Targeted Temperature Management Symposium,
By Gregor Boessner, MD, Raimund Helbok, MD, and Erich Schmutzhard, MD
The Fifth Innsbruck-Konstanz TTM Symposium discusses — in a very
broad inter- and multidisciplinary-format — the impact of temperature
and temperature management on the brain, brain function, and multiorgan
function and dysfunction
Neuro-Intensive Care Unit, Department of Neurology, Medical
University of Innsbruck, Austria
In a two-day symposium, body core temperature, brain
temperature, and targeted temperature management (TTM) served
as the basis for state-of-the-art lectures, “hot” discussions, and
“cool” presentations about new aspects of TTM in critical care,
particularly neurocritical care medicine.
After a short excursion into the history of therapeutic hypothermia
and TTM, led by Wilhelm Behringer and Jiri Bonaventura,
discussion quickly drifted into several major issues, namely “TTM
and cardiac arrest,” “the optimal dosage of TTM,” “duration
of TTM,” and “TTM in cardiovascular diseases beyond cardiac
arrest.” In these obviously cardio-specific topics, neurologists
and neurointensivists were highly involved, discussing the brainheart
interface and brain-heart interaction in cardiac arrest and/
or cardiac failure. No common ground was reached on whether
strict normothermia (TTM at 37°C) or therapeutic hypothermia
(33°C) in/after cardiac arrest is superior. Still, it was a consensus
that TTM is recommended in these patients.
Romuald Bellmann, an internal medicine ICU specialist,
presented new insights into the effect of therapeutic hypothermia
and targeted temperature management on drug disposition and
drug interaction — a highly important and frequently neglected
topic. He called for careful monitoring and titration of drugs
under therapeutic hypothermia or TTM, respectively.
Markus Foedisch (Germany) and
Romergryko Geocadin (U.S.)
of TTM, in line of what intensivists and neurointensivists all over
the world should know and practice on a daily basis, nevertheless
giving a very important compilation of the wide range of
techniques used in critical care and neurocritical care. Renaud
Tissier (France) provided an exciting glimpse into the future when
he introduced total liquid ventilation, rendering it from fiction
to a potentially factual concept in managing patients after cardiac
arrest or with severe global cerebral disease.
In his talk, Yuchuan Ding (Detroit, U.S.) gave a brief glimpse into
the potential capacity of drugs to be used as a means for TTM.
He introduced the term of “hibernisation,” a futuristic goal in
neurocritical care medicine.
A very broad range of lectures were dedicated to TTM in
neurocritical care, ranging from increased intracranial pressure
(Peter Andrews, Great Britain) to brain metabolism and brain
oxygenation under fever, TTM or therapeutic hypothermia
(Raimund Helbok, Innsbruck, Austria).
Gregor Boessner, Erich Schmutzhard (Innsbruck, Austria), and
Linde Kok (Netherlands) discussed the issue of prophylactic
controlled normothermia in neurocritical care patients,
allowing insight into the pathophysiological processes of
targeted temperature management, thereby avoiding secondary
Alois Schiefecker (Innsbruck, Austria) presented first results
of brain temperature and its relationship to cortical spreading
depolarization. Andrea Rossetti (Lausanne, Switzerland)
presented his exciting findings on long-term neurological
recovery (post-cardiac arrest) when treated with prophylactic
normothermia, targeted temperature management, or therapeutic
Emanuela Keller (Zuerich, Switzerland) discussed the issue of ICP
during therapeutic hypothermia, TTM, and, in particular, during
the rewarming period, provoking highly diverse discussion.
Finally, in the interest of interdisciplinary discussion, nurses
presented their view on the impact of ICU and/or stroke unit
nurses on temperature management, fever control, and therapy, on
the outcomes of Neuro ICU and/or stroke unit patients.
More than 120 participants contributed to the TTM symposium’s
rich and fruitful discussions in the form of both state-of-the-art
lectures and personal experiences. These discussions were highly
intensive and, occasionally, rather controversial, setting the stage
for future scientific collaboration, future scientific joint projects,
and improving practical management of future projects and
clinical management. More than 20 nations sent their delegates,
coming from Europe, China, and the Americas.
Fifth Innsbruck/Konstanz Targeted Temperature Management
Symposium, Konstanz, Germany, June 1–2, 2017
Gregor Boessner, MD Raimund Helbok,