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Ianosi B, Rass V, Gaasch M, Huber L, Lindner A, Hackl WO, Kofler M, Schiefecker AJ, Almashad S, Beer R, Pfausler B, Helbok R. An Observational Study on the Use of Intravenous Non-Opioid Analgesics and Antipyretics in Poor-Grade Subarachnoid Hemorrhage: Effects on Hemodynamics and Systemic and Brain Temperature. Ther Hypothermia Temp Manag 2020; 10:27-36. [DOI: 10.1089/ther.2018.0046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Bogdan Ianosi
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Medical Informatics, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall, Austria
| | - Verena Rass
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Max Gaasch
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lukas Huber
- Institute of Medical Informatics, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall, Austria
| | - Anna Lindner
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner O. Hackl
- Institute of Medical Informatics, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall, Austria
| | - Mario Kofler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alois Josef Schiefecker
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Salma Almashad
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ronny Beer
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Pfausler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Walsh JJ, Huang Y, Simmons JW, Goodrich JA, McHugh B, Rothman DL, Elefteriades JA, Hyder F, Coman D. Dynamic Thermal Mapping of Localized Therapeutic Hypothermia in the Brain. J Neurotrauma 2019; 37:55-65. [PMID: 31311414 DOI: 10.1089/neu.2019.6485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Although whole body cooling is used widely to provide therapeutic hypothermia for the brain, there are undesirable clinical side effects. Selective brain cooling may allow for rapid and controllable neuroprotection while mitigating these undesirable side effects. We evaluated an innovative cerebrospinal fluid (CSF) cooling platform that utilizes chilled saline pumped through surgically implanted intraventricular catheters to induce hypothermia. Magnetic resonance thermal imaging of the healthy sheep brain (n = 4) at 7.0T provided dynamic temperature measurements from the whole brain. Global brain temperature was 38.5 ± 0.8°C at baseline (body temperature of 39.2 ± 0.4°C), and decreased by 3.1 ± 0.3°C over ∼30 min of cooling (p < 0.0001). Significant cooling was achieved in all defined regions across both the ipsilateral and contralateral hemispheres relative to catheter placement. On cooling cessation, global brain temperature increased by 3.1 ± 0.2°C over ∼20 min (p < 0.0001). Rapid and synchronized temperature fall/rise on cooling onset/offset was observed reproducibly with rates ranging from 0.06-0.21°C/min, where rewarming was faster than cooling (p < 0.0001) signifying the importance of thermoregulation in the brain. Although core regions (including the subcortex, midbrain, olfactory tract, temporal lobe, occipital lobe, and parahippocampal cortex) had slightly warmer (∼0.2°C) baseline temperatures, after cooling, temperatures reached the same level as the non-core regions (35.6 ± 0.2°C), indicating the cooling effectiveness of the CSF-based cooling device. In summary, CSF-based intraventricular cooling reliably reduces temperature in all identified brain regions to levels known to be neuroprotective, while maintaining overall systemic normothermia. Dynamic thermal mapping provides high spatiotemporal temperature measurements that can aid in optimizing selective neuroprotective protocols.
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Affiliation(s)
- John J Walsh
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Yuegao Huang
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | | | - James A Goodrich
- Department of Comparative Medicine, Yale University, New Haven, Connecticut
| | - Brian McHugh
- Department of Neurosurgery, Yale University, New Haven, Connecticut.,Inova Medical Group Neurosurgery, Fairfax, Virginia
| | - Douglas L Rothman
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut.,Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | | | - Fahmeed Hyder
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut.,Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Daniel Coman
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
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