Talk:Targeted temperature management

Bot report : Found duplicate references !
In the last revision I edited, I found duplicate named references, i.e. references sharing the same name, but not having the same content. Please check them, as I am not able to fix them automatically :) DumZiBoT (talk) 04:06, 13 August 2008 (UTC) 71.15.92.103 (talk) 17:30, 27 December 2008 (UTC)This article is informative and seems to be medically accurate. Although not in as formal language as a medical journal article, this article contains language that is somewhat stilted and thus does not present its content in a way to make the information usable to the largest number of people.  I recommend that someone with the necessary knowledge and writing skills and time perform a major rewrite on this article, keeping substantially all the content, but revising quite a bit of the language.
 * "main" :
 * [Polderman, Kees H. “Application of therapeutic hypothermia in the ICU.” Intensive Care Med. (2004) 30:556-575. http://www.springerlink.com/content/9n1h8x2bj8vcc5b8/]
 * This animal data was supported by two landmark human studies published simultaneously in 2002 by the New England Journal of Medicine. Both studies, one occurring in Europe and the other in Australia, demonstrated the positive effects of mild hypothermia applied following cardiac arrest.Holzer, Michael. “Mild Hypothermia to Improve the Neurologic Outcome After Cardiac Arrest.” New England Journal of Medicine. (2002) Vol. 346, No. 8.

Popular Science
The February 2009 issue of Popular Science has an extensive article about this. —Preceding unsigned comment added by Rockingbeat (talk • contribs) 16:26, 15 January 2009 (UTC)

Advertisements?
Someone with Artic Sun keeps modifying this page to advertise their equipment. It's a shame they can't be less obvious with their advertising. —Preceding unsigned comment added by 64.232.243.190 (talk) 18:56, 28 March 2009 (UTC)

Artic Sun
First of all, anyone with any familiarity with the technology knows that the arctic sun is not a water blanket. It has a control module for one. It should be differentiated from water blankets. —Preceding unsigned comment added by 134.173.12.223 (talk) 02:54, 28 April 2009 (UTC)
 * That's not true. I am a Med student in California with extensive knowledge of the various technologies. I have provided an objective analysis. —Preceding unsigned comment added by 134.173.12.223 (talk • contribs) 23:11, April 4, 2009
 * Are you kidding me? If you are a med student I would hate to see your research papers. Wikipedia is designed to be free of advertising influence. It is quite obvious that instead of a "med student" you work for Medivance. If you would like to provide an "objective analysis" do so without mentioning any products. —Preceding unsigned comment added by 166.82.187.40 (talk • contribs) 22:04, April 9, 2009
 * "Doctor Fluffy", I do not care if you are a "med student at UCLA" as you claim. I am a physician and have lectured extensively (over 50 lectures at international conferences) on therapeutic hypothermia. Please stop editing this page to put in commercial links. —Preceding unsigned comment added by N506MT (talk • contribs) 14:33, April 22, 2009
 * I find it ironic that you keep complaining that my article--and I wrote the whole thing--is an "advertisement", while you yourself are editing it into a blatant advertisement for catheters.
 * p.s. I am not Doctor Fluffy... —Preceding unsigned comment added by 134.173.12.223 (talk) 20:53, 23 April 2009 (UTC)
 * You did well writing the initial article with the exception of the advertisement section. You will note in this new revision I have left my information on cooling catheters, and your information on water blankets, san the advertisement for Artic Sun. Perhaps we can be mature enough to leave it like this instead of maintaining an editing war. —Preceding unsigned comment added by N506MT (talk • contribs) 03:38, 27 April 2009 (UTC)

(outdent) First of all, anyone with any familiarity with the technology knows that the arctic sun is not a water blanket. It has a control module for one. It should be differentiated from water blankets. —Preceding unsigned comment added by 134.173.12.223 (talk) 02:54, 28 April 2009 (UTC)

Talk page cleanup, 3O and copyvio
I've gone ahead and cleaned up this talk page. To all editors: your comments go at the bottom of the section, not the top. Don't just click edit and type wherever you want. If you want to start a new section, then create one. This page should go in chronological order and show a logical discussion.

Having said that, here's my third opinion. The Arctic Sun section is a little heavy on the advertisement, so I've marked it as such. That does not give you justification to remove the section outright! Clean up the text. Right now, it looks as if what's there is a direct copy of the text on Arctic Sun, so maybe just snip it down and link to the main article. Also, N506MT, don't just blindly remove fact tags. Leave them in until someone makes them better. &mdash;  Hello Annyong  (say whaaat?!) 03:38, 4 May 2009 (UTC)
 * I just realized that this entire page is a huge ripoff of http://www.cardiaccarecritique.com/programs/hypothermic/index.php and it's probably an issue of copyvio. I'm starting a thread at WP:AN. &mdash;  Hello Annyong  (say whaaat?!) 03:54, 4 May 2009 (UTC)
 * False alarm, as it turns out. See the full story. &mdash;  Hello Annyong  (say whaaat?!) 13:10, 4 May 2009 (UTC)
 * there areother possibilities also--see my comment there. DGG (talk) 20:51, 4 May 2009 (UTC)

I wrote this article. The similarities with Arctic Sun page actually come the other way around. I first wrote the page for therapeutic hypothermia and later someone copied what I had written and put it into the Arctic Sun page. I do not work for the Arctic Sun, I am just familiar with the industry (I wrote a detailed research paper on therapeutic hypothermia in Med School.) Everything I said about the Arctic Sun is true. Ask any doctor it is their preferred technology and has by the largest market share without question —Preceding unsigned comment added by 134.173.165.116 (talk) 22:28, 6 May 2009 (UTC)
 * Oh and if you want proof that the page was written by me first and not critical care critique, I have the article as it was originally written in a word document. —Preceding unsigned comment added by Spencer233416 (talk • contribs) 22:32, 6 May 2009 (UTC)
 * By this, I'm assuming that Spencer233416 and 134.173.165.116 are the same person - is that correct? Also, I don't care that you have it in a Word document; that doesn't prove anything to me. Stop adding that text back to the Arctic Sun section; it's already on Arctic Sun, so it doesn't need to be duplicated here too. &mdash;  Hello Annyong  (say whaaat?!) 00:20, 7 May 2009 (UTC)


 * Did you not read what I wrote? I wrote the information about the Arctic Sun here first, the Arctic Sun article copied what I had written. That information is painfully relevant in the therapeutic hypothermia article. I outlined the three major technologies, it would not make sense to leave one out. You should stop changing it back.


 * Also, as you saw when you took it to the copyvio people on wikipedia, that website ripped me off, not the other way around. Just as the Arctic Sun article came second, that website came second as well. So do a little fact checking next time before you claim copyright violation. Mirroring without proper documentation is pretty common occurrence... —Preceding unsigned comment added by 134.173.165.116 (talk • contribs) 3:25, May 7, 2009
 * Yes, I read what you wrote. Fact is that the text about Arctic Sun belongs on the Arctic Sun article. Just because you wrote it here doesn't mean it needs to stay here forever; we are allowed to move text around. You don't own this article. And we investigated that website just to be careful. &mdash;  Hello Annyong  (say whaaat?!) 03:30, 7 May 2009 (UTC)

Who made you supreme arbitrator of truth? I am saying it does belong here because the other two technologies, catheters and water blankets, are outlined IN THE THERAPEUTIC HYPOTHERMIA ARTICLE, so therefore so should the Arctic Sun! You have yet to address this complaint and simple say that because YOU believe it shouldn't be here, it shouldn't it--without any justification. —Preceding unsigned comment added by 134.173.165.116 (talk) 22:14, 7 May 2009 (UTC)
 * I didn't say it doesn't belong here - I said that we don't need the entire Arctic Sun article on here. That's why we have separate articles for separate topics. By your logic, we should take the articles for every different type of birth control pills and merge them all into one article. I edited it so there were a few lines explaining what Arctic Sun is, and there was a huge link to the main article. So what's the problem with that? &mdash;  Hello Annyong  (say whaaat?!) 23:29, 7 May 2009 (UTC)
 * No by my logic, if in the article on birth control you described three out of the four main methods of birth control, you should probably also describe the fourth... —Preceding unsigned comment added by 134.173.165.116 (talk) 01:11, 8 May 2009 (UTC)
 * I'm not saying not to keep the fourth! There is still an Arctic Sun section on this page! It links to the main article about Arctic Sun! What is wrong with that? &mdash;  Hello Annyong  (say whaaat?!) 01:45, 8 May 2009 (UTC)

←Hi. I was invited to weigh in here, and I just wanted to point out that what we're talking about is a matter addressed in Wikipedia's guideline Summary style. One relevant quotation, "When there is enough text in a given subtopic to merit its own article, that text can be summarized from the present article and a link provided to the more detailed article." I have attempted to provide a slightly more detailed summary in the hopes that this will meet consensus. The purpose, of course, is to allow Wikipedians to easily access more information about it if they have interest, but to provide enough of a basic overview that they do not have to. --Moonriddengirl (talk) 15:26, 8 May 2009 (UTC)

I am going to remove the citations at the top of the article unless I am provided with a legitimate reason why they should reamin.134.173.173.154 (talk) 22:06, 11 May 2009 (UTC)

-I am confused as to why there is still reference to specific product (i.e. Arctic Sun) and not the technology (i.e. gel pads)? —Preceding unsigned comment added by N506MT (talk • contribs) 23:44, 17 May 2009 (UTC)

Neutrality Disputed
This page is seriously biased. Arctic Sun is a trademark of Medivance Corp and no other surface cooling method apart from water blankets is included (which does include Arctic Sun, I design these things so I should kinow). I am happy to provide additional content to balance the article, but not if this is to be deleted and re-biased by someone blatently favouring Arctic Sun. Could a moderator please look into this and see what can be done to prevent such blatent commercial bias in a medical/academic page? The alledged author says "Everything I said about the Arctic Sun is true. Ask any doctor it is their preferred technology..." not only is that irrelevant but if it doesn't reveal bias then I don't know what does! Besides, the same contributor claims that cooling methods should not be left out, so where is air-cooling, cold packs, ice, alcohol/water evaporation and cooled intravenous infusion? This is an important therapeutic subject, including but not limited to Arcic Sun, and deserves to be treated in a more reputable manner. Billysugger (talk) 16:32, 13 July 2009 (UTC)


 * Be WP:BOLD and make whatever changes you deem necessary. If they're really outrageous, we'll go down a BRD path. &mdash;  Hello Annyong  (say whaaat?!) 16:42, 13 July 2009 (UTC)


 * Wilco. Billysugger (talk) 22:13, 14 July 2009 (UTC)

Discussion of deep hypothermic circulatory arrest doesn't belong in TTM article
A proposal was made today to delete the Wikipedia article on Deep Hypothermic Circulatory Arrest (DHCA), and merge the content into the TTM article. The use of deep hypothermic circulatory arrest in surgery is a separate practice in medicine from Targeted Temperature Management (TTM) also known as therapeutic hypothermia. All book references and PubMed references to TTM pertain to therapeutic hypothermia, not hypothermic circ arrest. Therapeutic hypothermia is the reduction of normal body temperature by several degrees after cardiac arrest or other neurological injury for purposes of facilitating neurological recovery by reducing the immune-inflammatory cascade that happens after injury. In lay terms, think of it like putting a cold compress on an injury to reduce swelling. In contrast, deep or profound hypothermic circulatory arrest is instituted as a protective measure before causing injury by stopping blood circulation to do surgery in a bloodless field. Not only are the names, mode of use, and purposes different, but the mechanisms by which cold protects the brain from injury during circulatory arrest are different from the mechanisms by which mild cold helps the brain heal after circulatory arrest or other injury. The protection mechanism of deep (and even colder) hypothermic circulatory arrest protection is primarily reduction of cerebral metabolic demand by supressing brain activity to conserve metabolic resources during ischemia. The healing facilitation of mild hypothermia after circulatory arrest is reduction of post-ischemic pathological processes. They are apples and oranges. Cryobiologist (talk) 20:49, 10 April 2016 (UTC)
 * Oh it will be deleted; that article is nothing. (The AFD is here, btw)  And while your opinion is lovely, it has no value in Wikipedia.  you need to bring sources showing that these things are so incredibly different that they must be separated.  The DHCA article as it stands is very clearly a cryonics WP:POV fork and a poor one at that.  A Wikipedia article is not two extended quotations from oldish sources. Jytdog (talk) 21:01, 10 April 2016 (UTC)
 * To dismiss DHCA as a mere cryonics "POV fork" is beyond ludicrous. You're comparing a medical procedure which has been successfully used to save the lives of people living and breathing today, and which is an area of active, federally-funded clinical research to a speculative practice that is currently dismissed out-of-hand by most cryobiologists and physicians. A PubMed title search for "hypothermic circulatory arrest" produces 705 hits, with the most recent results published in March and April of this year. It is utterly irrelevant who created or maintains this article and why. Blacksun1942 (talk) 23:51, 10 April 2016 (UTC)
 * My source is PubMed. A PubMed search for "Targeted Temperature Management" produces 187 hits. A PubMed search for "hypothermic circulatory arrest" produces 2113 hits. A PubMed search for "Targeted Temperature Managment" and "hypothermic circulatory arrest" produces zero hits. When two subjects are so different in medicine that they would rarely be discussed concurrently, it's difficult to find references that would bother explaining the distinction. It's like finding references that would explain the distinction between submarines and spaceships. No references have been provided showing that anyone, even in error, called DHCA a form of TTM, or to justify why if any such reference existed it should be given weight over the overwhelming totality of TTM references, including the ones in this article, that use TTM to mean temperature management during recovery from cerebral ischemic injuries. Cryobiologist (talk) —Preceding undated comment added 22:47, 10 April 2016 (UTC)
 * It isn't productive to repeat the same things at the AfD as you are doing here. As I noted over there, yes TTM is more EM and a DCA is more CV surgery, but a search for "therapeutic hypothermia" brings in plenty of both - same approach with the same neuroprotective goal.   So how about what I offered there? I'll close the AfD, we do the redirect here and rename this to TH, and we work together to make this a really good, full article on therapeutic hypothermia, and if we need to split out content on the DHCA because it has become elaborated and bulky enough to be split, we split at that time, and are able to have a really good article on that?   How about it? Jytdog (talk) 23:43, 10 April 2016 (UTC)
 * I agree with Cryobiologist that the distinction is important (I am an aspiring physician who's currently studying exactly these topics and hopes to actually specialize in them), however, for what it's worth, I don't think it would be wrong to merge with TH and simply have a separate section mentioning DHCA as a related procedure. I simply take extreme exception to the notion that this is *merely* a cryonics POV fork. Blacksun1942 (talk) 23:58, 10 April 2016 (UTC)
 * "As I noted over there, yes TTM is more EM and a DCA is more CV surgery, but a search for "therapeutic hypothermia" brings in plenty of both - same approach with the same neuroprotective goal." I urge you to actually *click* a few of those links and devote some minutes to careful reading. Cryonics or no, Cryobiologist is absolutely right about the distinction; it is not trivial. Blacksun1942 (talk) 00:06, 11 April 2016 (UTC)
 * It is not clear Blacksun if you are arguing to merge or not. Would you please clarify?  Thanks. Jytdog (talk) 01:58, 11 April 2016 (UTC)
 * As I said above: "I don't think it would be wrong to merge with TH and simply have a separate section mentioning DHCA as a related procedure." I hope that clears things up. Blacksun1942 (talk) 03:07, 11 April 2016 (UTC)

Necessary deletion of new "Cardiovascular surgery" text in "Medical uses" section
In conjunction with the proposed deletion of the Deep hypothermic circulatory arrest (DHCA) article, the following was added to the Targeted Temperature Management (TTM) article, "TTM is used in cardiovascular surgeries to improve neurological outcomes. In surgeries on the aortic arch, reducing the temperature of the brain to 18.0°C to 20.0°C (deep or profound hypothermia) leads to outcomes of 4.8% to 12.5% rates of permanent neurologic dysfunction and mortality rates between 6.3% and 13.3%, prior to the use of TTM along with various reperfusion techniques, mortality rates were about 26%." Since I think we are all clear now from the proposed DHCA article deletion discussion that DHCA isn't TTM, and the reference attached to this text, in addition to making no mention of TTM, has been retracted(!), Jytdog, can you please now delete this text from the TTM article? Even if editors were to agree to merge TTM and DHCA into a single large article of undecided title dealing with all forms of induced hypothermia, no matter how different, this text would still need to be rewritten. DHCA isn't only used for cardiac surgeries, but some neurosurgery also. The bottom line is that as a retracted paper, the cited reference can't be used. Cryobiologist (talk) 07:59, 11 April 2016 (UTC)
 * nice catch on the source!  doesn't show that, nor does the PMC version.  So Thanks. (I've emailed pubmed too so hopefully they will update that record)  Updating now with content based on the source that ref was plagiarized from which is much better.  "we" have all been clear that TTM and DHCA are both nontrivial medical applications of hypothermia that are of course distinct.  And yes this needs to elaborated - I was just getting started when you reverted the redirect and so I stopped what i was doing.   Now we need to work out how things will go.  Jytdog (talk) 08:18, 11 April 2016 (UTC)
 * Thanks. I'm going to go ahead and make some improvements to the DHCA article as time permits. DHCA is unique and notable enough for a much better article than the present place-holder. After sufficient development, we might consider merging Emergency Preservation and Resuscitation, an experimental application of cold circ arrest in emergency medicine, into the DHCA article. The TTM article is a well-developed article on the specific notable topic of TTM that is best left alone. Cryobiologist (talk) 23:32, 11 April 2016 (UTC)
 * Was pinged to here. TTM is a major well known therapy. This is the current name for therapeutic hypothermia. I guess the question is is DHCA a type of not? Doc James  (talk · contribs · email) 14:07, 11 April 2016 (UTC)
 * In this article and in the general scientific literature, Targeted Temperature Management (TTM) is utilization of mild hypothermia no lower than +30C for purposes of mitigating post-ischemic injury mechanisms, such as inflammation, in patients with blood circulation. In contrast, DHCA is the establishment of deep hypothermic temperatures (deep hypothermia being defined in Table 1 of this consensus reference as temperatures between +14C and +20C) prior to and during arrested blood circulation for purposes of increasing tolerance to cerebral ischemia, principally by reducing cerebral metabolic demand and resource consumption as reflected by establishment of electrocortical silence. DHCA is intra-ischemia injury prevention, TTM is post-ischemia injury treatment. Pubmed search shows no overlap between "targeted temperature management" and "deep hypothermic circulatory arrest" or even the more general "hypothermic circulatory arrest." Cryobiologist (talk) 20:27, 11 April 2016 (UTC)


 * i went ahead and removed that as i have abandoned my effort to make this into a solid high level article covering the use of moderate to deep hypothermia in medicine. Jytdog (talk) 06:39, 23 April 2016 (UTC)

Are patients usually conscious during TTM?
The article says drugs prevent shivering. Are patients conscious? Is the cold temperature uncomfortable? I found one small study in awake patients, which implies patients are not usually awake otherwise: https://onlinelibrary.wiley.com/doi/abs/10.1197/j.aem.2006.03.559 Numbersinstitute (talk) 03:10, 3 January 2019 (UTC)