Advertisement

Neurocritical Care

, Volume 18, Issue 3, pp 400–405 | Cite as

First Clinical Experience with Intranasal Cooling for Hyperthermia in Brain-Injured Patients

  • Jacob Bertram Springborg
  • Karoline Kanstrup Springborg
  • Bertil Romner
Take Notice Technology

Abstract

Introduction

Hyperthermia is common in brain-injured patients and associated with a worse outcome. As brain rather than body temperature reduction, theoretically, is the most important in cerebral protection, there is logic in targeting cooling at the brain. Selective brain cooling can, in theory, be obtained by cooling the skull or by heat loss from the upper airways. In this preliminary safety and efficacy study, we report clinical data from brain-injured patients who because of hyperthermia were treated with intranasal cooling.

Methods

Nine intubated brain-injured patients with hyperthermia were treated using a prototype intranasal balloon system perfused with cold saline. Temperature in the cerebrum, esophagus, and bladder was monitored together with intracranial pressure.

Results

In only two of nine patients, normothermia was reached in the esophagus and in only four of nine patients it was reached in the bladder. When normothermia was reached, the time to normothermia was delayed. In the brain, normothermia was reached in two of five patients after approximately 72 h. Median temperature curves from the first 72 h of cooling showed that normothermia was not reached in any of the three compartments. The temperature in the brain and bladder were on average 0.6 and 0.5 °C higher than in the esophagus. ICP increased with increasing brain temperature. We found no signs of clinical important injury to the nasal mucosa from the cold saline or pressure in the balloons.

Conclusion

In brain-injured patients with hyperthermia, cooling with a prototype intranasal balloon system was clinically inadequate as the effect was delayed and not brain selective.

Keywords

Brain cooling Brain injury Hyperthermia Neurointensive care Temperature 

Notes

Acknowledgments

Quickcool AB provided the cooling device and the esophagus and cerebral temperature probes. The company also afforded technical assistance and funding for a research nurse.

References

  1. 1.
    Albrecht RF, Wass CT, Lanier WL. Occurrence of potentially detrimental temperature alterations in hospitalized patients at risk for brain injury. Mayo Clin Proc. 1998;73:629–35.PubMedCrossRefGoogle Scholar
  2. 2.
    Kilpatrick MM, Lowry DW, Firlik AD, Yonas H, Marion DW. Hyperthermia in the neurosurgical intensive care unit. Neurosurgery. 2000;47:850–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Georgilis K, Plomaritoglou A, Dafni U, Bassiakos Y, Vemmos K. Aetiology of fever in patients with acute stroke. J Intern Med. 1999;246:203–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Cairns CJ, Andrews PJ. Management of hyperthermia in traumatic brain injury. Curr Opin Crit Care. 2002;8:106–10.PubMedCrossRefGoogle Scholar
  5. 5.
    Diringer MN, Reaven NL, Funk SE, Uman GC. Elevated body temperature independently contributes to increased length of stay in neurologic intensive care unit patients. Crit Care Med. 2004;32:1489–95.PubMedCrossRefGoogle Scholar
  6. 6.
    Li J, Jiang JY. Chinese Head Trauma Data Bank: effect of hyperthermia on the outcome of acute head trauma patients. J Neurotrauma. 2012;29:96–100.PubMedCrossRefGoogle Scholar
  7. 7.
    Grande PO, Reinstrup P, Romner B. Active cooling in traumatic brain-injured patients: a questionable therapy? Acta Anaesthesiol Scand. 2009;53:1233–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Polderman KH. Induced hypothermia and fever control for prevention and treatment of neurological injuries. Lancet. 2008;371:1955–69.PubMedCrossRefGoogle Scholar
  9. 9.
    Arrich J, Holzer M, Herkner H, Mullner M. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database Syst Rev. 2009;4:CD004128.PubMedGoogle Scholar
  10. 10.
    Jacobs S, Hunt R, Tarnow-Mordi W, Inder T, Davis P. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2007;4:CD003311.PubMedGoogle Scholar
  11. 11.
    Badjatia N. Hyperthermia and fever control in brain injury. Crit Care Med. 2009;37:S250–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Harris BA, Andrews PJ, Murray GD. Enhanced upper respiratory tract airflow and head fanning reduce brain temperature in brain-injured, mechanically ventilated patients: a randomized, crossover, factorial trial. Br J Anaesth. 2007;98:93–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Andrews PJ, Harris B, Murray GD. Randomized controlled trial of effects of the airflow through the upper respiratory tract of intubated brain-injured patients on brain temperature and selective brain cooling. Br J Anaesth. 2005;94:330–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Koehn J, Kollmar R, Cimpianu CL, et al. Head and neck cooling decreases tympanic and skin temperature, but significantly increases blood pressure. Stroke. 2012;43:2142–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Covaciu L, Allers M, Lunderquist A, Rubertsson S. Intranasal cooling with or without intravenous cold fluids during and after cardiac arrest in pigs. Acta Anaesthesiol Scand. 2010;54:494–501.PubMedCrossRefGoogle Scholar
  16. 16.
    Covaciu L, Allers M, Enblad P, Lunderquist A, Wieloch T, Rubertsson S. Intranasal selective brain cooling in pigs. Resuscitation. 2008;76:83–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Harris B, Andrews P. Intranasal selective brain cooling in pigs. Resuscitation. 2008;78:102–3.PubMedCrossRefGoogle Scholar
  18. 18.
    Einer-Jensen N, Khorooshi MH. Cooling of the brain through oxygen flushing of the nasal cavities in intubated rats: an alternative model for treatment of brain injury. Exp Brain Res. 2000;130:244–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Covaciu L, Weis J, Bengtsson C, et al. Brain temperature in volunteers subjected to intranasal cooling. Intensive Care Med. 2011;37:1277–84.PubMedCrossRefGoogle Scholar
  20. 20.
    Abou-Chebl A, Sung G, Barbut D, Torbey M. Local brain temperature reduction through intranasal cooling with the RhinoChill device: preliminary safety data in brain-injured patients. Stroke. 2011;42:2164–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.PubMedCrossRefGoogle Scholar
  22. 22.
    Mcilvoy L. Comparison of brain temperature to core temperature: a review of the literature. J Neurosci Nurs. 2004;36(1):23–31.PubMedCrossRefGoogle Scholar
  23. 23.
    Schwab S, Spranger M, Aschoff A, Steiner T, Hacke W. Brain temperature monitoring and modulation in patients with severe MCA infarction. Neurology. 1997;48:762–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jacob Bertram Springborg
    • 1
  • Karoline Kanstrup Springborg
    • 2
  • Bertil Romner
    • 1
  1. 1.University Clinic of NeurosurgeryCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
  2. 2.University Clinic of Oto-Rhino-Laryngology, Head and Neck SurgeryCopenhagen University Hospital, RigshospitaletCopenhagenDenmark

Personalised recommendations