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Hyperthermia in Pediatric Patients with Severe Traumatic Brain Injury: A Quality Improvement Initiative

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Hyperthermia in Pediatric Patients with Severe Traumatic Brain Injury: A Quality Improvement Initiative
Marlina Lovett, MD, Nicole O'Brien, MD, Onsy Ayad, MD, Shannon Bowshier, RN and Jessica Dopkiss, RN, Nationwide Children's Hospital, Columbus OH

Objective: Pediatric patients with severe traumatic brain injury (TBI) suffer significant morbidity and mortality. The goal of management in the Pediatric Intensive Care Unit (PICU) is to reduce secondary brain injury. Previous studies have stressed the importance of avoiding hypoxia and hypotension, monitoring intracranial pressure, and reducing cerebral metabolic demand. Hyperthermia contributes to the inflammatory process and increases cerebral metabolic demand. It has been associated with increased PICU length of stay (LOS) as well as increased hospital LOS. In an effort to reduce secondary brain injury, we have implemented a quality improvement project to reduce the hyperthermia burden in severe TBI patients (characterized by post resuscitation GCS ? 8, intubated on arrival to the PICU, and abnormal head CT). Preliminary background data within our institution have shown that greater than 80% of pediatric severe TBI patients experience hyperthermia (temperature ? 38C) within the first week, and greater than 75% have hyperthermia within the first 72 hours of admission. To reduce that burden, we have instituted a goal of normothermia (36 � 37.5C). Interventions have included education on the importance of temperature management, and ensuring placement of a cooling blanket on the bed for any Level 1 Neuro-Trauma patient prior to arrival. Our goal is to reduce the hyperthermia burden within the first 72 hours of admission, by 25% over a period of six months, and to maintain that goal for an additional six months. Secondary outcome measures include complications from cooling blanket use, PICU LOS, and hospital LOS.
Objective: To discuss the importance of normothermia within the severe TBI population and to describe one way to reduce hyperthermia.Objective Content: Hyperthermia increases cerebral metabolic demand and contributes to secondary brain injury. To optimize management of TBI patients, it is prudent to aim for normothermia.


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