PICU/PCU Clinical Pathway for Thermoregulation

Child Requiring Thermoregulation
Non-neurologic Injury
Targeted Temperature Management 36°C
for Cardiac Arrest
Formerly controlled normothermia
Targeted Temperature Management 36.8°C
for Non-Cardiac Arrest
Formerly controlled normothermia
Targeted Temperature Management 33°C
Formerly induced hypothermia

Device Selection

Never use more than 1 device at a time
Arctic Sun
Indications Probe Requirements Features Tips
Acute neurologic injury
  • Continuous core temperature monitoring
  • 1st probe to the device (esophageal preferred)
  • 2nd probe to the monitor (required for TTM 33°C)
  • Device-controlled
  • Warms or cools with pads applied to child’s skin
  • Temperature probe connects to device to help maintain tight temperature control
  • Device auto adjusts temperature based on feedback from the measured core temperature
  • Controlled rate of re-warming when indicated
  • Preferred method of thermoregulation for children with acute neurologic injury if available
  • Device has preset modes based on targeted temperature and once temperature is set, no adjustments are needed
  • Pads are single use, can be used up to 5 days and may remain on child while transporting off unit
  • Placement and size of pads varies based on child size
Blanketrol
Indications Probe Requirements Features Tips
  • Acute neurologic injury
  • or
  • Hyperthermia
  • or
  • Acute hypothermia
  • or
  • Acute on chronic hypothermia
  • Continuous core temperature monitoring
  • 1st probe to the device (esophageal preferred)
  • 2nd probe to the monitor (required for TTM 33°C)
  • Device-controlled
  • Warms or cools with blanket from above and/or below
  • Temperature probe connects to device to help maintain tight temperature control
  • Device auto adjusts temperature based on feedback from the measured core temperature
  • Automatic mode should be used to rapidly decrease temperature
    • e.g., reduce fever or induce hypothermia
  • When goal temperature is reached, switch device to gradient 10 smart mode for child’s comfort and to minimize temperature swings
  • Guidelines for adjusting Blanketrol temperature:
Bair Hugger
Indications Probe Requirements Features Tips
  • Temperature > 34°C
  • and
  • Awake at neurologic baseline
    • e.g., post-operative, or baseline hypothalamic temperature dysregulation
  • Continuous core temperature monitoring
  • Probe to the monitor
  • Provider-controlled
  • Warms with a cover from above only
  • Temperature probe does not connect to device
  • There is no feedback mechanism to help control the child’s temperature
    • e.g., does not decrease from high to medium heat as the child’s temperature increases
    • Patient must be able to communicate discomfort
  • Plastic side should be facing up
  • Airflow towards child
Thermoflect Blanket
Indications Probe Requirements Features Tips
  • Acute mild hypothermia 35-36°C
  • without
  • Acute neurologic injury where hypothermia is not being used as a treatment
  • or
  • Chronic hypothermia with baseline hypothalamic temperature dysregulation
  • Acute hypothermia: continuous core temperature monitoring
  • Probe to the monitor
  • Chronic hypothermia: minimum intermittent monitoring
  • Passive rewarming using child’s own body heat
  • Is not a device, but blanket
  • Low risk of overheating
  • Tuck in around child
  • Does not matter which side is up
Posted: July 2015
Last Revised: July 2024
Editors: Clinical Pathways Team