Sun21November0452PM 16

Are the following true regarding temperature management in the critically ill adult patient?

True / False

Increased cardiac irritability leading to arrhythmias is frequently seen at temperatures <30°C Correct

Hypothermia should be corrected at a rate greater than 0.5°C per hour Incorrect answer selected

Shivering is an acceptable result of therapeutic hypothermia Correct

Therapeutic hypothermia has shown benefit in traumatic brain injury and ischaemic stroke Incorrect answer selected

Targeting a patient temperature of 33°C following VT/VF cardiac arrest improves neurological outcome compared with a targeted temperature of 36°C Correct

Explanation

Hypothermia should not be corrected at rate greater than 0.5°C per hour to avoid complications related to localised temperature differences leading to cerebral hypoxia and impaired cerebrovascular reactivity.

Trials in therapeutic hypothermia have thus far only provided equivocal results.

In comatose post cardiac arrest patients: There is strong evidence (i.e. RCTs) is available only for VF/VT as presenting rhythms in adult , the ACLS (2010) guidelines recommend in PEA and asystole based on positive observational studies

FEVER correlates with worse outcomes and should be avoided Hypothermia significantly mitigates/prevents destructive processes following ischemia/reperfusion brain injury

Targeted temperature management of 36°C for 28h seems to offer equal benefits as a targeted temperature of 33°C

This intervention should be started within 4h from return of spontaneous circulation

Shivering must be prevented since it increases oxygen demand and generates heat. The shivering reflex is obtunded at <33°C, before that sedation and neuromuscular blocking agents should be used.

Reference:

Nielsen N, Wetterslev J,Cronberg T, et al. Targeted Temperature Management at 33 degrees C versus 36 degree C after Cardiac Arrest. N Engl J Med 2013.

Answer Statistics

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Average score: 84.23%

Times answered: 265