includes treatments starting up to 12 hours within the scope of payment.
Is advanced grief an exclusion criterion for hypothermia treatment (TTM)?
If the main goal of this treatment is to increase the chance of positive neurologic survival in the living group, advanced age should not be an exclusion criterion. In summary, for the 75 years and older group, a decision should be made considering the patient's condition and the risks associated with treatment.
What are the patient selection criteria in the Communiqué on Health Practices of Hypothermia Treatment (SUT)?
Targeted temperature management-TTM applications are the first step in the diagnosis of hypoxic ischemic encephalopathy or in comatose patients with spontaneous systemic circulation after cardiopulmonary resuscitation (Glasgow Coma Scale < 9) in healthcare providers with a tertiary neonatal/pediatric intensive care unit and a second/third level adult intensive care unit. It is applied only in third level neonatal/pediatric intensive care units and adult second/third level intensive care units for a maximum of 72 hours, provided that it is started within 12 hours. It is billed in addition to the newborn/child or adult intensive care procedure score up to three times in the same hospitalization period.
To whom is hypothermia applied in newborns?
Hypothermia is the first effective potential neuroprotective intervention in neonates who have suffered life-threatening asphyxia. Therapeutic hypothermia is an emerging treatment in term or late preterm hypoxic ischemic infants.
Is Therapeutic Hypothermia Treatment Necessary in Newborns?
Numerous randomized controlled trials have shown that therapeutic hypothermia has become a standard treatment, leading to a reduction in mortality and neurologic sequelae rates in neonates with moderate to severe hypoxic ischemic encephalopathy.
Features that should be in Therapeutic Hypothermia Application devices.
It is important that an ideal device used to create hypothermia can immediately reduce to the desired target temperature, maintain this temperature for 72 hours, and provide slow and controlled reheating (0.2-0.5°C/hour). Tool; It should have features that can be easily used, require little data collection by the nurse, and do not cause side effects such as tremor.
What is Therapeutic Hypothermia?
It is a treatment that takes advantage of the neuroprotective effect of cooling the brain tissue by keeping the body temperature in a certain range and for a certain period of time. Performing this procedure with the aid of a device designed for therapeutic purposes is called 'therapeutic hypothermia' or 'active cooling' in the medical literature. In some literature, 'cooling' is used as cooling and in some places 'hypothermia' is used as hypothermia. If the device can work by changing its own temperature setting according to the baby's body temperature setting, this is called 'servo-controlled' cooling therapy.
Therapeutic Hypothermia Mechanism of action:
Every 1°C decrease in body temperature causes a 6-10% decrease in brain metabolism. The effectiveness of hypothermia treatment may vary depending on the severity of the brain damage and the genetic characteristics of the patient. In order for the treatment to be successful, it is necessary to pay attention to the following four factors:
It is very important to start quickly, to start treatment as soon as the damage develops, 'time is brain'.
Time of cooling; cooling for a certain period of time and at the same interval is essential for the effectiveness of the treatment.
Heating; It is extremely important that the heating is done slowly and gradually.
Management and protection of side effects