University of California Davis, Sacramento, CA, USA.
Riverside Methodist Hospital, Columbus, OH, USA.
Neurocrit Care. 2017 Dec;27(3):468-487. doi: 10.1007/s12028-017-0469-5.
Targeted temperature management (TTM) is often used in neurocritical care to minimize secondary neurologic injury and improve outcomes. TTM encompasses therapeutic hypothermia, controlled normothermia, and treatment of fever. TTM is best supported by evidence from neonatal hypoxic-ischemic encephalopathy and out-of-hospital cardiac arrest, although it has also been explored in ischemic stroke, traumatic brain injury, and intracranial hemorrhage patients. Critical care clinicians using TTM must select appropriate cooling techniques, provide a reasonable rate of cooling, manage shivering, and ensure adequate patient monitoring among other challenges.
The Neurocritical Care Society recruited experts in neurocritical care, nursing, and pharmacotherapy to form a writing Committee in 2015. The group generated a set of 16 clinical questions relevant to TTM using the PICO format. With the assistance of a research librarian, the Committee undertook a comprehensive literature search with no back date through November 2016 with additional references up to March 2017.
The Committee utilized GRADE methodology to adjudicate the quality of evidence as high, moderate, low, or very low based on their confidence that the estimate of effect approximated the true effect. They generated recommendations regarding the implementation of TTM based on this systematic review only after considering the quality of evidence, relative risks and benefits, patient values and preferences, and resource allocation.
This guideline is intended for neurocritical care clinicians who have chosen to use TTM in patient care; it is not meant to provide guidance regarding the clinical indications for TTM itself. While there are areas of TTM practice where clear evidence guides strong recommendations, many of the recommendations are conditional, and must be contextualized to individual patient and system needs.
目标温度管理（TTM）常用于神经重症监护中，以尽量减少二次神经损伤并改善预后。TTM 包括治疗性低温、控制性正常体温和发热治疗。虽然 TTM 也在缺血性脑卒中、创伤性脑损伤和颅内出血患者中进行了探索，但它主要得到新生儿缺氧缺血性脑病和院外心脏骤停证据的支持。使用 TTM 的重症监护临床医生必须选择适当的冷却技术，提供合理的冷却速度，管理寒战，并确保其他挑战患者的充分监测。
神经重症监护学会于 2015 年招募神经重症监护、护理和药物治疗方面的专家组成写作委员会。该小组使用 PICO 格式提出了一组与 TTM 相关的 16 个临床问题。在研究图书馆员的协助下，委员会进行了全面的文献搜索，时间范围截至 2016 年 11 月，之后又增加了截至 2017 年 3 月的参考文献。
委员会利用 GRADE 方法根据他们对效应估计值接近真实效应的信心，将证据质量评定为高、中、低或极低。他们根据系统评价生成了关于 TTM 实施的建议，仅在考虑证据质量、相对风险和益处、患者价值观和偏好以及资源分配之后。
本指南适用于选择在患者护理中使用 TTM 的神经重症监护临床医生；它并不是旨在为 TTM 的临床指征提供指导。虽然 TTM 实践的某些领域有明确的证据支持强有力的建议，但许多建议是有条件的，必须根据患者和系统的具体需求进行调整。
