Fig. 45.12. A: CritiCool machine. B: Water tank to be filled with tap water to the area between the two

red lines. C: Tips of the rectal and skin temperature sensors. D: CureWrap with the Velcro fasteners for

infants 3.5 kg < and >3.5 kg. E: Connecting tube ends for insertion over the male connector of the

CureWrap.

Chapter 45 ■ Brain and Whole Body Cooling 335

d. Tap water

e. Rectal temperature probe ×2 (reusable) or adapter

with single-use rectal probes

f. Skin temperature probe (reusable) or adapter with

single-use probes

g. Layered bubble wrap pillow.

Technique

a. Position CritiCool unit and lock front wheels.

b. Fill tank of the temperature management unit with

tap water to between the two red lines (Fig. 45.12A, B).

c. Select the size of the CureWrap (“cooling jacket”)

appropriate to the size of the infant (<3.5 kg and

>3.5 kg) (Fig. 45.12D).

d. Connect the connecting tubes to the temperature

management unit and the CureWrap (Fig. 45.12A).

e. Pull the collar off the female end of the connecting

tube and insert over the male connector to the

CureWrap.

f. Connect the connecting tubes to the metallic sockets in front of the temperature management unit.

g. Switch on the temperature management unit after

connecting the power cable.

A prompt to confirm mode will appear with an

audio alarm.

h. Cure wrap will fill with water; ensure the CureWrap

is filled with water prior to wrapping and securing

on infant.

i. Confirm neonatal cooling mode (Fig. 45.13A).

The default set core temperature in the management unit is 33.5°C. Water will not flow in the wrap

without a valid core temperature reading.

j. Connect grey temperature sensor into Core socket

and green temperature sensor into Surface socket.

(Fig. 45.12A).

k. Circulation is confirmed when the “flow icon” (top

right of display) is rotating (Fig. 45.13B).

l. Place the infant in the supine position on the

CureWrap (which is shaped to fit the infant) in an

open crib/bed.

m. Undress the infant down to a small diaper.

n. Insert the rectal temperature probe (grey sensor)

supplied with the equipment 6 cm into the rectum

(see E) (Fig. 45.2A).

o. Insert a second calibrated rectal probe to 6 cm,

alongside the previous probe. The second probe is

connected to a separate patient monitor to serve as a

means to double check the rectal temperature.

p. Secure both the rectal temperature sensors (see E).

q. Cover the infant’s legs and the trunk with the

CureWrap, and secure with the Velcro straps (Fig.

45.14D).

r. Expose the umbilicus to allow insertion of umbilical

lines and monitoring for bleeding (Fig. 45.14D).

s. Place six layers of bubble wrap between the head

and the head portion of the wrap (Fig. 45.14B, C).

This insulates the head from the cycling temperature in the CureWrap (30). Keeping the head

exposed in an open bed maintains the superficial

brain colder (29). The experimental evidence indicates that the fluctuation in the mattress temperature every 12 minutes induces similar fluctuations

in the superficial brain temperature.

t. Secure the surface temperature probe to the forehead with tape (Fig. 45.14D).

u. Monitor core and surface temperature every 15 minutes during induction of HT and rewarming, and

every 30 minutes during maintenance phase of HT.

v. After 72 hours of HT, rewarm using either the manual or controlled mode.

(1) During the manual mode, the user increases the

set core temperature in the CritiCool by 0.2°C to

0.3°C per 30 minutes to increase the core temperature by 0.4°C to 0.5°C per hour. Rewarming

A, B

D E

C

Fig. 45.13. Setting up CritiCool for

neonatal cooling and automatic

rewarming mode. A–E show the LCD

display on the CritiCool.