Therapeutic hypothermia and temperature management最新文献

{"title":"Renin-Aldosterone Activation and Enhanced Urinary Potassium Excretion in Asphyxiated Newborns Treated with Therapeutic Hypothermia: A Prospective Study.","authors":"Osman Baştuğ, Bahadır İnan, Ahmet Özdemir, Funda Baştuğ, Çiğdem Karakükcü","doi":"10.1177/21537658261416472","DOIUrl":"https://doi.org/10.1177/21537658261416472","url":null,"abstract":"<p><p>Hypoxic-ischemic encephalopathy (HIE) is a critical neonatal condition for which therapeutic hypothermia (TH) remains the cornerstone of neuroprotective intervention. Clinical observations and prior studies note that electrolyte imbalances-particularly hyponatremia and hypokalemia-frequently emerge during TH. Therefore, this study explores how activation of the renin-angiotensin-aldosterone system (RAAS) may contribute to sodium (Na) and potassium (K) disturbances in asphyxiated neonates receiving TH. In this prospective study, 38 newborns with HIE treated with TH and 21 healthy term newborns were enrolled. Serum renin, aldosterone, Na, K, and urinary electrolyte levels were measured at 24, 48, and 72 hours postnatally. Receiver operating characteristic analyses assessed the diagnostic performance of renin and aldosterone. Renin and aldosterone levels were significantly elevated in the TH group compared with controls (<i>p</i> < 0.05). Serum sodium levels were consistently lower at all time points (<i>p</i> = 0.001), while potassium levels were significantly reduced at 24 and 72 hours (<i>p</i> < 0.05). Fractional excretion of sodium was increased at 24 hours, and potassium excretion remained elevated throughout the TH period (<i>p</i> < 0.05). Among the biomarkers, aldosterone demonstrated excellent diagnostic performance at 24 hours (AUC = 0.919). Activation of the RAAS is evident in asphyxiated neonates undergoing TH, with aldosterone playing a pivotal role in electrolyte disturbances. These results highlight the clinical importance of vigilant monitoring and timely correction of serum sodium and potassium levels during the hypothermia protocol.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":"16 4","pages":"176-182"},"PeriodicalIF":0.9,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Pulmonary Hypertension Among Infants Undergoing Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy: A Systematic Review and Meta-Analysis.","authors":"Rashida Javed, Tim J Van Hasselt, Narasimha Rao, Harsha Gowda","doi":"10.1177/21537658251370950","DOIUrl":"10.1177/21537658251370950","url":null,"abstract":"<p><p>To perform a systematic review and meta-analysis to examine the association between persistent pulmonary hypertension (PPHN) and receipt of therapeutic hypothermia (TH), compared to those who did not receive TH, among infants with moderate or severe hypoxic-ischemic encephalopathy (HIE). Systematic review and meta-analysis based on Ovid, Medline, Embase and Cochrane central searches from 01/01/2000 to 31/03/2025. We included only randomized control trials for meta-analysis and followed international guidelines for conducting systematic reviews. The primary outcome of the study was PPHN in infants undergoing TH for moderate to severe HIE. Among 185 articles identified using search strategy, 19 articles were assessed for eligibility. Eight randomized control trials (RCTs) met the inclusion criteria, and seven were included in meta-analysis. A random effects model used for the outcome of PPHN, comparing TH with NT or usual care, involving a pooled population of 1006 infants across seven studies. The relative risk of PPHN for TH versus NT was 1.13 (95% confidence interval 0.81 to 1.57). We noted risk of bias in the blinding of participants across included RCTs. We assessed nine observational studies and performed a narrative review. We noted that a considerable number of infants developed PPHN across TH and NT groups. We did not find evidence of an association between TH and PPHN in infants with moderate to severe HIE, although a considerable number of infants developed PPHN across both groups. We suggest that clinicians should be aware of the risk of PPHN to allow prompt investigation and management.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"143-152"},"PeriodicalIF":0.9,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-Based Nursing Practices to Prevent Perioperative Unintentional Hypothermia in Elective Surgeries: An Observational Study.","authors":"Özlem Şahin Akboğa, Bilal Akboğa","doi":"10.1177/21537658251414552","DOIUrl":"10.1177/21537658251414552","url":null,"abstract":"<p><p>Although evidence-based recommendations for preventing perioperative unintentional hypothermia have long been available, observational studies evaluating their implementation in hospital practice and the effectiveness of preventive interventions in at-risk patients are limited. This study aimed to determine the scope of nursing interventions for preventing perioperative unintentional hypothermia and examine the relationship between patient characteristics and these practices. This study employed a descriptive observational design. Patients undergoing elective surgery in the surgical units (orthopedics, gynecology, urology, neurosurgery, general surgery, and cardiovascular surgery) of a tertiary hospital in Turkey were observed preoperatively, intraoperatively, and on the first postoperative day. The mean age of the participants was 51.30 ± 19.32 years; 77% were overweight or obese, 55.2% had chronic diseases, and 39.6% underwent surgeries lasting more than 2 hours. The findings indicated that the duration of surgery was a significant determinant of nurses' perioperative hypothermia prevention practices. In longer procedures, nurses' awareness of hypothermia risk increased, which was reflected in patient education, environmental temperature management, and the use of active and passive warming methods (<i>p</i> < 0.05). This study highlights the importance of educational programs, strengthening standard care protocols, and policy development to enhance nurses' awareness and practice in preventing perioperative unintentional hypothermia. In conclusion, effective strategies are needed to improve nursing practice and promote evidence-based interventions in this area.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":"16 4","pages":"167-175"},"PeriodicalIF":0.9,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Long-Term Outcomes of Combined Hypothermia and Whole Body Cooling Therapy in Newborns with Hypoxic-Ischemic Encephalopathy.","authors":"Nermin İsmayilova, Ayşe Melike Adak, Ezgi Çağlar, Eyşan Sevimli, Khatuna Makharoblidze, Çetin Okuyaz, Ayşen Orman, Yalçın Çelik","doi":"10.1177/21537658251415126","DOIUrl":"https://doi.org/10.1177/21537658251415126","url":null,"abstract":"<p><p>Therapeutic hypothermia is widely used as a neuroprotective intervention in infants with hypoxic-ischemic encephalopathy (HIE); however, limited data exist regarding the long-term neurodevelopmental outcomes of different cooling strategies. The aim of this study is to compare the long-term neurodevelopmental and cognitive outcomes of combined hypothermia (CH) and whole-body cooling (WBC) treatments in children diagnosed with HIE with each other and with a healthy control group without an HIE diagnosis. This retrospective study included a total of 50 children diagnosed with HIE and treated with cooling therapy, who were followed in the Neonatal Intensive Care Unit of Mersin University between 2015 and 2021. Additionally, a control group was formed from healthy children of a similar age group who attended outpatient clinic checkups between these dates and whose archive records were accessible. We used the Wechsler Intelligence Scale for Children-IV (WISC-IV), the Stroop Test, and the Denver II Developmental Screening Test for neurodevelopmental assessments. Neurodevelopmental outcomes were generally found to be similar between the two groups. However, the Full Scale IQ of the CH group was found to be significantly lower compared to the control group. The groups that underwent cooling treatment showed more abnormalities in the Stroop and Denver tests compared to the control group. Although no significant difference was found between the CH and WBC methods in terms of overall results, weak outcomes in some cognitive subdomains in the CH group were noteworthy. Larger sample sizes and prospective studies are needed.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":"16 4","pages":"161-166"},"PeriodicalIF":0.9,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the Relationship Between Core Temperature, Heat Balance, and Energy Expenditure.","authors":"Victor Wu, Ryann DeMaio, Andrea Jonsson, Jenna Monteleone, Katharyn Flickinger, Alexandra Weissman, Francis Guyette, Daniel Buysse, Jonathan Birabaharan, Philip Empey, Clifton W Callaway","doi":"10.1177/21537658251387188","DOIUrl":"10.1177/21537658251387188","url":null,"abstract":"<p><p>Core body temperature reflects core heat content, which is determined by the balance of heat production and heat loss. Studies and interventions focusing on temperature rarely measure metabolic heat production and heat loss. This study tests whether net heat balance (NHB) in humans can predict core temperature changes and secondarily whether NHB combined with skin surface temperatures (ST) can estimate core temperature. We conducted a laboratory study of healthy volunteers cooled with gel-adhesive circulating water pads with or without treatment with a drug (dexmedetomidine) to prevent shivering. We measured heat flux on the forehead, deltoid, anterior abdominal wall, and above the knee. We measured energy expenditure (W) using indirect calorimetry and core temperature (T) using deep gastrointestinal temperature. Thirteen participants (age 20-51 years; height 160-188 cm; mass 61-101 kg) participated in 21 protocol days. Mean (standard deviation [SD]) NHB ranged from +14 (26) W at baseline to -56 (25) W with drug and cooling pads. NHB predicted change in core temperature 60 minutes later (lagged regression slope: 0.33°C/100W; 95% confidence interval [CI] [0.2, 0.5]) (pseudo r² = 12.81%). Forehead ST had the narrowest limits of agreement [-2.6°C, -2.4°C] for predicting core temperature with a mean bias of -2.5°C. In conclusion, NHB of -100W predicts a 0.33°C/60 minutes decrease in core temperature. Forehead temperature is the most consistent peripheral site to predict core temperature. While a cooling device increases heat loss, energy expenditure (EE) also rises with surface cooling, minimizing NHB, and core temperature change unless a drug is utilized to suppress the increase in EE.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"153-160"},"PeriodicalIF":0.9,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Buspirone in Antishivering Protocols for Post-Cardiac Arrest Targeted Temperature Management: What Evidence Supports Its Use?","authors":"Arghyadeep Ganguly, Suryasnata Bhowmik, Adrija Hajra","doi":"10.1177/21537658261464859","DOIUrl":"10.1177/21537658261464859","url":null,"abstract":"<p><p>Shivering is a common complication of targeted temperature management (TTM), which could undermine its neuroprotective benefits by increasing cerebral oxygen consumption and metabolic demand. Buspirone, a 5-HT1A receptor partial agonist, is incorporated into many antishivering protocols for TTM following cardiac arrest, despite limited evidence supporting its efficacy in critically ill patients. We conducted a targeted literature review using PubMed to assess the evidence in favor of the use of buspirone in antishivering protocols during TTM. Experimental, physiological, and clinical studies were reviewed with emphasis placed on study design, patient population, and relevance to critically ill individuals undergoing TTM. Experimental studies in animals and healthy human volunteers show that buspirone can modestly lower core temperature or shivering thresholds. Two small studies (<i>n</i> = 8 each) in healthy male volunteers demonstrated that buspirone reduced the shivering threshold by approximately 0.7°C. A retrospective cohort study (<i>n</i> = 131) in post-cardiac arrest patients showed a reduction in shivering with a multidrug protocol including buspirone, but the independent contribution of buspirone could not be isolated. No randomized controlled trials have evaluated buspirone's efficacy as a standalone antishivering agent in critically ill patients. Current evidence to support the buspirone's use in antishivering protocols is limited and largely extrapolated from noncritical care settings. Given that most patients undergoing TTM already receive sedatives and analgesics with more potent antishivering effects, the incremental benefit of buspirone remains unproven. Furthermore, it adds to the already high burden of polypharmacy in ICU patients and could, in theory, increase the risk of serotonin syndrome. Randomized trials comparing protocols with and without buspirone are needed to determine its clinical utility.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"183-188"},"PeriodicalIF":0.9,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Prognostic Model for Predicting Adverse Outcomes in Neonates with Hypoxic-Ischemic Encephalopathy before Therapeutic Hypothermia.","authors":"Tomonori Kurimoto, Takuya Tokuhisa, Itaru Hayasaka, Hiroshi Ohashi, Tsuyoshi Yamamoto, Eiji Hirakawa, Takatsugu Maeda, Masato Kamitomo, Satoshi Ibara","doi":"10.1177/21537658251370513","DOIUrl":"10.1177/21537658251370513","url":null,"abstract":"<p><p>Hypoxic-ischemic encephalopathy (HIE) affects 1.3-1.7 per 1000 live births and remains a major cause of neurodevelopmental impairment (NDI). Despite therapeutic hypothermia (TH), nearly half of infants with moderate to severe HIE experience death or NDI. Identifying early prognostic indicators before TH initiation is crucial for improving management and outcomes. We conducted a retrospective case-control study of 144 infants with HIE treated with TH at Kagoshima City Hospital (2000-2022); 100 underwent developmental evaluations at 18 months. Clinical parameters, including amplitude-integrated EEG (aEEG), Thompson scores, and resuscitation details, were analyzed. Logistic regression identified predictors of adverse outcomes: death, cerebral palsy, or developmental quotient <70. Univariate analysis revealed significant predictors, including low Apgar scores, low umbilical artery pH, aEEG abnormalities, high Thompson scores, and resuscitation details. Multivariate regression identified three independent predictors: aEEG abnormalities (adjusted odds ratios [aOR] 7.1, 95% confidence interval [CI]: 1.3-38.2), Thompson score ≥12 (aOR 5.4, 95% CI: 1.5-18.7), and chest compressions (aOR 31.6, 95% CI: 4.3-231.6). We developed and derived early prognostic model from these predictors, assigning +2 points for aEEG abnormalities, +2 points for a Thompson score ≥12, and +3 points for chest compressions. A total score ≥4 achieved high sensitivity (70.4%) and specificity (90.4%), with an area under the curve of 0.87 (95% CI: 0.77-0.94). The early prognostic model may serve as an effective tool for early risk stratification in neonates with HIE before TH initiation, supporting individualized treatment decisions. This score could help identify high-risk neonates who may benefit from additional neuroprotective strategies.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"116-122"},"PeriodicalIF":0.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stepping Out of the Cold: The Use of Surface Cooling Devices for Targeted Normothermia Temperature Management in Out of Hospital Cardiac Arrest Survivors-Common Pitfalls and Proposed Solutions.","authors":"Emma Ford, Josh Fox, James Williams","doi":"10.1177/21537658251378205","DOIUrl":"10.1177/21537658251378205","url":null,"abstract":"<p><p>The critical care unit at the University Hospital of Wales is a 38-bedded tertiary center. In 2023, the unit admitted 1251 unscheduled patients, of which 131 were out-of-hospital cardiac arrest (OOHCA) patients. The unit also participated in the Targeted Temperature Management 2 study and adopted the findings shortly after its publication in 2021. This gave us a unique exposure into the pitfalls associated with changing surface cooling protocols. The aim of this quality and safety initiative was to explore the causes of failure to comply with normothermic temperature targets in the OOHCA population, following a protocol change away from targeted therapeutic hypothermia. This article uses surface cooling data from OOHCA survivors. We discuss our findings from analysis of surface cooling data from 36 patients-13 pre-protocol change (targeted hypothermia) and 23 post-protocol change (targeted normothermia). Concerningly, following the change to targeted normothermia, rather than therapeutic hypothermia, the fever burden increased from an average of 2 to12 hours per patient. To address this problem, we reviewed the data and identified several causes of this failure. These failures included the failure to start the therapy at the selected trigger point, the interruption of therapy, inadequate pad sizing, and the failure to select the correct protocol. Surface cooling pitfalls are not commonly discussed in the literature, and therefore there remains a risk that units may overlook them, either when transitioning between protocols or when continuing with an ongoing surface cooling device. With evidence suggesting that pyrexia contributes to poorer outcomes, it is of vital importance that staff are aware of any potential pitfalls of surface cooling devices to mitigate unnecessary fever burden.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"123-129"},"PeriodicalIF":0.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Thermal Blanket on Patients' Vital Signs, Shivering Level, Chill Status, and Thermal Comfort Perception in the Preoperative and Postoperative Periods.","authors":"İpek Köse Tosunöz, Evşen Nazik, Gülay İpek Çoban","doi":"10.1177/21537658251371364","DOIUrl":"10.1177/21537658251371364","url":null,"abstract":"<p><p>This study aimed to determine the effects of the thermal blanket on patients' vital signs, shivering level, chill status, and thermal comfort perception in preoperative and postoperative periods. The study was designed as a randomized controlled trial and included 44 female patients who had undergone elective gynecological surgery in a hospital in the south of Turkey. The experimental group (<i>n</i> = 22) was warmed using the passive warming method via a thermal blanket, and the control group (<i>n</i> = 22) was administered routine care via a cotton pique. The data collection tools included the \"Patient Information Form,\" the \"Patient Follow-Up Form,\" the \"Shivering Level Diagnosis Form,\" and the \"Thermal Comfort Perception Scale.\" Patients were warmed passively before (at least 10 minutes) and after surgery (at least 60 minutes) with a thermal blanket or cotton pique according to their groups. Patients' vital signs and oxygen saturation were recorded during the preoperative and postoperative periods at 15-minute intervals. The patients' shivering levels were recorded at 15-minute intervals, and chill status and thermal comfort perceptions were recorded at 30-minute intervals during the postoperative period. The data obtained in the research were analyzed using the SPSS 24.0 program. There were no statistically significant differences between the vital signs and oxygen saturation of the intervention and control groups during the first 60 minutes after surgery. The shivering level and coldness of the control group were higher in the postoperative period, but the difference between the groups was not statistically significant. There were no statistical differences between the groups in the time to reach 36.0°C (<i>p</i> > 0.05). Thermal comfort perception scores during the first 90 minutes were significantly higher in the intervention group (<i>p</i> < 0.05). The thermal blanket is not superior to the cotton pique used in standard care in maintaining body temperature, but it is effective in increasing thermal comfort perception.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"130-138"},"PeriodicalIF":0.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted Temperature Management Strategies in Pediatric Patients with Return of Spontaneous Circulation after Out-of-Hospital Cardiac Arrest: A Grading of Recommendations, Assessment, Development, and Evaluation-Assessed Systematic Review and Meta-Analysis.","authors":"Mohammed Alsabri, Shree Rath, Ibrahim Kamal, Salma Tamer Abdelrahman, Mayam Mohamed Aziz, Eric Lusinski, Zena Saleh","doi":"10.1177/21537658251379156","DOIUrl":"10.1177/21537658251379156","url":null,"abstract":"<p><p>Out-of-hospital cardiac arrest (OHCA) in children is a rare but catastrophic event, often resulting in significant neurological injury. Targeted temperature management (TTM), including therapeutic hypothermia (TH), has been proposed as a neuroprotective strategy. This systematic review and meta-analysis aims to evaluate the effects of different TTM strategies on survival and neurological outcomes in pediatric patients after OHCA. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Embase, and the Cochrane Library. Pooled outcomes were synthesized using odds ratios (OR) with 95% confidence intervals (CI), and the certainty of evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach. A total of nine studies encompassing 2107 pediatric patients were included. TH was associated with significantly higher odds of survival (OR: 1.72; 95% CI: 1.36-2.18; <i>p</i> < 0.0001) and favorable neurological outcome (OR: 1.64; 95% CI: 1.16-2.33; <i>p</i> = 0.006) compared to normothermia. Subgroup analysis demonstrated greater survival benefit at 12 months and improved neurological outcomes at 6-12 months. There were no statistically significant differences between groups in blood lactate levels, odds of arrhythmia, culture-proven infections, or length of hospital stay. The certainty of evidence for most outcomes was graded as low due to the predominance of nonrandomized studies and imprecision. TH as a TTM strategy following pediatric OHCA may offer survival and neurological advantage, particularly at longer-term follow-up, without a significant increase in adverse events. However, the low certainty of evidence highlights the need for further high-quality randomized trials to inform clinical practice and optimize neuroprotective care in this vulnerable population.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"87-96"},"PeriodicalIF":0.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}