Selective therapeutic hypothermia: A review of invasive and noninvasive techniques

Straus, David J.; Prasad, Vinay; Munoz, Lorenzo F.

doi:10.1590/s0004-282x2011000700025

Cited by 18 publications

(14 citation statements)

References 42 publications

(39 reference statements)

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“…6 Selective brain cooling (SBC) methods, such as the use of a cooling helmet or nasopharyngeal cooling, have been proposed to alleviate the complications associated with systemic hypothermia by directly cooling the brain while maintaining body temperature as close to normal as possible. 7 However, SBC requires a method that can measure local brain temperature rather than body temperature because the latter may not reflect the actual brain temperature. 8 Several approaches have been developed to assess brain temperature.…”

Section: Introductionmentioning

confidence: 99%

Monitoring brain temperature by time-resolved near-infrared spectroscopy: pilot study

et al. 2014

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Mild hypothermia (HT(32°C-33°C)) is an effective neuroprotective strategy for a variety of acute brain injuries. However, the wide clinical adaptation of HT(32-33°C) has been hampered by the lack of a reliable noninvasive method for measuring brain temperature, since core measurements have been shown to not always reflect brain temperature. The goal of this work was to develop a noninvasive optical technique for measuring brain temperature that exploits both the temperature dependency of water absorption and the high concentration of water in brain (80%-90%). Specifically, we demonstrate the potential of time-resolved near-infrared spectroscopy (TR-NIRS) to measure temperature in tissue-mimicking phantoms (in vitro) and deep brain tissue (in vivo) during heating and cooling, respectively. For deep brain tissue temperature monitoring, experiments were conducted on newborn piglets wherein hypothermia was induced by gradual whole body cooling. Brain temperature was concomitantly measured by TR-NIRS and a thermocouple probe implanted in the brain. Our proposed TR-NIRS method was able to measure the temperature of tissue-mimicking phantoms and brain tissues with a correlation of 0.82 and 0.66 to temperature measured with a thermometer, respectively. The mean difference between the TR-NIRS and thermometer measurements was 0.15°C ± 1.1°C for the in vitro experiments and 0.5°C ± 1.6°C for the in vivo measurements.

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Section: Introductionmentioning

confidence: 99%

Monitoring brain temperature by time-resolved near-infrared spectroscopy: pilot study

et al. 2014

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“…Similarly, the application of a cool air fan did not effectively lower brain temperature. 19 In contrast, Wang et al introduced a cooling helmet by which they were able to generate and maintain a temperature difference of 1.6°C. However, systemic temperature was also affected in a delayed manner in spite of warming blankets attached to the body.…”

Section: Discussionmentioning

confidence: 99%

“…Direct administration of cold fluid onto the brain surface or into the subdural or subarachnoid space requires open access to the brain. 19 Ventricular infusion of cold fluid via an external ventricular drainage is not practical in severe TBI patients with elevated ICP who depend on continuous cerebrospinal fluid drainage via ventricular drainage.…”

Section: Discussionmentioning

confidence: 99%

Selective Brain Cooling after Traumatic Brain Injury: Effects of Three Different Cooling Methods—Case Report

Westermaier

Nickl

Koehler

et al. 2016

J Neurol Surg A Cent Eur Neurosurg

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In experimental models of neuronal damage, therapeutic hypothermia proved to be a powerful neuroprotective method. In clinical studies of traumatic brain injury (TBI), this very distinct effect was not reproducible. Several meta-analyses draw different conclusions about whether therapeutic hypothermia can improve outcome after TBI. Adverse side effects of systemic hypothermia, such as severe pneumonia, have been held responsible by some authors to counteract the neuroprotective effect. Selective brain cooling (SBC) attempts to take advantage of the protective effects of therapeutic hypothermia without the adverse side effects of systemic hypothermia. Three different methods of SBC were applied in a patient who had severe TBI with recurrent increases of intracranial pressure (ICP) refractory to conventional forms of treatment: (1) external cooling of the scalp and neck using ice packs prior to hemicraniectomy, (2) external cooling of the craniectomy defect using ice packs after hemicraniectomy, and (3) cooling by epidural irrigation with cold Ringer solution after hemicraniectomy. External scalp cooling before hemicraniectomy, external cooling of the craniectomy defect, and epidural irrigation with cold fluid resulted in temperature differences (brain temperature to body temperature) of - 0.2°, - 0.7°, and - 3.6°C, respectively. ICP declined with decreasing brain temperature. Previous external cooling attempts for SBC faced the problem that brain temperature could not be lowered without a simultaneous decrease of systemic temperature. After hemicraniectomy, epidural irrigation with cold fluid may be a simple and effective way to lower ICP and apply one of the most powerful methods of cerebroprotection after severe TBI.

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“…[30] While surface cooling of brain in adults has disadvantage of not cooling brain parenchyma uniformly, cooling caps have been successfully used for selective HT in neonates with hypoxic ischaemic encephalopathy (HIE) owing to the unique neonatal anatomy and intracranial dynamics [32] • Selective cerebral cooling through upper airway: It is another emerging technique to provide selective cerebral HT. [33,34,35] Transnasal evaporative cooling uses a mixture of liquid coolant and oxygen sprayed into nasopharynx through disposable nasal catheter [ Figure 3]. The liquid undergoes rapid evaporation under the administration of high flow oxygen.…”

Section: Antipyreticsmentioning

confidence: 99%

“…Selective cooling can also be attained by irrigating the intracranial spaces with chilled saline. [35,36] Among the selective cerebral cooling techniques only surface cooling methods and intranasal cooling systems have been tested in humans. Potential concerns regarding the uneven cooling of the brain is a concern with some regional methods including surface, epidural and intranasal cooling.…”

Section: Antipyreticsmentioning

confidence: 99%

Targeted temperature management in neurocritical care: Boon or bust

Bindra

Gupta

2016

Journal of Neuroanaesthesiology and Critical Care

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Temperature management in neurocritical care is important and has gained due importance in recent years. Targeted temperature management (TTM) includes deliberate reduction of core body temperature to a range of 32–34°C in comatose survivors of cardiac arrest after return of spontaneous circulation and also therapeutic hypothermia (33–35°C) in normothermic patients or controlled normothermia (cooling patients to 37°C) in hyperthermic patients. This review focuses on the practical aspects of cooling and temperature management in neurocritical care. An electronic search of Google Scholar, MEDLINE (OVID), EMBASE and the Cochrane library was performed. The physiological changes, potential side effects along with significant research and clinical applications in the field of temperature management are main highlights. Currently, the research evidence is available for TTM in adults following cardiac arrest, neonatal hypoxic ischaemic encephalopathy and raised intracranial pressure. Controlled normothermia in neurocritical care population is rapidly gaining popularity. However, data on disease specific therapeutic markers, therapeutic depth and duration and prognostication of this modality are limited. Overall in experienced hands, the technique is safe to execute without the major morbidity and a potential to improve the outcome. Though over the years, clinical applications are unable to consistently demonstrate its benefits, but TTM in neurological insult has become an established and promising concept.

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Selective therapeutic hypothermia: A review of invasive and noninvasive techniques

Cited by 18 publications

References 42 publications

Monitoring brain temperature by time-resolved near-infrared spectroscopy: pilot study

Monitoring brain temperature by time-resolved near-infrared spectroscopy: pilot study

Selective Brain Cooling after Traumatic Brain Injury: Effects of Three Different Cooling Methods—Case Report

Targeted temperature management in neurocritical care: Boon or bust

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