Targeted temperature management in ICU (newborns except)

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 Core Society [Societe de reanimation de longue francaise (SRLF)] and the French Society of Anaesthesia and Intensive Care Medicine [Societe francaise d'anesthesie et de reanimation (SFAR)] with the participation of the French Emergency Medicine Association [Societe francaise de medecine d'urgence (SFMU)], the French Group for Paediatric Intensive Core and Emergencies [Groupe francophone de reanimation et urgences pediatriques (GFRUP)], the French Notional Association of Neuro-Anesthesiology and Critical Care [Association notionale de neuro-anesthesie reanimation francaise (ANARLF)], and the French Neurovascular Society [Societe francaise 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, which are exposed in the present article.