Targeted Temperature

Management

BD-31606
What’s your definition of…….?
• Targeted Temperature
Management
• Hypothermia
• Normothermia
• Therapeutic Hypothermia
• Hyperthermia
• Refractory Fever

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What is Temperature
• Temperature is a quantification of how hot or cold an object is¹
• Temperature is physically measuring the amount of heat energy
available for work in an object¹
• Thermometers quantify heat energy¹

Temperature of object = measure of the average

Kinetic Energy (KE) of the particles (atoms and
molecules) within that object¹

Greater Kinetic Energy = objects move faster¹

²
1. Chestnut B, Average Kinetic Energy & Temperature of a system (2020, February 24). Retrieved from
https://study.com/academy/lesson/average-kinetic-energy-temperature-of-a-system.html.
2.
https://www.researchgate.net/figure/Diagrammatic-illustration-of-body-temperature-in-the-human-body-a-In-cold-envir
onments_fig1_51178470
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Targeted Temperature Management (TTM)

• Prescribed TTM includes dosage and duration

• Hyperthermia control with targeted temperature
management in either the hypothermic or
normothermic mode

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41.0°C 105.8°F
40.5°C 104.9°F
40.0°C 104.0°F
39.5°C 103.1°F
39.0°C 102.2°F
38.5°C 101.3°F
38.0°C 100.4°F What temperature will
37.5°C 99.5°F trigger you to initiate the
37.0°C 98.6°F Arctic Sun™ Temperature
36.5°C 97.7°F
Management System?
36.0°C 96.8°F
35.3°C 95.5°F
35.0°C 95.0°F
34.5°C 94.1°F
34.0°C 93.2°F
33.5°C 92.3°F
33.0°C 91.4°F

BD-31606
Definition of Fever

Mayer, SA. & Sessler, DI. Eds. (2009). Boca Raton: Taylor & Francis Group, p. 5.

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Let’s walk through the patient pathway

BD-31606
4 Phases of TTM

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Company.
Precision
<6 24
hours hours
Time to Normothermia
Initiation 36.5- 36.5-
37˚C 37.5˚C

≤ 0.5˚C perhour
24
hours
Maintenance
33-
35˚C

9 © 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company.
BD-31606
 Phases of
Therapy
Induction Phase
• Careful monitoring of fluid balance
• Heamodynamic monitoring.
• Glucose control
• Monitor for hypertension
• Electrolyte management
• Prevention of shivering

General Considerations: This list may vary depending on the patient’s underlying condition.
1. Bader, MK. & Littlejohn, LR. (2009). AANN Core Curriculum for Neuroscience Nursing. St. Louis, MO: Saunders. pp.
237-246.
2. Guanci, MM. & Mathiesen, C. (2009). Foundations of Neuroscience Nursing. pp. 237-246.

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 Phases of
Therapy
Maintenance Phase
• Keep fluctuations to maximum of 0.5°C from target.
• Monitor for shivering
• Adjust Ventilators and drugs dosage. Keep patient
adequately sedated.
General Considerations: This list may vary depending on the patient’s underlying condition.
1. Bader, MK. & Littlejohn, LR. (2009). AANN Core Curriculum for Neuroscience Nursing. St. Louis, MO: Saunders. pp.
237-246.
2. Mehta, S. (2010). PA: HMP Communications. pp. 603-612.
3. Nunnally, ME. (2010). Mount Prospect: SCCM. pp. 21-27.
4. Guanci, MM. & Mathiesen, C. (2009). Foundations of Neuroscience Nursing. pp. 237-246.

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 Phases of
Therapy
Maintenance Phase
• Monitor for: • Maintain fluid status
• EKG changes • Infection surveillance
• Bleeding • Frequent electrolyte
• Skin changes monitoring
• Blood gases • Avoid
hyperglycemia
• Monitor Bowel
movement
General Considerations: This list may vary depending on the patient’s underlying condition.
1. Bader, MK. & Littlejohn, LR. (2009). AANN Core Curriculum for Neuroscience Nursing. St. Louis, MO: Saunders. pp.
237-246.
2. Mehta, S. (2010). PA: HMP Communications. pp. 603-612.
3. Nunnally, ME. (2010). Mount Prospect: SCCM. pp. 21-27.
4. Guanci, MM. & Mathiesen, C. (2009). Foundations of Neuroscience Nursing. pp. 237-246.

BD-31606 BMD/
 Phases of
Therapy
Rewarming Phase
• Slow and controlled rewarming (0.01 – 0.5°C
per
hour)
• Rapid rewarming may lead to:
• Hypoglycemia
• Increased ICP
• Rapid electrolyte shifts (hyperkalemia)
• Sudden vasodilation
• Cardiac arrest
General Considerations: This list may vary depending on the patient’s underlying condition.
1. Bader, MK. & Littlejohn, LR. (2009). AANN Core Curriculum for Neuroscience Nursing. St. Louis, MO: Saunders. pp. 237-246.
2. Guanci, MM. & Mathiesen, C. (2009). Foundations of Neuroscience Nursing. pp. 237-246.

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 Phases of
Controlled Therapy
Normothermia Phase

• Fever during the first 72 hours after ROSC has been

associated with poor outcome
• Many clinicians attempt to maintain normothermia (36 -
37°C) during this time for at least 72 hours after ROSC

General Considerations: This list may vary depending on the patient’s underlying condition.
Seder, DB. & Van der Kloot, TE. (2009). Crit Care Med. 37(7): S212.

BD-31606 BMD/
Practical Applications of Targeted
Temperature Management

Arctic Sun™ 5000 Temperature Management System

BD-31606
Indications for Use

The Arctic Sun™ Temperature

Management System is a thermal
regulating system, indicated for
monitoring and controlling patient
temperature in adults and pediatric
patients of all ages.

BD-31606
What’s your device therapy settings?
Select and Maintain

• Follow your institution’s protocol

• Up to 4 protocols programmed
into device

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 Arctic Sun™ 5000 Display Screen

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BD Confidential Information – Do not distribute.
BD-31606
 ArcticGel™ Pad Energy Transfer
• Highly Thermal Conductive Inner Layer- Hydrogel
is highly heat conductive and allows for conductive
heat transfer from the patient to the pad¹

• Direct Contact- Adheres directly to the patient’s skin

for intimate pad-skin contact for most efficient heat
transfer¹

conductive layer
Hydrogel creates a solid to
solid connection path greatly
increasing conductivity²

• Insulative Outer Layer Made of closed cell foam,

insulating the water from ambient conditions¹

1. English MJ, Hemmerling, T.M., Heat Transfer Coefficient: Medivance Arctic Sun Temperature Management System vs. Water Immersion. European Journal of Anesthesiology; 2008 25:531-537
2. https://www.cradle-cfd.com/technology/glossary/ja_P/detail0054.html

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ArcticGel™ Pad Size Charts

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ArcticGel™ Pad Details

• Pad Sizing Pads come in a variety of sizes,

designed to cover 30-40% patient body surface
area
• Access to patient care areas will not
be compromised
• Non-sterile, single patient use only
• Will not collapse under patient's body
weight, ensuring even distribution of water flow
and temperature throughout all pads
• Water flows through pads via negative
pressure circulation, creating a leak-proof
system
• Not made with natural rubber latex, not
made with metal, and radiolucent

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23
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BD-31606
ArcticGel™ Pad Placement
• ArcticGel™ Pad Kit: Consists of 4 pads: left/right
torso, left/right leg.
• Pad Placement: Locate pad edges away from
articulating areas of the body and place the pads to
allow for full respiratory excursions.
• Patients Greater than 100 kg: one or two
universal pads may be utilized in the abdominal
region. The system can accommodate up to 6
ArcticGel™ pads.
• Skin: Place the pads on healthy, clean skin only. Do
not place the pads on skin that has signs of
ulcerations, burns, hives, or rash.
• Record: Record the size, date and time on the pad
label.
• Connections: Keep all connections and tubes
anterior. All lines should end up at the foot of the bed
and positioned so that they are not under the
patient.
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BD-31606
Where do you place
EKG leads,
defibrillation pads,
dressings?

Where are your

concerns about
pressure points?

BD-31606
ArcticGel™ Pads & Skin

If accessible, examine the patient’s skin under the pads often, especially those that are at higher risk of skin injury.

Periodically check that the pads remain moist and adherent.

Replace pads when hydrogel no longer uniformly adheres to the skin. We recommend replacing the pads at least every 5 days.

Due to underlying medical or physiological conditions, some patients may be more susceptible to skin damage from pressure and heat or
cold. Patients at risk include those with poor tissue perfusion or poor skin integrity due to diabetes, peripheral vascular disease, poor
nutritional status, or high dose vasopressor therapy.

Pads should be repositioned to accommodate patient swelling to help prevent mechanical injury.

BD-31606
Monitoring Temperature in the ICU

• Common Questions
– Which method?
• Core or Peripheral
– Continuous or Intermittent?
– Optimal temperature measurement site for device?
• Esophageal, bladder or rectal

BD-31606
 Temperature Measurement
THE ARCTIC SUNTM TEMPERATURE
MANAGEMENT SYSTEM WILL
MONITOR AND CONTROL PATIENT
CORE TEMPERATURE BASED ON THE
TEMPERATURE PROBE ATTACHED TO
THE SYSTEM.
THE CLINICIAN IS RESPONSIBLE FOR
CORRECTLY PLACING THE
TEMPERATURE PROBE AND VERIFYING
THE ACCURACY AND PLACEMENT OF
THE PATIENT PROBE AT THE START
OF THE PROCEDURE.
BD-31606
THE TEMPERATURE DISPLAY ON THE ARCTIC
SUN™ TEMPERATURE MANAGEMENT SYSTEM
CONTROL PANEL AND THE HOSPITAL
MONITOR REPRESENTS THE SAME PROBE
READING BUT MAY NOT BE IDENTICAL DUE
TO CALIBRATION DIFFERENCES BETWEEN
THE CONTROL MODULE AND THE MONITOR.
 Thank You

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of Becton, Dickinson and Company. All other trademarks are the property of their respective owners.
Registered under Act 737. Medical device GC15470828318 BD-31606