Targeted Temperature Management (TTM) - Therapeutic Hypothermia - Hypothermia Protocol

[@ICUAdvantage]

Notes for this lesson (and other perks) are available to KZbin and Patreon members. Show support and get a leg up in learning! KZbin: adv.icu/3C4fiuR Patreon: adv.icu/3A3m8yO

[@SG-mo6yg]

How to download notes ? I can’t find anything in that link?

[@edtanedo6303]

Just ask Steve Rogers, he was submerged, frozen in the Arctic Ocean for 70 years but came back to life as Captain America. Kidding aside, I love your videos, I am a retired CVICU/Trauma nurse, Acute Clinical Nurse Specialist, took care of many post-op CABG and other cardio-thoracic surgery patients (clinical part). I wish I was young again, I miss taking care of critically ill patients, teaching and giving lectures. You have a God given talent, skillful hands, critical mind and caring heart. Keep doing what you are doing, newbies and old timers like me learn a lot from your videos. God bless.

[@sharonfarrar5316]

Thank you for this video and explanation😄 I'm an out of hospital cardiac arrest survivor. It's been almost two years ago now and I'm still struggling with understanding everything that happened to me while I was being treated. I just want to say thank you to everyone who is in the medical field for doing what you all do. It takes someone special to dedicate yourself to saving others. Thank you, thank you, thank you all. ❤❤❤

[@دعاءاسماعيل-ع3ب]

Thank god that you are okay now❤🎉 I’m still a medical student but your comment is just so beautiful as (far as I think)as you!❤️

[@jordanrebeccafries7336]

I just started in the ICU a few months ago and these videos are SO helpful! I always come and find one if I am introduced to a new topic in the clinical setting and the information here makes me feel much more confident in caring for patients!

[@amoray03]

Incredibly thorough and easy to follow, even for non-ICU folks. Congrats, it's a ton of work to get such a video done (and adding the literature - in order)! Thank you for all the work you put into this!

[@ICUAdvantage]

Great to hear this. Making these videos truly is a ton of work and I don't think most people realize that. Really glad you enjoyed it!

[@Jamomaro]

Currently having my first TTM and finishing the cooking process. Rewarming will start soon and I’m glad I watched this. Definitely will have to take off a few drips when rewarming! Thank you!

[@antwanchamp7175]

Awesome video had my first TTM patient this week using the solex intravascular thermoguard cooling device. Your explanations and complications are right on point and saw them in my patient in real time. Boluses of sedation and analgesia with versed and fentanyl were pretty successful with shivering control. At our facility we also use push doses of Demerol based on shivering scores. Also the patient is usually on acetaminophen and buspar around the clock. Thanks for everything you do for the ICU community!

[@ICUAdvantage]

Awesome to hear! Always great to hear of how the info in these lessons was actually seen or applied in practice. Thanks for sharing!

[@naomimeade6383]

Thank you for this lesson I recently used a device called arctic sun due to my ventilated patient spiking a temp of 38.5 I wish I watched this video beforehand I’ve learnt a lot and now I know what to do next time

[@harrisonlee9360]

Great Video! Just entered ICU as a clerk this week This video covered almost all questions asked during morning meetings

[@ICUAdvantage]

Really glad to hear this! Best of luck to you!

[@4shelove]

Thank you for keeping it simple. Now I understand

[@bonniehuang8696]

Eddie, I love how you incoorporated research studies to explaine the "why" thoroughly. Thank you again for such an informative video, so much work being put into making it I can see. I have a question regarding a TBI pt that I recently had and wondering if you could enlighten me a bit?

[@ICUAdvantage]

Yeah there was a LOT of varying info on this subject and the studies help to show why. But yes, I do end up spending a bit of time on these so I'm glad you appreciate them! Feel free to shoot me an email (see contact details in the "about" section) and I'd be happy to try and answer any questions.

[@majdakaddouri]

Hello Eddie, I just discovered your awesome channel a month ago, roughly, and I appreciate what you've just done in that video. I wish you best of luck, and I am grateful for your generosity in providing us with such content.

[@ICUAdvantage]

Thank you so much! Really glad that you find the videos helpful for you as that is truly the goal in making all of them.

[@abbieweatherley526]

Excellent presentation. Enjoyed the patho and research. Thank you!

[@ICUAdvantage]

Awesome! Thanks so much Abbie!

[@RGLover641]

Thank you for these videos! Just started becoming a CICU nurse and love all this info

[@ICUAdvantage]

You are very welcome and congrats on the new CICU position! Glad you are enjoying the videos!

[@rma3899]

Amazing video. Like always you continue to amaze me!

[@ICUAdvantage]

Thanks as usual! This was one that a lot of people asked about so glad to finally get it done

[@missjackson9680]

Loved this! It was very helpful. And by the way @ICU Advantage can you please do a video on chest tubes?!?

[@ICUAdvantage]

Glad to hear it! And yes, I do have it on the todo list. So many things on there and just not enough time lol

[@bonniehuang8696]

Thanks!

[@ICUAdvantage]

Thank you so much Bonnie!

[@kateyavendano4464]

Hi Eddie! Hopefully you get my question. I was wondering what's the rationale for possibly Not using TTM therapy when patient might be comatose due to status epilepticus? timestamp I'm referring to is 7:13 . Thank you!

[@ICUAdvantage]

Hey Katey! So it wasn't necessarily anything with status epilepticus specifically. The point I was trying to make there is that we use TTM post code if the patient remains comatose following ROSC. The goal with TTM is to preserve brain functioning and limit damage in these patients. That said, if there is another cause that could be causing the patient to be comatose, then we need to consider whether to use of TTM would be indicated here as it may not be post code related. Does that make sense?

[@thepalettewhispererasmr1227]

Just a silly ER nurse, getting smaeter everyday by watching these. 💙

[@peoplearewater]

Thank you for your video. I might take this topic for my capstone project!

[@ICUAdvantage]

You are very welcome! It would make a great capstone I think.

[@nimochoudhary6265]

U r awesome. Nd ur videos like blessings for student. Thnkw sir . Plz add some video about pead asthma or peads management in different disease.👍

[@ICUAdvantage]

Glad you liked it. As for peds, I don't cover those topics as I have no experience in that world. Sorry.

[@Flippinpinoy09]

Thoughts on not doing TTM? My intencivisit has bypassed ttm post rosc. Apparently there is new literature showing normothermia is as effective with keeping neurological fxn. My hospital is probably infuriated because they just bought ALOT of new Zolls lol

[@C5drummer]

The real literature on this, especially w/ CPR lasting 21 minutes or more no matter what the cause of CP Arrest, appears to be less than stellar with what one would consider a "successful neurological outcome." Our large intensivist stopped doing Targeted Temperature Protocol @ 2 years ago and we just try to prevent hyperthermia.

[@Victormusicworld]

Not true. Most studies show protective mechanisms of hypothermia. If hypothermia is applied too late, damage is already done and not possible to heal, no? Also, how do you prevent hyperthermia? - With ttm

[@C5drummer]

@@Victormusicworld ==> NOPE! :)

[@C5drummer]

@@Victormusicworld a.) Dankiewicz J, Cronberg T, Lilja G, et al. Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med 2021;384:2283-2294. b.) Taccone FS, Picetti E, Vincent JL. High quality targeted temperature management (TTM) after cardiac arrest. Crit Care 2020;24:6-6. c.) Arrich J, Herkner H, Müllner D, Behringer W. Targeted temperature management after cardiac arrest: a systematic review and meta-analysis of animal studies. Resuscitation 2021;162:47-55. d.) Minini A, Annoni F, Peluso L, Bogossian EG, Creteur J, Taccone FS. Which target temperature for post-anoxic brain injury? A systematic review from “real life” studies. Brain Sci 2021;11:186-186. Takeaway: Normothermic and try to establish STABLE ROSC ASAP. Have CPR for Asystole or VF over 15 minutes? Hope that prolonged CPR was "high-quality!" Cheers! :)

[@Victormusicworld]

While this one proves the importance of early cooling @@C5drummer pubmed.ncbi.nlm.nih.gov/34103095/

[@lobarita]

First time admitting a TTM! Thanks !!

[@ICUAdvantage]

Nice! What temp did you cool to?

[@abiyashabu8183]

Thank you so much ❤

[@andreamcnairy310]

At my facility we take the cooling wraps off for the rewarding period. Do you recommend keeping the wraps on and adjusting the goal temperature every hour?

[@ICUAdvantage]

That's how we do it to allow for precise rewarming. Again, big thing is avoiding that rebound fever.

[@tellmeofyourhomeworldusul6060]

We have a shivering protocol that includes buspar

[@ICUAdvantage]

Now that you mention that, I feel like I may have heard of that before. Definitely haven't seen it used nor heard about it in a while. I'll have to look into it. Thanks for sharing Sara!

[@dazzlingmichael6855]

can pls make a video about code blue drugs or anything about code blue or warning signs before arrest pls....

[@ICUAdvantage]

I will probably do a video just on emergency drugs. I do have a whole ACLS series. As for warning signs, I'll stew on that one. Kind of a wide topic and not sure if theres a video in there or not. I'll think on it.

[@lauramumme4294]

I had a TTM pt the other day who's BP and HR shot up after the rewarming process. I didn't know this was something that could happen before brain stem herniation. Do you you think you could make a video of the pathophysiology of brain herniation?

[@ICUAdvantage]

I do have herniation on the todo list when I start covering neuro topics after a get through more cardiac stuff.

[@melissaberges702]

TTm and hypothermia protocol is apparently associated with increased harm and no benefit in all age groups! Recent meta analysis published a few weeks ago! Interesting timing for this video 😳.

[@Flippinpinoy09]

Yeah my intencivisit is bypassing TTM. My hospital jusr bought several Zolls too lolol

[@ICUAdvantage]

Yup, I mentioned at the end about the most recent study which was much anticipated. It's looking like more evidence is pointing towards normothermia being the main benefit. That said, this has been a highly asked for topic. The reason for it, is that there are still a lot of places still doing this, including full hypothermia temperatures. Where I come from, 36 deg is the goal, and it seems there isn't much consequence to this. Certainly much less than 32-34. If I were a betting man, I bet 36 deg will remain in practice.

[@stephenharris7644]

What sources are you referencing. I’m new to ICU and want to bring this up to my preceptor

[@ems1632]

What is the rate of Fluid when starting TTM? Im. A little bit confused about the rate.thank you

[@ao4733]

big thank you, sir

[@ICUAdvantage]

You are most welcome!

[@gretchenanderson4728]

Any recommendations for caring for a patient who after being rewarmed to goal of 37 their temperature was running 37.5- 37.8? The Drs didn't want to make any changes in orders.

[@ICUAdvantage]

You can keep the cooling device set to 37 and it will regulate the temperature to ensure they stay there as opposed to turning it off once they are warmed. Is that what you were asking, or am I missing your question? :)

[@dangmateo00]

This is great!! Thank you!

[@ICUAdvantage]

You're so welcome!

[@jamesk896]

nice articles rivew!

[@dream2020as]

hi eddie, I haven't done this in a while on my unit but I do know the goal for the cooling temp is 33 and then keep them at 37 but i'm still unclear as to what's the duration for each as in the cooling and rewarming time

[@ICUAdvantage]

Cooling as quick as possible. Often post arrest, they are pretty cool and it doesn't take long to get there. Typically sustain at target temperature for 24 hours, and then rewarming is usually 0.5 deg C per hour.

[@LoanTran-hi1po]

Thank you so much!!!

[@ICUAdvantage]

You are very welcome!

[@sssrt6992]

Limite age ? On TTM

[@michaelburatovich3199]

Eddie, does giving the patient cooled air through a respirator have a role in TTM?

[@ICUAdvantage]

Good question. I haven't seen that used.

[@simoned.6993]

Is it your experience that CT scan is done prior to initiating the TTM protocol?

[@ICUAdvantage]

Not typically

[@mariafilipinaamita3275]

CT head needs to be done before TTM. Head bleed is a contraindication for ttm.

[@FaTaLthe13th]

Thank you !

[@ICUAdvantage]

Truly my pleasure! Glad you liked it!

[@aliamer2868]

I can't wait

[@ICUAdvantage]

I hope you enjoyed it Ali!

[@23dfmahghd]

Is this really done in hospitals?

[@tukon5187]

Thnku

[@Finess199]

Ty

[@ICUAdvantage]

You're welcome!

[@SG-mo6yg]

I doc can u tell me how can I get notes for dis lesson ?

[@ZLUVCRUCE]

What about HYPOglycemia?

[@ICUAdvantage]

This is one of the risks during rewarming, especially from lower temps, as the body responds again to the insulin.

[@kokolada4272]

33C is gone based on new trials aka TTM2. RIP hypotermia, Lets stop harming our patients, normotermia is goal

[@ICUAdvantage]

Yup this is what I discussed in the lesson… That said it is not gone as places are still doing it.

[@sabrinadrake3791]

Thank you so much

[@ICUAdvantage]

You're very welcome Sabrina!