Thermoregulation Clinical Pathway — PICU and PCU | Children's Hospital of Philadelphia

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: TTM 36.8°C TTM 36°C TTM 33°C

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

Authors:
- A. Topjian, MD;
- K. Lourie, RN;
- K. Agarwal, RN;
- J. Fowler, MD;
- A. Alcamo, MD

Editors: Clinical Pathways Team

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

PICU/PCU Clinical Pathway for Thermoregulation

Device Selection

Evidence