Methods of Cooling

In this week’s post I will discuss different methods of cooling for therapeutic hypothermia.  There are many different methods that can be used and hospitals employ them based on their set protocol—which is typically dependent upon the preference of the hospital or current evidence based research available that supports one method over another. There are two different types of cooling methods: surface and core cooling.  Surface cooling includes the use of blankets or ice packs whereas core cooling involves the use of chilled IV fluids administered directly into the veins of the patient. 

Surface cooling is beneficial in that it is the least invasive method of achieving hypothermia.  As mentioned before, ice packs and blankets can be utilized.  When compared to core cooling, this method of cooling is relatively inexpensive and can be initiated almost immediately after the hypoxic insult.  However, as with any procedure, there are some disadvantages.  While surface cooling reaches the appropriate temperature pretty quickly, it is very difficult to regulate the patient’s body temperature with this method. Another disadvantage is the direct application of the cold to the patient’s skin—this can cause tissue damage if it is done incorrectly or not monitored closely.

Core cooling involves the use of invasive IV fluids in order to achieve and maintain therapeutic cooling temperatures. Maintaining correct temperatures during cooling is critical.  If a patient’s temperature is not low enough, there is no benefit.  If a patient’s temperature is too low, there is an increased risk for adverse effects.  In contrast to surface cooling, core cooling allows the clinician to closely and accurately monitor the patient’s temperature.

When either of these methods are employed, paralytics and sedating drugs are used to keep the patient from shivering, which would negate the effects of TH.  If you are interested about the different cooling methods of TH, you can find more information here.