Trinity Life Sciences, Waltham, Massachusetts, USA.
Becton Dickinson, Franklin Lakes, New Jersey, USA.
Ther Hypothermia Temp Manag. 2024 Jun;14(2):68-79. doi: 10.1089/ther.2023.0015. Epub 2023 May 22.
Targeted temperature management (TTM) has been proposed to reduce mortality and improve neurological outcomes in postcardiac arrest and other critically ill patients. TTM implementation may vary considerably among hospitals, and "high-quality TTM" definitions are inconsistent. This systematic literature review in relevant critical care conditions evaluated the approaches to and definitions of TTM quality with respect to fever prevention and the maintenance of precise temperature control. Current evidence on the quality of fever management associated with TTM in cardiac arrest, traumatic brain injury, stroke, sepsis, and critical care more generally was examined. Searches were conducted in Embase and PubMed (2016 to 2021) following PRISMA guidelines. In total, 37 studies were identified and included, with 35 focusing on postarrest care. Frequently-reported TTM quality outcomes included the number of patients with rebound hyperthermia, deviation from target temperature, post-TTM body temperatures, and number of patients achieving target temperature. Surface and intravascular cooling were used in 13 studies, while one study used surface and extracorporeal cooling and one study used surface cooling and antipyretics. Surface and intravascular methods had comparable rates of achieving target temperature and maintaining temperature. A single study showed that patients with surface cooling had a lower incidence of rebound hyperthermia. This systematic literature review largely identified cardiac arrest literature demonstrating fever prevention with multiple TTM approaches. There was substantial heterogeneity in the definitions and delivery of quality TTM. Further research is required to define quality TTM across multiple elements, including achieving target temperature, maintaining target temperature, and preventing rebound hyperthermia.
目标温度管理（TTM）已被提议用于降低心脏骤停和其他危重病患者的死亡率并改善神经结局。TTM 的实施在医院之间可能有很大差异，并且“高质量 TTM”的定义不一致。本系统文献复习在相关的重症监护条件下，评估了与预防发热和精确温度控制有关的 TTM 质量的方法和定义。检查了与心脏骤停、创伤性脑损伤、中风、脓毒症和一般重症监护相关的 TTM 中发热管理的质量的现有证据。根据 PRISMA 指南，在 Embase 和 PubMed 中进行了搜索（2016 年至 2021 年）。共确定并纳入了 37 项研究，其中 35 项专注于心脏骤停后护理。经常报告的 TTM 质量结果包括反弹性高热患者数量、偏离目标温度、TTM 后体温和达到目标温度的患者数量。13 项研究使用了体表和血管内冷却，一项研究使用了体表和体外冷却，一项研究使用了体表冷却和退热剂。体表和血管内方法达到目标温度和维持温度的比率相当。一项研究表明，使用体表冷却的患者反弹性高热的发生率较低。本系统文献复习主要确定了展示使用多种 TTM 方法预防发热的心脏骤停文献。高质量 TTM 的定义和实施存在很大的异质性。需要进一步研究来定义跨多个要素的高质量 TTM，包括达到目标温度、维持目标温度和预防反弹性高热。
