Targeted Temperature Management Protocol in a Pediatric Intensive Care Unit: A Quality Improvement Project

Area of Science:

• Pediatric Critical Care
• Neurology
• Quality Improvement

Background:

• Acute neurological injury can cause dangerous intracranial pressure fluctuations.
• Maintaining normothermia is crucial for pediatric patients post-neurological injury.
• Abrupt temperature changes negatively impact cerebral blood flow.

Purpose of the Study:

• To enhance hyperthermia management in a pediatric intensive care unit.
• To implement and evaluate a targeted temperature management protocol.
• To standardize care for pediatric patients with acute neurological injury.

Main Methods:

• Utilized a plan-do-study-act quality improvement framework.
• Conducted a retrospective analysis of electronic medical records.
• Compared patient data before and after protocol implementation.
• Protocol included environmental, pharmacological, and cooling device interventions, plus shivering management.

Main Results:

• Pre-protocol: 64% of patients had temperatures >37.5°C; 10% used cooling devices.
• Post-protocol: >80% of patients had temperatures >37.5°C; 62% used cooling devices.
• Increased use of body surface cooling without neuromuscular blockade (6% to 31%).

Conclusions:

• Implementing a targeted temperature management protocol enhanced hyperthermia care.
• Increased nurses' documented use of body surface cooling devices.
• Improved management of hyperthermia in pediatric intensive care unit patients.