Intranasal Perfluorochemical Spray for Preferential Brain Cooling in Sheep

Wolfson, Marla R.; Malone, Debra L.; Wu, Jichuan; Hoffman, J. K.; Rozenberg, A. Ya.; Shaffer, Thomas H.; Barbut, Denise

doi:10.1007/s12028-008-9064-0

Cited by 30 publications

(17 citation statements)

References 68 publications

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“…This technique has been used in sheep and porcine models of hypothermia and was more rapid than surface cooling at achieving brain cooling in the former and more rapid than intravenous cold saline infusion in the latter. 14,15 In the sheep study, surface cooling was unable to achieve the target T b within 2 hours but with nasal cooling therapeutic T b was achieved within 15 minutes. 15 A limitation of these sheep and porcine experiments is they do not perfectly model human physiology and anatomy due to the presence of a rete and a larger nose-to-brain volume; therefore, human testing is essential in conclusively proving cooling efficacy.…”

Section: Discussionmentioning

confidence: 97%

“…14,15 In the sheep study, surface cooling was unable to achieve the target T b within 2 hours but with nasal cooling therapeutic T b was achieved within 15 minutes. 15 A limitation of these sheep and porcine experiments is they do not perfectly model human physiology and anatomy due to the presence of a rete and a larger nose-to-brain volume; therefore, human testing is essential in conclusively proving cooling efficacy. In this current safety study, intranasal cooling with the RCD was both safe and feasible.…”

Section: Discussionmentioning

confidence: 97%

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Local Brain Temperature Reduction Through Intranasal Cooling With the RhinoChill Device

Aböu-Chebl

Sung

Barbut

et al. 2011

Stroke

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Background and Purpose-Hypothermia is neuroprotectant but currently available cooling methods are laborious, invasive, and require whole-body cooling. There is a need for less invasive cooling of the brain. This study was conducted to assess the safety and efficacy of temperature reduction of the RhinoChill transnasal cooling device. Methods-We conducted a prospective single-arm safety and feasibility study of intubated patients for whom temperature reduction was indicated. After rhinoscopy, the device was activated for 1 hour. Brain, tympanic, and core temperatures along with vital signs and laboratory studies were recorded. All general and device-related adverse events were collected for the entire hypothermia treatment. Results-A total of 15 patients (mean age, 50.3Ϯ17.1 years) were enrolled. Brain injury was caused by intracerebral hemorrhage, trauma, and ischemic stroke in equal numbers. Hypothermia was induced for fever control in 9 patients and for neuroprotection/intracranial pressure control in 6. Core temperature, brain temperature, and tympanic temperature were reduced an average of 1.1Ϯ0.6°C (range, 0.3 to 2.1°C), 1.4Ϯ0.4°C (range, 0.8 to 5.1°C), and 2.2Ϯ2°C (range, 0.5 to 6.5°C), respectively. Only 2 patients did not achieve the goal of Ն1°C decrease in temperature. Brain temperature , tympanic temperature , and core temperature reductions were similar between the afebrile and febrile patients. There were no unanticipated adverse events and only 1 anticipated adverse event: hypertension in 1 subject that led to discontinuation of cooling after 30 minutes. There were no nasal complications. Conclusions-Intranasal cooling with the RhinoChill device appears safe and effectively lowers brain and core temperatures. Further study is warranted to assess the efficacy of hypothermia through intranasal cooling for brain-injured patients. (Stroke. 2011;42:2164-2169.)

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Local Brain Temperature Reduction Through Intranasal Cooling With the RhinoChill Device

Aböu-Chebl

Sung

Barbut

et al. 2011

Stroke

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“…In a sheep trial, the RhinoChill device was compared with wholebody surface cooling. 44 In that study, brain cooling was significantly faster with the RhinoChill device than with systemic hypothermia. Furthermore, brain-to-systemic temperature gradients were maintained, and the brain therapeutic hypothermia zone (defined as ≤ 3.5°C below baseline) was reached within 15 minutes.…”

Section: Intranasal Sbcmentioning

confidence: 84%

“…41 Based on the limited studies available, the intranasal method can be used to reach the target hypothermic zone in less time than the helmet (15 minutes vs 3.4 hours). 41,44 Potential concerns regarding the uneven distribution of cooling of various brain regions have been reported in association with some regional methods, including surface, epidural, and intranasal cooling.…”

Section: Discussionmentioning

confidence: 99%

A review of selective hypothermia in the management of traumatic brain injury

Christian¹,

Zada²,

Sung

et al. 2008

FOC

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Object Traumatic brain injury (TBI) remains a significant cause of morbidity and death in the US and worldwide. Resuscitative systemic hypothermia following TBI has been established as an effective neuroprotective treatment in multiple studies in animals and humans, although this intervention carries with it a significant risk profile as well. Selective, or preferential, methods of inducing cerebral hypothermia have taken precedence over the past few years in order to minimize systemic adverse effects. In this report, the authors explore the current methods available for inducing selective cerebral hypothermia following TBI and review the literature regarding the results of animal and human trials in which these methods have been implemented. Methods A search of the PubMed archive (National Library of Medicine) and the reference lists of all relevant articles was conducted to identify all animal and human studies pertaining to the use of selective brain cooling, selective hypothermia, preferential hypothermia, or regional hypothermia following TBI. Results Multiple methods of inducing selective cerebral hypothermia are currently in the experimental phases, including surface cooling, intranasal selective hypothermia, transarterial or transvenous endovascular cooling, extraluminal vascular cooling, and epidural cerebral cooling. Conclusions Several methods of conferring preferential neuroprotection via selective hypothermia currently are being tested. Class I prospective clinical trials are required to assess the safety and efficacy of these methods.

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“…[Wolfson et al 2008;Jordan and Carhuapoma, 2007]. Each system has its advantages and disadvantages [see review by Jordan and Carhuapoma, 2007].…”

Section: Implications For Current and Future Uses Of Hypothermia In Cmentioning

confidence: 99%

Review: Therapeutic applications of hypothermia in cerebral ischaemia

Meloni

Mastaglia

Knuckey

2008

Ther Adv Neurol Disord

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There is considerable experimental evidence that hypothermia is neuroprotective and can reduce the severity of brain damage after global or focal cerebral ischaemia. However, despite successful clinical trials for cardiac arrest and perinatal hypoxia-ischaemia and a number of trials demonstrating the safety of moderate and mild hypothermia in stroke, there are still no established guidelines for its use clinically. Based upon a review of the experimental studies we discuss the clinical implications for the use of hypothermia as an adjunctive therapy in global cerebral ischaemia and stroke and make some suggestions for its use in these situations.

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Intranasal Perfluorochemical Spray for Preferential Brain Cooling in Sheep

Abstract: The NP-PFC procedure more rapidly induced preferential brain cooling as compared to WBC without adverse effects.

Cited by 30 publications

References 68 publications

Local Brain Temperature Reduction Through Intranasal Cooling With the RhinoChill Device

Local Brain Temperature Reduction Through Intranasal Cooling With the RhinoChill Device

A review of selective hypothermia in the management of traumatic brain injury

Review: Therapeutic applications of hypothermia in cerebral ischaemia

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