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Targeted temperature management in the ICU: Guidelines from a French expert panel

Alain Cariou 1, 2, 3 Jean-François Payen 4 Karim Asehnoune 5 Gérard Audibert 6 Astrid Botte 7 Olivier Brissaud 8 Guillaume Debaty 9, 10 Sandrine Deltour 11 Nicolas Deye 12 Nicolas Engrand 13 Gilles Francony 1, 2, 3 Stephane Legriel 14 Bruno Lévy 15 Philippe Meyer Jean-Christophe Orban 16 Sylvain Renolleau 17 Bernard Vigué 18 Laure de Saint Blanquat 19, 20 Cyrille Mathien Lionel Velly 21
Abstract : Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term “targeted temperature management” (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method. Indications are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of TTM in adult and paediatric critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de réanimation de langue française [SRLF]) and the French Society of Anesthesia and Intensive Care Medicine (Société francaise d’anesthésie réanimation [SFAR]) with the participation of the French Emergency Medicine Association (Société française de médecine d’urgence [SFMU]), the French Group for Pediatric Intensive Care and Emergencies (Groupe francophone de réanimation et urgences pédiatriques [GFRUP]), the French National Association of Neuro-Anesthesiology and Critical Care (Association nationale de neuro-anesthésie réanimation française [ANARLF]), and the French Neurovascular Society (Société française neurovasculaire [SFNV]). Fifteen experts and two coordinators agreed to consider questions concerning TTM and its practical implementation in five clinical situations: cardiac arrest, traumatic brain injury, stroke, other brain injuries, and shock. This resulted in 30 recommendations: 3 recommendations were strong (Grade 1), 13 were weak (Grade 2), and 14 were experts’ opinions. After two rounds of rating and various amendments, a strong agreement from voting participants was obtained for all 30 (100%) recommendations, which are exposed in the present article.
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https://hal.archives-ouvertes.fr/hal-02070707
Contributeur : Stéphane Tanguy <>
Soumis le : lundi 18 mars 2019 - 11:12:19
Dernière modification le : dimanche 14 avril 2019 - 01:12:02

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Alain Cariou, Jean-François Payen, Karim Asehnoune, Gérard Audibert, Astrid Botte, et al.. Targeted temperature management in the ICU: Guidelines from a French expert panel. Anaesthesia Critical Care & Pain Medicine, Elsevier Masson, 2018, 37 (5), pp.481-491. ⟨10.1016/j.accpm.2017.06.003⟩. ⟨hal-02070707⟩

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