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Brain temperature in healthy volunteers subjected to intranasal cooling
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. (Sten Rubertsson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Division of thoracic sciences, Department of clinical sciences, Lund University.
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2011 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 37, no 8, 1277-1284 p.Article in journal (Other academic) Published
Abstract [en]

Purpose:

Intranasal cooling can be used to initiate therapeutic hypothermia. However, direct measurement of brain temperature is difficult and the intra-cerebral distribution of temperature changes with cooling is unknown. The purpose of this study was to measure the brain temperature of human volunteers subjected to intranasal cooling using non-invasive magnetic resonance (MR) methods.

Methods:

Intranasal balloons catheters circulated with saline at 20 °C were applied for 60 min in 10 healthy, unsedated volunteers. Brain temperature changes were measured and mapped using MR spectroscopic imaging (MRSI) and phase-mapping techniques. Heart rate and blood pressure were monitored throughout the experiment. Rectal temperature was measured before and after the cooling. Mini Mental State Examination (MMSE) test and nasal inspection were done before and after the cooling. Questionnaires about the subjects personal experience were filled after the experiment.

Results:

Brain temperature decrease measured by MRSI was -1.7 ± 0.8°C and by phase-mapping -1.8 ± 0.9°C at the end of cooling. Spatial distribution of temperature changes was relatively uniform. Rectal temperature decreased by -0.5 ± 0.3°C. The physiological parameters were stable and no shivering was reported. The volunteers remained alert during cooling and no cognitive dysfunctions were apparent at MMSE test. Postcooling nasal examination detected increased nasal secretion in 9 of the 10 volunteers. Volunteer’s acceptance of the method was good.   

Conclusion:

Both MR techniques revealed brain temperature reductions after 60 min intranasal cooling with balloons circulated with saline at 20 °C in healthy and unsedated volunteers.

Place, publisher, year, edition, pages
2011. Vol. 37, no 8, 1277-1284 p.
Keyword [en]
Therapeutic hypothermia, Brain temperature, Magnetic resonance spectroscopy, selective brain cooling, trigeminal reflex
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-134228DOI: 10.1007/s00134-011-2264-7PubMedID: 21647717OAI: oai:DiVA.org:uu-134228DiVA: diva2:372057
Available from: 2010-11-23 Created: 2010-11-23 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Intranasal Cooling for Cerebral Hypothermia Treatment
Open this publication in new window or tab >>Intranasal Cooling for Cerebral Hypothermia Treatment
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The controlled lowering of core body temperature to 32°C to 34°C is defined as therapeutic hypothermia (TH). Therapeutic hypothermia has been shown to improve neurological outcome and survival in unconscious patients successfully resuscitated after cardiac arrest. Brain temperature is important for cerebral protection therefore methods for primarily cooling the brain have also been explored.

This thesis focuses on the likelihood that intranasal cooling can induce, maintain and control cerebral hypothermia. The method uses bilaterally introduced intranasal balloons circulated with cold saline.

Selective brain cooling induced with this method was effectively accomplished in pigs with normal circulation while no major disturbances in systemic circulation or physiological variables were recorded. The temperature gradients between brain and body could be maintained for at least six hours.

Intranasal balloon catheters were used for therapeutic hypothermia initiation and maintenance during and after successful resuscitation in pigs. Temperature reduction was also obtained by combined intranasal cooling and intravenous ice-cold fluids with possible additional benefits in terms of physiologic stability after cardiac arrest. Rewarming was possible via the intranasal balloons.

In these studies brain temperature was recorded invasively by temperature probes inserted in the brain. The fast changes in pig’s brain temperature could also be tracked by a non-invasive method. High-spatial resolution magnetic resonance spectroscopic imaging (MRSI) without internal reference showed a good association with direct invasive temperature monitoring. In addition the mapping of temperature changes during brain cooling was also possible.

In awake and unsedated volunteers subjected to intranasal cooling brain temperature changes were followed by two MR techniques. Brain cooling was shown by the previously calibrated high-spatial resolution MRSI and by the phase-mapping method. Intranasal cooling reduced body temperature slightly. The volunteers remained alert during cooling, the physiological parameters stable, and no shivering was reported.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Uppsaliensis, 2010. 58 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 627
Keyword
Selective brain cooling, cerebral hypothermia, therapeutic hypothermia, cardiac arrest, stroke, traumatic brain injury, brain temperature, magnetic resonance spectroscopy, trigeminal reflex
National Category
Anesthesiology and Intensive Care Radiology, Nuclear Medicine and Medical Imaging
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-134278 (URN)978-91-554-7959-6 (ISBN)
Public defence
2011-01-14, Rosénsalen, Akademiska Sjukhuset, Uppsala, 13:00 (English)
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Supervisors
Available from: 2010-12-21 Created: 2010-11-23 Last updated: 2011-01-13Bibliographically approved

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Covaciu, LucianWeis, JanBengtsson, CarolineAhlström, HåkanRubertsson, Sten

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