Influence of intranasal and carotid cooling on cerebral temperature balance and oxygenation

Nybo, Lars; Wanscher, Michael; Secher, Niels H.

doi:10.3389/fphys.2014.00079

Cited by 17 publications

(17 citation statements)

References 31 publications

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“…However, Springbord et al, (432) later found that the cerebral cooling from intranasal cold balloon insertion parallels reductions in esophageal temperature, and therefore, does not provide a functional means for SBC. These findings are corroborated by a recent study from Nybo and colleagues (333).…”

Section: Can the Brain Selectively Cool?supporting

confidence: 93%

Cerebral Vascular Control and Metabolism in Heat Stress

Bain

Nybo

Ainslie

2015

Comprehensive Physiology

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This review provides an in-depth update on the impact of heat stress on cerebrovascular functioning. The regulation of cerebral temperature, blood flow, and metabolism are discussed. We further provide an overview of vascular permeability, the neurocognitive changes, and the key clinical implications and pathologies known to confound cerebral functioning during hyperthermia. A reduction in cerebral blood flow (CBF), derived primarily from a respiratory-induced alkalosis, underscores the cerebrovascular changes to hyperthermia. Arterial pressures may also become compromised because of reduced peripheral resistance secondary to skin vasodilatation. Therefore, when hyperthermia is combined with conditions that increase cardiovascular strain, for example, orthostasis or dehydration, the inability to preserve cerebral perfusion pressure further reduces CBF. A reduced cerebral perfusion pressure is in turn the primary mechanism for impaired tolerance to orthostatic challenges. Any reduction in CBF attenuates the brain's convective heat loss, while the hyperthermic-induced increase in metabolic rate increases the cerebral heat gain. This paradoxical uncoupling of CBF to metabolism increases brain temperature, and potentiates a condition whereby cerebral oxygenation may be compromised. With levels of experimentally viable passive hyperthermia (up to 39.5-40.0 °C core temperature), the associated reduction in CBF (∼ 30%) and increase in cerebral metabolic demand (∼ 10%) is likely compensated by increases in cerebral oxygen extraction. However, severe increases in whole-body and brain temperature may increase blood-brain barrier permeability, potentially leading to cerebral vasogenic edema. The cerebrovascular challenges associated with hyperthermia are of paramount importance for populations with compromised thermoregulatory control--for example, spinal cord injury, elderly, and those with preexisting cardiovascular diseases.

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Section: Can the Brain Selectively Cool?supporting

confidence: 93%

Cerebral Vascular Control and Metabolism in Heat Stress

Bain

Nybo

Ainslie

2015

Comprehensive Physiology

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“…Similarly, heat stress during exercise reduces cerebral blood flow and oxygenation which is suggested to alter central motor output (Nybo et al, 2002a ). Attempts to selectively cool the brain remain relatively unsuccessful (e.g., Nybo et al, 2014 ), and it appears as though global lowering of body temperature is required, as arterial blood will gradually lower brain temperature (Nybo et al, 2002b ). CWI increases mean arterial pressure and cardiac output, which should result in an increase in cerebral oxygenation (Vaile et al, 2008a ).…”

Section: Temperature Regulationmentioning

confidence: 99%

Is it time to turn our attention toward central mechanisms for post-exertional recovery strategies and performance?

et al. 2015

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Key Points Central fatigue is accepted as a contributor to overall athletic performance, yet little research directly investigates post-exercise recovery strategies targeting the brainCurrent post-exercise recovery strategies likely impact on the brain through a range of mechanisms, but improvements to these strategies is neededResearch is required to optimize post-exercise recovery with a focus on the brainPost-exercise recovery has largely focused on peripheral mechanisms of fatigue, but there is growing acceptance that fatigue is also contributed to through central mechanisms which demands that attention should be paid to optimizing recovery of the brain. In this narrative review we assemble evidence for the role that many currently utilized recovery strategies may have on the brain, as well as potential mechanisms for their action. The review provides discussion of how common nutritional strategies as well as physical modalities and methods to reduce mental fatigue are likely to interact with the brain, and offer an opportunity for subsequent improved performance. We aim to highlight the fact that many recovery strategies have been designed with the periphery in mind, and that refinement of current methods are likely to provide improvements in minimizing brain fatigue. Whilst we offer a number of recommendations, it is evident that there are many opportunities for improving the research, and practical guidelines in this area.

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“…Wang et al reported a mean brain-core temperature difference of À 1.6°C using a cooling helmet. Several other methods of SBC have been used in humans such as cooling by a nasopharyngeal balloon perfused by cold saline in patients after cardiac arrest 9,10 or by an intracarotid cooling device or cold fluid infusion. 9,11 One clinical trial investigated cooling by subdural infusion of cold fluid via a surgically placed catheter in patients with severe TBI.…”

Section: Introductionmentioning

confidence: 99%

“…Several other methods of SBC have been used in humans such as cooling by a nasopharyngeal balloon perfused by cold saline in patients after cardiac arrest 9,10 or by an intracarotid cooling device or cold fluid infusion. 9,11 One clinical trial investigated cooling by subdural infusion of cold fluid via a surgically placed catheter in patients with severe TBI. 12 This article reports the effects of three different methods of SBC, introducing a method of cooling by epidural irrigation with cold fluid via surgical drains after decompressive hemicraniectomy following severe TBI.…”

Section: Introductionmentioning

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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Influence of intranasal and carotid cooling on cerebral temperature balance and oxygenation

Cited by 17 publications

References 31 publications

Cerebral Vascular Control and Metabolism in Heat Stress

Cerebral Vascular Control and Metabolism in Heat Stress

Is it time to turn our attention toward central mechanisms for post-exertional recovery strategies and performance?

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

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