Libyan Journal of Medicine

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Temperature management in the intensive care

unit: a practical survey from China

Lingyang Meng, Chaofan Wang, Xinyan Liu, Yang Bi, Kehan Zhu, Yanru Yue,
Chunting Wang & Xuan Song

To cite this article: Lingyang Meng, Chaofan Wang, Xinyan Liu, Yang Bi, Kehan Zhu, Yanru
Yue, Chunting Wang & Xuan Song (2023) Temperature management in the intensive
care unit: a practical survey from China, Libyan Journal of Medicine, 18:1, 2275416, DOI:
10.1080/19932820.2023.2275416

To link to this article: https://doi.org/10.1080/19932820.2023.2275416

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LIBYAN JOURNAL OF MEDICINE
2023, VOL. 18, 2275416
https://doi.org/10.1080/19932820.2023.2275416

ORIGINAL ARTICLE

Temperature management in the intensive care unit: a practical survey from

China
Lingyang Menga*, Chaofan Wangb*, Xinyan Liuc*, Yang Bib, Kehan Zhub, Yanru Yueb, Chunting Wangd
and Xuan Songd,e
a
Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai
Jiao Tong University School of Medicine, Shanghai, China; bIntensive Care Medicine, Shandong First Medical University, Jinan,
Shandong, China; cIntensive Care Unit, Dong E Hospital, Liaocheng, Shandong, China; dIntensive Care Unit, Shandong Provincial
Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China; eShandong Institute of Endocrine and Metabolic
Diseases, Jinan Key Laboratory of Translational Medicine on Metabolic Diseases, Endocrine and Metabolic Diseases Hospital of
Shandong First Medical University, Jinan, Shandong, China

ABSTRACT ARTICLE HISTORY

Introduction: Temperature management is an important aspect of the treatment of critically Received 26 July 2023
ill patients, but there are differences in the measurement and management of temperature in Accepted 22 October 2023
different Intensive Care Units (ICUs). The objective of this study was to understand the current
KEYWORDS
situation of temperature measurement and management in ICUs in China, and to provide
Body temperature; critical
a basis for standardized temperature management in ICUs. care; fever; management;
Methods: A 20-question survey was used to gather information on temperature manage­ survey
ment strategies from ICUs across China. Data such as method and frequency of temperature
measurement, management goals, cooling measures, and temperature management recom­
mendations were collected.
Results: A total of 425 questionnaires from unique ICUs were included in the study, with
responses collected from all provinces and autonomous regions in China. Mercury thermo­
meters were the most widely used measurement tool (82.39%) and the axilla was the most
common measurement site (96.47%). There was considerable variability in the frequency of
temperature measurement, the temperature at which intervention should begin, intervention
duration, and temperature management goals. While there was no clearly preferred drug-
based cooling method, the most widely used equipment-based cooling method was the ice
blanket machine (93.18%). The most frequent recommendations for promoting temperature
management were continuous monitoring and targeted management.
Conclusion: Our investigation revealed a high level of variability in the methods of tempera­
ture measurement and management among ICUs in China. Since fever is a common clinical
symptom in critically ill patients and can lead to prolonged ICU stays, we propose that
standardized guidelines are urgently needed for the management of body temperature (BT)
in these patients.

1. Introduction usually not considered, resulting in uncertainties in

Body temperature (BT) is an important vital sign used
to evaluate critically ill patients [1]. The normal tem­
perature of the human body is between 36.0 and
37.5°C [2]. Fever is usually defined as core BT > 38°C,
while hypothermia is defined as core BT < 36°C [3].
Disrupted BT is common in critically ill patients and
predicts adverse outcomes [4–6], with elevated BT
detected in approximately 50% of intensive care unit
(ICU) adult patients [7], including those with acute
neurological disease, noninfectious fever, and fever
during ICU stay [5]. In an observational study of
24,204 adult ICU patients, BT ≥ 39.5°C was associated
with increased mortality (20% vs 12%) [8]. However, in
some studies, temperature measurement methods are
accuracy and reliability [9,10].
BT measurement methods commonly used in ICU
include axillary temperature, oral temperature, ear
temperature, rectal temperature, and bladder tem­
perature [11]. Pulmonary artery temperature measure­
ment is the core BT measured by pulmonary artery
catheter, which is the gold standard for BT measure­
ment; however, this measurement is difficult to obtain
routinely in ICUs [12]. Due to the critical condition of
ICU patients, conventional oral or anal temperature
monitoring methods are often not suitable [11].
Likewise, axillary temperature monitoring is not suita­
ble for patients who are emetic or unable to coop­
erate [13]. Three observational studies conducted in

CONTACT Xuan Song songxuan0303@163.com Intensive Care Unit, Shandong Provincial Hospital affiliated to Shandong First Medical
University, 9677 Jingshi Road, Shandong 250014, China
*
Lingyang Meng, Chaofan Wang and Xinyan Liu have equally contributed as first authors.
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/),
which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article
has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
2 L. MENG ET AL.
ICUs in Australia and New Zealand confirmed the
widespread use of various non-invasive methods
[14–16], and a survey showed different attitudes of
doctors and nurses towards temperature manage­
ment in ICUs [17]. However, even small alterations in
BT can lead to changes in inflammation and immune
function, both of which may affect the prognoses of
patients [18]. Therefore, possessing a method to accu­
rately obtain the real BT is of great significance for
assessing disease, establishing early diagnoses, guid­
ing treatment, and judging the prognoses of ICU
patients.
Temperature management is important in critically ill
patients, and several large trials have been conducted to
clarify temperature targets, management strategies, and
timing. Although patient temperatures are well docu­
mented in the ICU [19], it is often unclear when and
how to intervene when a patient’s temperature rises.
Young et al. [20] showed that across all critically ill
patients, active treatment of fever did not improve the
survival rate. In the treatment of ICU patients with fever,
reduced intervention and active intervention had similar
prognoses. ‘Target body temperature management’
(TTM) has become a measure to intervene in each
patient’s individual specific temperature, as the level of
target BT may vary from case to case, to prevent fever,
maintain normal BT, or lower the central BT [21]. However,
indications for TTM are still based on varying levels of
evidence, some of which are contradictory [18]. Especially
in ischemia anoxic encephalopathy in patients with
severe head injury, to reduce the brain metabolism,
reduce tissue inflammation, and prevent neuronal apop­
tosis, hypothermia treatment is recommended [22].
However, controlling temperature to achieve low tem­
perature treatment goals and duration remains contro­
versial, various medical institutions there exist great
differences in the working process [23].
To understand the current situation of temperature
measurement and management in ICUs in China and to
standardize the management of ICU temperature, we
conducted a nationwide questionnaire survey to explore
the methods of temperature measurement, the goals of
temperature management, and the strategies of tem­
perature management in ICU patients.
Figure 1. Flowchart of survey administration, quality control, and data analysis. ICU: intensive care unit.
2. Methods
We designed a 20-question online questionnaire
(Questionnaire Star) that was administered nation­
wide from August to September 2022 (Appendix;
Figure 1). Survey participants included all provinces
and autonomous regions in China (Figure 2). The
survey was deemed exempt by the Institutional
Ethics Review Board of Shandong Provincial
Hospital. Patients and the public were not involved
in the development of this survey. All methods were
carried out in accordance with relevant guidelines
and regulations. The survey included basic informa­
tion about the ICUs, methods and frequency of tem­
perature measurement, goals of temperature
management, cooling measures, and recommenda­
tions for temperature management. The survey was
administered to comprehensive ICUs (ie; who provide
care across a wide range of diagnoses) and specia­
lized ICUs (ie; provide diagnosis-specific care) at all
levels of hospitals nationwide. We defined ‘ICU’ as
a unit capable of providing invasive mechanical ven­
tilation and organ function support, such as the use
of vasoactive drugs and renal replacement therapy.
Each ICU was also required to have an independent
management system as a primary clinical unit in
a hospital.
To ensure the integrity of the returned questionnaire,
answers to all questions in the questionnaire were
required; otherwise, the submission could not be com­
pleted. Duplicate submissions from the same ICU were
excluded. All participants completed the questionnaire
online through their mobile phone or computer browser.
To ensure the authenticity of the data, survey respon­
dents for each site were the quality control manager of
the ICU, the full-time attending doctor, or the ICU doctor.
All submitted data were reviewed and submitted by the
hospital director.
Data were analyzed using SPSS version 22 (IBM,
Armonk, NY). Descriptive and summary statistics were
performed for all variables. Enumeration data were
described including count, rate, constituent ratio, and
mean. Categorical data were analyzed by chi-square test
or Fisher exact test. When the P-value was less than 0.05,
the difference was statistically significant.

Figure 2. The distribution of survey participants throughout
China.
3. Results
A total of 559 questionnaires were collected, of which
32 were excluded due to obvious answer errors
including out of range values, inconsistent responses,
or nonsensical responses. Another 102 questionnaires
were excluded due to having respondents from dupli­
cate ICUs, leaving a total of 425 valid questionnaires
to be included in the study. This study included 237
ICUs from Class III Grade A hospitals (55.76%), 77 ICUs
from class III grade B hospitals (18.12%), 104 ICUs
from class II grade A hospitals (24.47%), and 7 ICUs
from class II grade B hospitals (1.65%).
3.1. Methods of temperature measurement in
each ICU
Mercury thermometers were the most widely used
tool for measuring BT (82.39%), followed by electronic
temperature guns (46.12%) and temperature probes
equipped with monitors or ice-blanket machines
(40%) (Figure 3A). The most common site for BT mea­
surement was axilla temperature (96.47%), followed
Figure 3. Body temperature (abbreviated ‘temp’) measurement instruments and sites. (A) Instruments used to obtain body
temperature measurements in intensive care unit (ICU) patients. Other refers to cooling blanket probe, electronic thermometer.
(B) Preferred sites of body temperature measurement in ICU patients. Other refers to forehead temperature, nasopharyngeal
temperature.
LIBYAN JOURNAL OF MEDICINE 3
by rectal temperature (28%) and bladder temperature
(11.53%). (Figure 3B). A percentage of 10.12% of ICUs
took BT measurements every hour, 10.59% took them
every two hours, 59.76% took them every four hours,
7.06% took them at intervals longer than four hours,
and 12.47% of ICUs used continuous temperature
monitoring; all used temperature probes. Among the
respondents, 65.53% thought rectal temperature best
reflected the actual BT of patients.
3.2. Objectives of temperature management
About half of ICUs adopted TTM (225, 52.94%), among
which 19.56% expected temperature control to be
exerted for BT between 36.0–36.5°C, 35.56% stated
that temperatures should be controlled if they are
below 37°C, 29.78% placed the cutoff at 37.5°C,
11.56% placed the cutoff at 38°C, and 3.56% placed
the cutoff at 38.5°C.
Only 1/4 of ICUs used preventive cooling (108,
25.41%), including 54.63% which have adopted preven­
tive cooling measures for BT > 38°C, 35.19% for BT >
37.5°C, 9.26% for BT > 37.0°C, and 0.93% for BT > 36.5°C.
3.3. Cooling measures adopted in each ICU
Among 425 ICUs, 417 (98.12%) ICUs were treated with
physical cooling, 374 (88.0%) ICUs were treated with drug
cooling, 374 (88.0%) icus were treated with equipment
cooling, and 329 (77.41%) ICUs were treated with all three
cooling methods. The most used physical cooling mea­
sures include ice packs (96.24%), cooling blankets
(69.88%), and lukewarm baths (46.35%). The most used
cooling drug dosage forms included oral (57.18%), intra­
muscular (66.12%), intravenous (47.06%), suppository
(64.0%), and 3.5% ICU would choose antifebrile patch,
enema and other methods. The most frequent antipyretic
drugs were compound aminobarbital injection (55.06%),
ibuprofen (51.06%), indomethacin suppository (45.41%),
and glucocorticoids (39.76%) (Figure 4).
4 L. MENG ET AL.

60% 55.06%
51.06%
50% 45.41%
40.94% 39.76%
40%
30%
20.71%
20% 12.47%
10% 5.65% 5.18% 4.71%
0%

Aspirin

Indometacin

Glucocorticoids

Other
Acetaminophen

Nimesulide

Diclofenac

Compound aminobarbital
Ibuprofen

Lysine Acetylsalicylate

injection
Figure 4. Antipyretic drugs used for the cooling of intensive care unit (ICU) patients.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Ice blanket machine 93.18%

Intelligent
thermoregulator 21.65%

Intravascular heat
4.24%
exchange cooling…
Blood purification
equipment 64.94%

Other 1.41%

Not use equipment 3.76%

Figure 5. Cooling equipment used for intensive care unit (ICU) patients with elevated body temperatures.

Ice blanket machines were the most used cooling 3.5. Recommendations to promote temperature
equipment (93.18%), followed by blood purification management in ICU
equipment (64.94%). Only 4.24% of ICUs were
A total of 106 respondents made recommendations
equipped with intravascular heat exchange cooling
for improved temperature management in ICUs. We
equipment, and 3.76% of ICUs did not use cooling
statistically analyzed the recommendations proposed
equipment (Figure 5). A percentage of 49.88% of ICUs
and found that the most frequent key phrases used
would administer cooling measures for one hour,
were ‘continuous temperature monitoring’ (29 times),
34.59% of ICUs for 2 hours, and 10.35% for 4 hours,
‘targeted temperature management’ (22 times), and
after which further cooling treatment would be con­
‘development of guidelines and norms related to tem­
sidered if BT had not dropped significantly.
perature management’ (19 times) (Figure 6).

3.4. Temperature control range under special 4. Discussion

circumstances
This study involved the distribution of a large-scale survey
For patients who required mild hypothermia after on temperature management in ICUs in China. Through
cardiopulmonary resuscitation or nerve injury, the survey, we found that there are substantial differ­
37.88% of ICUs reported controlling the BT between ences in the methods of temperature measurement and
32–34°C, 48.24% reported controlling the BT between in the strategies of mild hypothermia treatment in var­
34–36°C, and 12.0% reported controlling the BT ious ICUs. We recommend urgent establishment of rele­
between 35–37°C. For the duration of mild hypother­ vant guidelines and norms to unify and standardize
mia, 20.71% of ICUs preferred ≤24 h, 27.06% of ICUs temperature management in ICUs.
preferred ≤48 h, 39.06% of ICUs preferred ≤72 h, and This survey found that mercury thermometers
13.18% of ICUs preferred >72 h. remained the most widely used BT measurement

Figure 6. Frequency of key phrases used in respondent recommendations to promote temperature management.
tool, followed by electronic BT guns, and probes
equipped with monitors or ice blanket machines.
The most common sites for measuring BT were the
axilla, followed by the rectum and bladder. However,
a subset of the most severely ill patients may be
experiencing shock or tissue malperfusion. The axillary
and forehead temperatures measured by mercury
thermometers or electronic BT guns can only reflect
skin temperature rather than accurately reflecting
core temperature. Moreover, measurements may be
affected by ambient temperature, sweating, and eva­
poration, and it is not uncommon patients with ele­
vated core temperatures to show normal skin
temperature [24,25]. Therefore, this method of tem­
perature measurement is not suitable for use in the
ICU environment. Clinically, rectal temperature is rela­
tively common, but the rectal probe must be intro­
duced to a depth of 15 cm to accurately reflect core
BT. For conscious patients, insertion of the rectal
probe will cause considerable pain and discomfort;
for unconscious patients, due to temporary paralysis
of the autonomic nervous system, their rectal wall will
expand and thin, causing poor correlation between
rectal temperature and core temperature, and the
reading can be significantly delayed [26]. The bladder
temperature is very close to the core temperature and
is becoming more and more commonly used in ICUs
[27]. Indwelling catheters with temperature sensing
can continuously measure BT. Normal urine volume
has a good correlation with the core BT, but this
temperature measurement method is inaccurate if
the urine volume decreases due to decreased cardiac
output, acute kidney injury and other factors [11].
The accuracy of temperature measurements
depends on the location and method of measurement
[19]. The tympanic membrane, nasopharynx, esopha­
gus, and pulmonary artery are considered to be the
most responsive sites of core BT [26,28], but they
cannot be widely implemented in clinical practice
due to invasiveness and complex operation. Ideally,
temperature measurements should be simple, nonin­
vasive, and harmless, reflecting core temperature as
accurately as possible without being significantly
LIBYAN JOURNAL OF MEDICINE 5
affected by ambient temperature. Although we live
in an era of cutting-edge medical technology, no
standard technology has been developed to measure
BT. Therefore, at the present stage, regardless of
which method is adopted, the same measurement
method and site should be repeated to understand
the trend of continuous change.
Fever is a common clinical symptom in ICU, which
can lead to prolonged ICU stay. High temperature (ie;
>38°C) and persistent fever (ie; fever that lasts for an
extended period, typically beyond a week) are asso­
ciated with increased risk of death [29]. Although
a patient’s temperature is well documented during
an ICU stay, it is often unclear when and how to
intervene when a patient’s temperature rises. To alle­
viate disease, improve clinical symptoms, and try to
obtain a better clinical prognosis, clinicians usually
apply some cooling measures, including drug cooling
and physical cooling. Drug cooling aims to control BT
by inhibiting the release of endogenous heat source
(e.g. Interleukin-1, tumor necrosis factor). Physical
cooling reduces the BT by accelerating heat dissipa­
tion [30,31]. It was found that most ICUs preferred
physical cooling, including ice packs, cooling blankets,
and warm water baths. It was generally believed that
physical cooling was preferable to drug cooling [31].
Firstly, adverse reactions of antipyretic drugs, espe­
cially the use of non-steroidal drugs and glucocorti­
coids, were considered [32,33]. Second, fever that has
nothing to do with a physiological temperature-
increasing mechanism is less responsive to drug cool­
ing [34]. Third, although drug cooling achieves the
purpose of reducing BT by inhibiting the release of
endogenous substances promoting heat production,
it also interferes with the inflammatory response of
the body to a certain extent [35]. There is evidence
that temperature in ICU patients can be controlled
with medications [32] and physical cooling devices
[36]; however, it is not clear whether these measures
contribute to the development of hypothermia.
TTM can be used to prevent fever and maintain nor­
mal BT. This survey found that over half of ICUs used TTM,
and 85% of these ICUs kept their TTM below 37.5°C. The
6 L. MENG ET AL.
goal of temperature control in patients without nerve
damage is still unclear. A 2019 meta-analysis of individual
patient data showed that in ICU patients, more aggres­
sive temperature management did not improve survival
compared with passive temperature management stra­
tegies [20]. In the study, survival was similar across treat­
ment subgroups, regardless of whether they were
grouped according to age, disease severity, or receiving
specific organ support [20]. In addition, a phase II study of
active temperature reduction to normal in sedated and
mechanically ventilated sepsis patients found that active
temperature management reduced the early mortality of
such patients compared with conventional treatment
[36]. Young et al. [33] conducted a random evaluation
of active control of temperature and ordinary tempera­
ture management test. This multicenter randomized clin­
ical trial involving ICU patients with fever without acute
brain injury showed that mean BT was reduced by
approximately 0.5°C in the active temperature control
group compared with the ordinary temperature manage­
ment group [33].
Our current investigation found significant inconsis­
tencies across units in the management of BT, including
target BT and duration of mild hypothermia, for patients
requiring mild hypothermia after cardiopulmonary resus­
citation or neurological injury. Mild hypothermia therapy
is a treatment method that reduces the BT or local brain
temperature of patients by artificial physical methods,
thereby reducing cerebral oxygen consumption and pro­
moting the recovery of brain function [37]. It is suitable for
such purposes as brain protection during cardiopulmon­
ary bypass in cardiac surgery, craniocerebral injury related
to decreased cerebral perfusion pressure, and ischemic
hypoxic encephalopathy after cardiopulmonary resuscita­
tion. According to the target temperature setting, mild
hypothermia can be divided into four classes: mild (34.5–
36.5°C), moderate (32–34.5°C), severe (28–32°C) and
extreme mild (<28°C) [35]. Although an increasing num­
ber of studies have confirmed that adult out-of-hospital
cardiac arrest (CA) patients treated with mild hypothermia
have better neurological outcomes and lower mortality,
the optimal target temperature is still a range rather than
a specific value [21,37,38]. According to the guidelines
issued by the European Resuscitation Committee in
2015, the recommended target temperature for mild
hypothermia in patients with CA is 32–36°C [21,25]. It is
not clear whether patients in different CA subgroups can
benefit from lower temperature (32–34°C) or higher tem­
perature (36°C) [39]. The American Heart Association
guidelines for cardiopulmonary resuscitation published
in the same year also indicated that CA patients with
different characteristics may be suitable for different tar­
get temperatures [40]. In a recently published clinical
randomized controlled study, there was no significant
difference in the neurological outcome of patients treated
with different target temperatures (32°C, 33°C, and 34°C)
at 90 days after return of spontaneous circulation, and no
significant difference in the neurological outcome of
patients with a target temperature ≤ 34°C or > 34°C at
six months. There was no significant difference between
pediatric in-hospital CA patients treated with the target
temperature of 33.0°C and 36.8°C [41–43]. These debates
about the optimal target temperature suggest that the
most effective outcomes of mild hypothermia should be
achieved because of clinical bundle therapy strategies,
rather than simply cooling.
There are no definitive clinical data on the optimal
duration of maintaining the target temperature to answer
this question. From the perspective of the brain protective
mechanism of mild hypothermia, it seems that the longer
the target temperature is maintained, the greater the
benefit will be [13]. However, this is not the case. Clinical
studies have found that mild hypothermia lasting for 48 h
does not significantly improve the neurological prognosis
of patients at six months compared with 24 h, but the
incidence of adverse events is higher and the length of
ICU stay is longer [44]. Although blood flow velocity of
middle cerebral artery and oxygen saturation of jugular
sinus were significantly increased at 72 h after mild
hypothermia compared with the start of treatment, side
effects of mild hypothermia also increased [23]. Currently,
in the United States and European guidelines, the target
temperature for mild hypothermia after cardiopulmonary
resuscitation is 32–36°C, and the recommended mainte­
nance time is at least 24 h [29,30]. However, for patients
with craniocerebral injury, short-term (24-48 h) mild
hypothermia therapy is difficult to achieve significantly
better clinical effects. Mild hypothermia therapy lasting
longer than 48 h can reduce the mortality of patients with
traumatic craniocerebral injury. It is suggested that such
patients should maintain mild hypothermia treatment for
at least 3–5 days.
This study has several limitations. It may suffer from
sampling bias due to its voluntary participation, poten­
tially limiting its representativeness. The reliance on self-
reported data introduces response bias, and the cross-
sectional design provides only a static view of practices.
Moreover, it lacks clinical outcome assessment and does
not explore reasons behind practice variations or resource
influences. The study’s findings could become outdated,
and it does not consider language, cultural factors, or
publication bias. These limitations underscore the need
for caution when generalizing the results and suggest
room for more comprehensive research on this topic.
In conclusion, we found that there are great differ­
ences in the methods of temperature measurement,
temperature management, especially the strategies of
mild hypothermia treatment among ICUs in China. At
the same time, some problems in ICU temperature
management were exposed, such as whether drug-
based or physical cooling is preferable, the appropriate
threshold for cooling, and the ideal target temperature
of cooling. The goal and duration of mild hypothermia
after cardiopulmonary resuscitation and in patients with

craniocerebral injury are still in need of further research,
and relevant guidelines and norms are urgently needed
to unify and standardize temperature management
in ICU.
This work highlights the need for standardized guide­
lines in temperature management for ICU patients due to
significant variations in methods and strategies. It empha­
sizes the importance of adopting accurate temperature
measurement methods, such as bladder temperature
monitoring, and optimizing cooling measures to enhance
patient care. The study also underscores the necessity of
determining precise temperature control targets and the
duration of mild hypothermia treatment to improve
patient outcomes. In summary, the findings call for stan­
dardized, evidence-based approaches to temperature
management in ICUs to positively influence patient care.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Funding
This work was supported by National Natural Science
Foundation of China (Grant 82102274) and Natural Science
Foundation of Shandong Province, China (Grant
ZR202102210272), Taishan Scholars Foundation of
Shandong Province (Grant tsqn202211347) and Shandong
Provincial Postdoctoral Science Foundation (Grant SDCX-ZG
-202202025). The funders had no role in the design and
conduct of the study; collection, management, analysis, or
interpretation of the data; preparation, review, or approval
of the manuscript; and decision to submit the manuscript
for publication.
Authors’ contributions
XS was involved in the conceptualization, planning and
design of the project, and in the development and
execution of the survey. LM,CFW, and XL designed the
questionnaire, drafted the initial manuscript, reviewed
and revised the manuscript. YB, KZ and YY performed
the data collection, statistical analysis and assisted in
drafting and revising the manuscript. CTW assisted in
the execution of the survey and assisted in the develop­
ment of the manuscript. All the authors have accepted
responsibility for the entire content of this submitted
manuscript and approved of this submission.
Availability of data and materials
The data and materials used or analysed during the current
study are available from the corresponding author on rea­
sonable request.
Ethics approval and consent to participate
The questionnaire and methodology for this study were
deemed exempt by the Institutional Ethics Review Board
of Shandong Provincial Hospital, as it is a survey research.
Informed consent was obtained from all participants.
LIBYAN JOURNAL OF MEDICINE 7
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Appendix
Questionnaire of ICU temperature management survey
I. Basic information
1. The name of the hospital where you work:
2. Hospital level
A. LevelIII Grade A
B. LevelIII Grade B
C. Level II Grade A
D.LevelII Grade B
3. ICU style?
A. SurgicalICU
B. InternalICU
C. GeneralICU
D. EmergencyICU
E. CCU
F. NICU
G. RICU
H. Other
4. ICU beds number:

II. Current status of temperature management in ICU

5. What equipment does your department currently use to measure temperature for patients? (Multiple options
available)
A. Mercurythermometer
B. Electronictemperature gun
C. Monitorbody temperature probe
D. Catheter temperature probe
E. Other
6. What method of temperature measurement is currently applied in your department? (Multiple options available)
A. Axillary
B. Oral
C. Ear
D. Bladder
E. Rectal
F. Other
7. Which method do you think is best at detecting actual temperature?
A. Axillary
B. Oral
C. Ear
D. Bladder
E. Rectal
F. Other
8. How often is temperature measured in your department?
A. Continuousmonitoring
B. Eachhour
C. Every2 hours
D. Every4 hours
E. Over4 hours
9. Whether targeted temperature management is applied in your department ?
A. Yes
B. No
10. What is the target temperature ?
A. 36.0°C—36.5°C
B. <37.0°C
C. <37.5°C
D. <38.0°C
E. <38.5°C
11. Whether preventive cooling applied in your department?
A. Yes
B. No
12. What is the temperature above which preventive cooling measures should be taken?
A. >36.5°C
B. >37.0°C
C. >37.5°C
D. >38.0°C
10 L. MENG ET AL.

13. What cooling methods are applied in your department? (Multiple options available)
A. Physical
B. Medicine
B. Equipment
14. What physical cooling methods are commonly used in your department? (Multiple options available)
A. Icebag
B. Warmwater wiping
C. Alcoholwiping
D. Reducedcover on patients
E. Reduceroom temperature
15. What types of antipyretic drugs are commonly used in your department? (Multiple options available)
A. Oral
B. Injection
C. Suppository
16. What are the commonly used antipyretic drugs in your department? (Multiple options available)
A. Ibuprofen
B. Acetaminophen
C. Aspirin-DL-lysine
D. Aspirin
E. Indomethacin
F. Nimesulide
G. Diclofenac
H. Compoundaminobarbital injection
I. Hormone
J. Other
17. What cooling devices are commonly used in your department? (Multiple options available)
A. Iceblanket machine
B. Iceblanket machine
C. Intravascular heat exchange cooling
D. CVVH
18. How long after the cooling methods are taken, if the temperature does not decrease significantly, further cooling
measures will be taken?
A. 1hour
B. 2 hours
C. 4 hours
D. >4 hours
19. What is the range of temperature control for patients who require mild hypothermia after CPR or nerve
injury?
A. 32°C—34°C
B. 34°C—36°C
C. 35°C—37°C
D. Other
20. What are your recommendations for better temperature management in the ICU?