A pilot study of key nursing aspects with different cooling methods and devices in the ICU

Therapeutic hypothermia (TH) has become an integrated part of neurointensive care. Still, little data exists on the actual experience with cooling patients in the ICU from the intensive care nurse (ICN) perspective. The purpose of this survey was to evaluate important nursing aspects with different cooling methods and devices in ICU use.

The ICNs used a four-point rating scale (1=worst, 4=best possible) to evaluate (a) ease of application, (b) visual patient monitoring, (c) work load, (d) hygiene and (e) noise level with four cooling methods used in our ICU. Our simple, initial method of towels soaked in iced water spread over the torso was compared to three commercial cooling methods used; (1) Coolgard 3000 (Alsius, Irvine, USA), (2) Thermowrap (MTRE, Yavne, Israel) and (3) Artic Sun (Medivance, Louisville, USA).

There were significant differences in how the ICNs rated the nursing aspects of the different cooling methods. Ice-water soaked towels over the torso scored high with respect to ease of application and noise level. For work-load, all the three commercial devices scored significantly better than ice-water soaked towels (P<0.05). Only the Coolgard 3000 system scored significantly better than ice-water soaked towels for visual patient monitoring (P<0.001). For hygienic aspects, Artic Sun and Coolgard scored significantly higher than the others (P<0.05). Overall, the ICNs involved felt they had a general good understanding of TH but were only partly prepared in terms of training and knowledge of protocols and complications when TH was introduced in our ICU. The majority felt the new cooling protocol was acceptable.

We identified significant differences in the rating of key nursing aspects of the different cooling methods. More studies on implementation of new cooling methods and devices seem warranted.