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Annals of Intensive Care

, 6:4

First Online: 12 January 2016Received: 15 July 2015Accepted: 27 December 2015

Abstract

BackgroundTherapeutic hypothermia TH between 32 and 34 °C was recommended until recently in unconscious successfully resuscitated cardiac arrest CA patients, especially after initial shockable rhythm. A randomized controlled trial published in 2013 observed similar outcome between a 36 °C-targeted temperature management TTM and a 33 °C-TTM. The main aim of our study was to assess the impact of this publication on physicians regarding their TTM practical changes.

MethodsA declarative survey was performed using the webmail database of the French Intensive Care Society including 3229 physicians from May 2014 to January 2015.

ResultsFive hundred and eighteen respondents from 264 ICUs in 11 countries fulfilled the survey 16 %. A specific attention was generally paid by 94 % of respondents to TTM hyperthermia avoidance, normothermia, or TH implementation in CA patients, whereas 6 % did not. TH between 32 and 34 °C was declared as generally maintained during 12–24 h by 78 % of respondents or during 24–48 h by 19 %. Since the TTM trial publication, 56 % of respondents declared no modification of their TTM practice, whereas 37 % declared a practical target temperature change. The new temperature targets were 35–36 °C for 23 % of respondents, and 36 °C for 14 %. The duration of overall TTM including TH and-or normothermia was declared as applied between 12 and 24 h in 40 %, and between 24 and 48 h in 36 %. In univariate analysis, the physicians’ TTM modification seemed related to hospital category university versus non-university hospitals, P = 0.045, to TTM-specific attention paid in CA patients P = 0.008, to TH durations <12 versus 24–48 h, P = 0.01, and to new targets temperature 32–34 versus 35–36 °C, P < 0.0001.

ConclusionsThe TTM trial publication has induced a modification of current practices in one-third of respondents, whereas the 32–34 °C target temperature remained unchanged for 56 %. Educational actions are needed to promote knowledge translations of trial results into clinical practice. New international guidelines may contribute to this effort.

KeywordsSurvey Therapeutic hypothermia Targeted temperature management Cooling Temperature Heart arrest AbbreviationsCAcardiac arrest

FICS-SRLFFrench Intensive Care Society société de réanimation de langue française

ICUintensive care unit

ILCORinternational liaison committee on resuscitation

THtherapeutic hypothermia

TTMtargeted temperature management

ROSCreturn of spontaneous circulation

Electronic supplementary materialThe online version of this article doi:10.1186-s13613-015-0104-6 contains supplementary material, which is available to authorized users.

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Autor: Nicolas Deye - François Vincent - Philippe Michel - Stephan Ehrmann - Daniel da Silva - Michael Piagnerelli - Antoine Kim

Fuente: https://link.springer.com/



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