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Mertin V, Most P, Busch M, Trojan S, Tapking C, Haug V, Kneser U, Hundeshagen G. Current understanding of thermo(dys)regulation in severe burn injury and the pathophysiological influence of hypermetabolism, adrenergic stress and hypothalamic regulation—a systematic review. BURNS & TRAUMA 2022; 10:tkac031. [PMID: 36168403 PMCID: PMC9501704 DOI: 10.1093/burnst/tkac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/08/2022] [Indexed: 11/25/2022]
Abstract
Background In this systematic review, we summarize the aetiology as well as the current knowledge regarding thermo(dys)regulation and hypothermia after severe burn trauma and aim to present key concepts of pathophysiology and treatment options. Severe burn injuries with >20% total body surface area (TBSA) affected commonly leave the patient requiring several surgical procedures, prolonged hospital stays and cause substantial changes to body composition and metabolism in the acute and long-term phase. Particularly in severely burned patients, the loss of intact skin and the dysregulation of peripheral and central thermoregulatory processes may lead to substantial complications. Methods A systematic and protocol-based search for suitable publications was conducted following the PRISMA guidelines. Articles were screened and included if deemed eligible. This encompasses animal-based in vivo studies as well as clinical studies examining the control-loops of thermoregulation and metabolic stability within burn patients Results Both experimental animal studies and clinical studies examining thermoregulation and metabolic functions within burn patients have produced a general understanding of core concepts which are, nonetheless, lacking in detail. We describe the wide range of pathophysiological alterations observed after severe burn trauma and highlight the association between thermoregulation and hypermetabolism as well as the interactions between nearly all organ systems. Lastly, the current clinical standards of mitigating the negative effects of thermodysregulation and hypothermia are summarized, as a comprehensive understanding and implementation of the key concepts is critical for patient survival and long-term well-being. Conclusions The available in vivo animal models have provided many insights into the interwoven pathophysiology of severe burn injury, especially concerning thermoregulation. We offer an outlook on concepts of altered central thermoregulation from non-burn research as potential areas of future research interest and aim to provide an overview of the clinical implications of temperature management in burn patients.
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Affiliation(s)
- Viktoria Mertin
- University of Heidelberg Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, , 67071 Ludwigshafen am Rhein, Germany
| | - Patrick Most
- Department of Internal Medicine III University Hospital Heidelberg Division of Molecular and Translational Cardiology, , 69120 Heidelberg, Germany
- Deutsches Zentrum für Herz- und Kreislaufforschung (GCCR) , Partner site Heidelberg/Mannheim, Germany
| | - Martin Busch
- Department of Internal Medicine III University Hospital Heidelberg Division of Molecular and Translational Cardiology, , 69120 Heidelberg, Germany
- Deutsches Zentrum für Herz- und Kreislaufforschung (GCCR) , Partner site Heidelberg/Mannheim, Germany
| | - Stefan Trojan
- University of Witten/Herdecke Department of Anesthesiology and Intensive Care Medicine, Merheim Medical Center, Hospitals of Cologne, , 51109 Cologne, Germany
| | - Christian Tapking
- University of Heidelberg Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, , 67071 Ludwigshafen am Rhein, Germany
| | - Valentin Haug
- University of Heidelberg Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, , 67071 Ludwigshafen am Rhein, Germany
| | - Ulrich Kneser
- University of Heidelberg Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, , 67071 Ludwigshafen am Rhein, Germany
| | - Gabriel Hundeshagen
- University of Heidelberg Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, , 67071 Ludwigshafen am Rhein, Germany
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Smith T, Couillard P, McBeth P, Hruska P, Kortbeek J. Esophageal Cooling for Hypoxic Ischemic Encephalopathy: A Feasibility Study. Ther Hypothermia Temp Manag 2020; 11:179-184. [PMID: 33370218 DOI: 10.1089/ther.2020.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Targeted temperature management (TTM) is a recognized treatment to decrease mortality and improve neurological function in hypoxic ischemic encephalopathy. An esophageal cooling device (ECD) has been studied in animal models, but human data are limited. An ECD appears to offer similar benefits to intravascular cooling catheters, with potentially less risk to the patient. We studied whether the ECD could act as a substitute for intravascular cooling catheters in delivering adequate TTM after cardiac arrest. Nine patients admitted to the intensive care unit after cardiac arrest who required TTM were enrolled prospectively. The primary outcome measures were timeliness of insertion, ease of insertion, user Likert ratings, time to achieve a target temperature of 36°C, and time during which target temperature was maintained within 1°C of the 36°C goal for 24 hours by using an ECD. Time to reach target temperature was 0 to 540 minutes (mean: 113.33 minutes, median: 0 minute, standard deviation [SD]: 179.22). Maintenance of a target temperature of 36°C over 24 hours had a range of 58.33% to 100% (mean: 91.67%, median: 95.83%, SD: 13.34). Ease of insertion related to Likert ratings with a range of 1-9 (mean: 5.38, median: 5.5, SD: 3.43) and a simplicity of ECD uses a range of 4-10 (mean: 7.63, median: 8.0, SD: 1.65). Overall, there was preference for the ECD over intravascular cooling methods (mean: 6.71, mean: 6, SD: 3.01) and external cooling methods (mean: 8.0, median: 9.0, SD: 2.33). For patients requiring TTM, use of an ECD adequately allowed for TTM goals to be achieved and maintained. Overall, user evaluation was positive.
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Affiliation(s)
- Thane Smith
- Department of Family Medicine, Northern Ontario School of Medicine, Timmins and District Hospital, Timmins, Canada
| | - Philippe Couillard
- Department of Critical Care Medicine and Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Paul McBeth
- Department of Critical Care Medicine, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Pam Hruska
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - John Kortbeek
- Department of Critical Care Medicine, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
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3
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Assis FR, Ambadipudi S, Bhambhani H, Shah R, Daimee UA, Tandri H. Effects of High-Flow Transesophageal Dry Air on Core Temperature: A Novel Method of Therapeutic Hypothermia. Ther Hypothermia Temp Manag 2020; 11:88-95. [PMID: 32326838 DOI: 10.1089/ther.2019.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Therapeutic hypothermia (TH) is one of the few proven neuroprotective modalities in clinical practice. However, current methods to achieve TH are suboptimal. We investigated a novel esophageal device that utilizes high-flow transesophageal dry air to achieve TH via evaporating cooling. Seven Yorkshire pigs (n = 7) underwent hypothermia therapy using a novel esophageal device that compartmentalizes a segment of esophagus through which high-flow dry air freely circulates in and out of the esophagus. Efficacy (primary objective) and safety (secondary objective) were evaluated in all animals. Safety assessment was divided into two sequential phases: (1) acute safety assessment (n = 5; terminal studies) to evaluate adverse events occurring during therapy, and (2) chronic safety assessment (n = 2; survival studies) to evaluate adverse events associated with therapy within 1 week of follow-up. After 1 hour of esophageal cooling (mean airflow rate = 64.2 ± 3.5 L/min), a significant reduction in rectal temperature was observed (37.3 ± 0.2°C → 36.3 ± 0.4°C, p = 0.002). The mean rectal temperature reduction was 1 ± 0.4°C. In none of the seven animals was oral or pharyngeal mucosa injury identified at postprocedural visual examination. In the two animals that survived, no reduction of food ingestion, signs of swallowing dysfunction or discomfort, or evidence of gastrointestinal bleeding was observed during the 1-week follow-up period. Open-chest visual inspection in those two animals did not show damage to the esophageal mucosa or surrounding structures. A novel esophageal device, utilizing high-flow transesophageal dry air, was able to efficiently induce hypothermia despite external heating. Therapy was well-tolerated, and no acute or chronic complications were found.
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Affiliation(s)
- Fabrizio R Assis
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sravya Ambadipudi
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hrithika Bhambhani
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rushil Shah
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Usama A Daimee
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Schroeder DC, Maul AC, Guschlbauer M, Finke SR, de la Puente Bethencourt D, Becker I, Padosch SA, Hohn A, Annecke T, Böttiger BW, Sterner-Kock A, Herff H. Intravascular Cooling Device Versus Esophageal Heat Exchanger for Mild Therapeutic Hypothermia in an Experimental Setting. Anesth Analg 2020; 129:1224-1231. [PMID: 30418241 DOI: 10.1213/ane.0000000000003922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Targeted temperature management is a standard therapy for unconscious survivors of cardiac arrest. To date, multiple cooling methods are available including invasive intravascular cooling devices (IVDs), which are widely used in the clinical setting. Recently, esophageal heat exchangers (EHEs) have been developed providing cooling via the esophagus that is located close to the aorta and inferior vena cava. The objective was to compare mean cooling rates, as well as differences, to target temperature during maintenance and the rewarming period of IVD and EHE. METHODS The study was conducted in 16 female domestic pigs. After randomization to either IVD or EHE (n = 8/group), core body temperature was reduced to 33°C. After 24 hours of maintenance (33°C), animals were rewarmed using a target rate of 0.25°C/h for 10 hours. All cooling phases were steered by a closed-loop feedback system between the internal jugular vein and the chiller. After euthanasia, laryngeal and esophageal tissue was harvested for histopathological examination. RESULTS Mean cooling rates (4.0°C/h ± 0.4°C/h for IVD and 2.4°C/h ± 0.3°C/h for EHE; P < .0008) and time to target temperature (85.1 ± 9.2 minutes for IVD and 142.0 ± 21.2 minutes for EHE; P = .0008) were different. Mean difference to target temperature during maintenance (0.07°C ± 0.05°C for IVD and 0.08°C ± 0.10°C for EHE; P = .496) and mean rewarming rates (0.2°C/h ± 0.1°C/h for IVD and 0.3°C/h ± 0.2°C/h for EHE; P = .226) were similar. Relevant laryngeal or esophageal tissue damage could not be detected. There were no significant differences in undesired side effects (eg, bradycardia or tachycardia, hypokalemia or hyperkalemia, hypoglycemia or hyperglycemia, hypotension, overcooling, or shivering). CONCLUSIONS After insertion, target temperatures could be reached faster by IVD compared to EHE. Cooling performance of IVD and EHE did not significantly differ in maintaining target temperature during a targeted temperature management process and in active rewarming protocols according to intensive care unit guidelines in this experimental setting.
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Affiliation(s)
- Daniel C Schroeder
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Alexandra C Maul
- Center for Experimental Medicine, University Hospital of Cologne, Cologne, Germany
| | - Maria Guschlbauer
- Center for Experimental Medicine, University Hospital of Cologne, Cologne, Germany.,Decentral Animal Facility, University Hospital of Cologne, Cologne, Germany
| | - Simon-Richard Finke
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | | | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, University Hospital of Cologne, Cologne, Germany
| | - Stephan A Padosch
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Andreas Hohn
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Thorsten Annecke
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Bernd W Böttiger
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Anja Sterner-Kock
- Center for Experimental Medicine, University Hospital of Cologne, Cologne, Germany
| | - Holger Herff
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
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5
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Xu J, Jin X, Chen Q, Wu C, Li Z, Zhou G, Xu Y, Qian A, Li Y, Zhang M. Faster Hypothermia Induced by Esophageal Cooling Improves Early Markers of Cardiac and Neurological Injury After Cardiac Arrest in Swine. J Am Heart Assoc 2019; 7:e010283. [PMID: 30608213 PMCID: PMC6404192 DOI: 10.1161/jaha.118.010283] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background After cardiopulmonary resuscitation, the protective effects of therapeutic hypothermia induced by conventional cooling are limited. Recently, esophageal cooling (EC) has been shown to be an effective, easily performed approach to induce therapeutic hypothermia. In this study we investigated the efficacy of EC and its effects on early markers of postresuscitation cardiac and neurological injury in a porcine model of cardiac arrest. Methods and Results Thirty‐two male domestic swine were randomized into 4 groups: sham control, normothermia, surface cooling, and EC. Sham animals underwent the surgical preparation only. Ventricular fibrillation was induced and untreated for 8 minutes while defibrillation was attempted after 5 minutes of cardiopulmonary resuscitation. At 5 minutes after resuscitation, therapeutic hypothermia was induced by either EC or surface cooling to reach a target temperature of 33°C until 24 hours postresuscitation, followed by a rewarming rate of 1°C/h for 5 hours. The temperature was normally maintained in the control and normothermia groups. After resuscitation, a significantly faster decrease in blood temperature was observed in the EC group than in the surface cooling group (2.8±0.7°C/h versus 1.5±0.4°C/h; P<0.05). During the maintenance and rewarming phases the temperature was maintained at an even level between the 2 groups. Postresuscitation cardiac and neurological damage was significantly improved in the 2 hypothermic groups compared with the normothermia group; however, the protective effects were significantly greater in the EC group. Conclusions In a porcine model of cardiac arrest, faster hypothermia successfully induced by EC was significantly better than conventional cooling in improving early markers of postresuscitation cardiac and neurological injury.
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Affiliation(s)
- Jiefeng Xu
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China.,3 Department of Emergency Medicine Yuyao People's Hospital Medical School of Ningbo University Ningbo China
| | - Xiaohong Jin
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China.,4 Department of Emergency Medicine The First People's Hospital of Wenling Taizhou China
| | - Qijiang Chen
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China.,5 Department of Intensive Care Medicine The First Hospital of Ninghai Ningbo China
| | - Chunshuang Wu
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China
| | - Zilong Li
- 3 Department of Emergency Medicine Yuyao People's Hospital Medical School of Ningbo University Ningbo China
| | - Guangju Zhou
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China
| | - Yongan Xu
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China
| | - Anyu Qian
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China
| | - Yulin Li
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China
| | - Mao Zhang
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China
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Schroeder DC, Maul AC, Guschlbauer M, Finke SR, de la Puente Bethencourt D, Neumann T, Padosch SA, Annecke T, Böttiger BW, Sterner-Kock A, Herff H. Esophageal Heat Exchanger Versus Water-Circulating Cooling Blanket for Targeted Temperature Management. Ther Hypothermia Temp Manag 2019; 9:251-257. [PMID: 30893023 DOI: 10.1089/ther.2018.0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To date, the optimal cooling device for targeted temperature management (TTM) remains unclear. Water-circulating cooling blankets are broadly available and quickly applied but reveal inaccuracy during maintenance and rewarming period. Recently, esophageal heat exchangers (EHEs) have been shown to be easily inserted, revealed effective cooling rates (0.26-1.12°C/h), acceptable deviations from target core temperature (<0.5°C), and rewarming rates between 0.2 and 0.4°C/h. The aim of this study was to compare cooling rates, accuracy during maintenance, and rewarming period as well as side effects of EHEs with water-circulating cooling blankets in a porcine TTM model. Mean core temperature of domestic pigs (n = 16) weighing 83.2 ± 3.6 kg was decreased to a target core temperature of 33°C by either using EHEs or water-circulating cooling blankets. After 8 hours of maintenance, rewarming was started at a goal rate of 0.25°C/h. Mean cooling rates were 1.3 ± 0.1°C/h (EHE) and 3.2 ± 0.5°C/h (blanket, p < 0.0002). Mean difference to target core temperature during maintenance ranged between ±1°C. Mean rewarming rates were 0.21 ± 0.01°C/h (EHE) and 0.22 ± 0.02°C/h (blanket, n.s.). There were no differences with regard to side effects such as brady- or tachycardia, hypo- or hyperkalemia, hypo- or hyperglycemia, hypotension, shivering, or esophageal tissue damage. Target temperature can be achieved faster by water-circulating cooling blankets. EHEs and water-circulating cooling blankets were demonstrated to be reliable and safe cooling devices in a prolonged porcine TTM model with more variability in EHE group.
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Affiliation(s)
- Daniel C Schroeder
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Alexandra C Maul
- Department of Experimental Medicine, University Hospital of Cologne, Cologne, Germany
| | - Maria Guschlbauer
- Department of Experimental Medicine, University Hospital of Cologne, Cologne, Germany.,Decentral Animal Facility, University Hospital of Cologne, Cologne, Germany
| | - Simon-Richard Finke
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | | | - Tobias Neumann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Stephan A Padosch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Thorsten Annecke
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Anja Sterner-Kock
- Department of Experimental Medicine, University Hospital of Cologne, Cologne, Germany
| | - Holger Herff
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
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7
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Slisz S, Silva R, Kulstad E. Re: "Feasibility of a Miniature Esophageal Heat Exchange Device for Rapid Therapeutic Cooling in Newborns: Preliminary Investigations in a Piglet Model" by Dingley et al. (Ther Hypothermia Temp Manag 2018;8:36-44). Ther Hypothermia Temp Manag 2018; 8:2-3. [PMID: 29431594 DOI: 10.1089/ther.2017.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Rogelio Silva
- 2 Advocate Christ Medical Center , Oak Lawn, Illinois
| | - Erik Kulstad
- 3 Southwestern Medical Center, University of Texas , Dallas, Texas
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8
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Naiman MI, Gray M, Haymore J, Hegazy AF, Markota A, Badjatia N, Kulstad EB. Esophageal Heat Transfer for Patient Temperature Control and Targeted Temperature Management. J Vis Exp 2017:56579. [PMID: 29286452 PMCID: PMC5755452 DOI: 10.3791/56579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Controlling patient temperature is important for a wide variety of clinical conditions. Cooling to normal or below normal body temperature is often performed for neuroprotection after ischemic insult (e.g. hemorrhagic stroke, subarachnoid hemorrhage, cardiac arrest, or other hypoxic injury). Cooling from febrile states treats fever and reduces the negative effects of hyperthermia on injured neurons. Patients are warmed in the operating room to prevent inadvertent perioperative hypothermia, which is known to cause increased blood loss, wound infections, and myocardial injury, while also prolonging recovery time. There are many reported approaches for temperature management, including improvised methods that repurpose standard supplies (e.g., ice, chilled saline, fans, blankets) but more sophisticated technologies designed for temperature management are typically more successful in delivering an optimized protocol. Over the last decade, advanced technologies have developed around two heat transfer methods: surface devices (water blankets, forced-air warmers) or intravascular devices (sterile catheters requiring vascular placement). Recently, a novel device became available that is placed in the esophagus, analogous to a standard orogastric tube, that provides efficient heat transfer through the patient's core. The device connects to existing heat exchange units to allow automatic patient temperature management via a servo mechanism, using patient temperature from standard temperature sensors (rectal, Foley, or other core temperature sensors) as the input variable. This approach eliminates vascular placement complications (deep venous thrombosis, central line associated bloodstream infection), reduces obstruction to patient access, and causes less shivering when compared to surface approaches. Published data have also shown a high degree of accuracy and maintenance of target temperature using the esophageal approach to temperature management. Therefore, the purpose of this method is to provide a low-risk alternative method for controlling patient temperature in critical care settings.
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Affiliation(s)
- Melissa I Naiman
- Center for Advanced Design, Research, and Exploration, University of Illinois at Chicago; Attune Medical
| | | | | | | | | | | | - Erik B Kulstad
- Attune Medical; Department of Emergency Medicine, University of Texas, Southwestern Medical Center;
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9
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Goury A, Poirson F, Chaput U, Voicu S, Garçon P, Beeken T, Malissin I, Kerdjana L, Chelly J, Vodovar D, Oueslati H, Ekherian JM, Marteau P, Vicaut E, Megarbane B, Deye N. Targeted temperature management using the "Esophageal Cooling Device" after cardiac arrest (the COOL study): A feasibility and safety study. Resuscitation 2017; 121:54-61. [PMID: 28951293 DOI: 10.1016/j.resuscitation.2017.09.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/18/2017] [Accepted: 09/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Targeted temperature management (TTM) between 32 and 36°C is recommended after out-of-hospital cardiac arrest (OHCA). We aimed to assess the feasibility and safety of the "Esophageal Cooling Device" (ECD) in performing TTM. PATIENTS AND METHODS This single-centre, prospective, interventional study included 17 comatose OHCA patients. Main exclusion criteria were: delay between OHCA and return of spontaneous circulation (ROSC)>60min, delay between sustained ROSC and inclusion >360min, known oesophageal disease. A TTM between 32 and 34°C was performed using the ECD (Advanced Cooling Therapy, USA) connected to a heat exchanger console (Meditherm III®, Gaymar, France), without cold fluids' use. Primary endpoint was feasibility of inducing, maintaining TTM, and rewarming using the ECD alone. Secondary endpoints were adverse events, focusing on potential digestive damages. Results were expressed as median (interquartiles 25-75). RESULTS Cooling rate to reach the Target Temperature (33°C-TT) was 0.26°C/h [0.19-0.36]. All patients reached the 32-34°C range with a time spent within the range of 26h [21-28] (3 patients did not reach 33°C). Temperature deviation outside the TT during TTM-maintenance was 0.10°C [0.03-0.20]. Time with deviation >1°C was 0h. Rewarming rate was 0.20°C/h [0.18-0.22]. Among the 16 gastrointestinal endoscopy procedures performed, 10 (62.5%) were normal. Minor oeso-gastric injuries (37.5% and 19%, respectively) were similar to usual orogastric tube injuries. One patient experienced severe oesophagitis mimicking peptic lesions, not cooling-related. No patient among the 9 alive at 3-month follow-up had gastrointestinal complains. CONCLUSION ECD seems an interesting, safe, accurate, semi-invasive cooling method in OHCA patients treated with 33°C-TTM, particularly during the maintenance phase.
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Affiliation(s)
- Antoine Goury
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Florent Poirson
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Ulriikka Chaput
- Hépato-gastro-entérologie, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Sebastian Voicu
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Pierre Garçon
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Thomas Beeken
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Isabelle Malissin
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Lamia Kerdjana
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Jonathan Chelly
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France; Clinical Research Unit-Groupe Hospitalier Sud Île de France, 77000 Melun, France
| | - Dominique Vodovar
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Haikel Oueslati
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Jean Michel Ekherian
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Philippe Marteau
- Hépato-gastro-entérologie, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Hôpital Fernand Widal, AP-HP, Paris Cedex 10, France
| | - Bruno Megarbane
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France; INSERM UMRS-1144, Paris, France
| | - Nicolas Deye
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France; INSERM U942, Hôpital Lariboisière, Paris, France.
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Primožič KK, Svenšek F, Markota A, Sinkovič A. Rewarming After Severe Accidental Hypothermia Using the Esophageal Heat Transfer Device: A Case Report. Ther Hypothermia Temp Manag 2017; 8:62-64. [PMID: 28934599 DOI: 10.1089/ther.2017.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Patients with severe accidental hypothermia require active rewarming. External rewarming may not be successful in severe hypothermia, and use of invasive techniques is limited to regional centers and is associated with vascular access site and other complications. We present a patient with severe accidental hypothermia who was successfuly rewarmed using a novel esophageal heat transfer device. A 55-year-old male (175 cm, 71 kg) was admitted with the first recorded temperature 23.3°C. Rewarming using renal replacement therapy circuit was unsuccessful because of severe hypotension. We inserted the esophageal heat transfer device and rewarmed him successfully to target temperature 35-36°C. After rewarming, we maintained his body temperature in the range 35-36°C until accidental removal of the device. We observed no major adverse effects. To conclude, rewarming from severe accidental hypothermia was possible using the esophageal heat transfer device.
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Affiliation(s)
- Katarina Katja Primožič
- 1 Department of Anaesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor , Maribor, Slovenia
| | - Franci Svenšek
- 2 Medical Intensive Care Unit, Intensive Care and Pain Management, University Medical Centre Maribor , Maribor, Slovenia
| | - Andrej Markota
- 2 Medical Intensive Care Unit, Intensive Care and Pain Management, University Medical Centre Maribor , Maribor, Slovenia
| | - Andreja Sinkovič
- 2 Medical Intensive Care Unit, Intensive Care and Pain Management, University Medical Centre Maribor , Maribor, Slovenia
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11
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Tommasi E, Lazzeri C, Bernardo P, Sori A, Chiostri M, Gensini GF, Valente S. Cooling techniques in mild hypothermia after cardiac arrest. J Cardiovasc Med (Hagerstown) 2017; 18:459-466. [DOI: 10.2459/jcm.0000000000000130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Lyden P, Mayer SA, Lurie K, Schmutzhard E. Temperature Management in Neurological and Neurosurgical Intensive Care Unit. Ther Hypothermia Temp Manag 2017; 7:70-74. [PMID: 28586295 DOI: 10.1089/ther.2017.29029.pjl] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Patrick Lyden
- 1 Department of Neurology, Cedars-Sinai Medical Center , Los Angeles, California
| | - Stephan A Mayer
- 2 Department of Neurology, Henry Ford Health System , Detroit, Michigan
| | - Keith Lurie
- 3 Department of Internal and Emergency Medicine, University of Minnesota , Minneapolis, Minnesota.,4 St. Cloud Hospital , St. Cloud, Minnesota
| | - Erich Schmutzhard
- 5 Department of Neurology and Neurocritical Care Unit, Medical University Innsbruck , Innsbruck, Austria
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13
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Hegazy AF, Lapierre DM, Butler R, Martin J, Althenayan E. The esophageal cooling device: A new temperature control tool in the intensivist's arsenal. Heart Lung 2017; 46:143-148. [PMID: 28410771 DOI: 10.1016/j.hrtlng.2017.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 03/04/2017] [Accepted: 03/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Therapeutic hypothermia has been demonstrated to improve neurological outcome in comatose survivors of cardiac arrest. Current temperature control modalities however, have several limitations. Exploring innovative methods of temperature management has become a necessity. METHODS We describe the first use of a novel esophageal cooling device as a sole modality for hypothermia induction, maintenance and rewarming in a series of four postcardiac arrest patients. The device was inserted in a manner similar to standard orogastric tubes and connected to an external heat exchange unit. RESULTS A mean cooling rate of 0.42 °C/hr (SD ± 0.26) was observed. An average of 4 hr 24 min (SD ± 2 hr 6 min) was required to reach target temperature, and this was maintained 90.25% (SD ± 16.20%) of the hypothermia protocol duration. No adverse events related to device use were encountered. Questionnaires administered to ICU nursing staff regarding ease-of-use of the device and its performance were rated as favorable. CONCLUSIONS When used as a sole modality, objective performance parameters of the esophageal-cooling device were found to be comparable to standard temperature control methods. More research is required to further quantify efficacy, safety, assess utility in other patient populations, and examine patient outcomes with device use in comparison to standard temperature control modalities.
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Affiliation(s)
- Ahmed F Hegazy
- Department of Anesthesia and Perioperative Medicine, University of Western Ontario, LHSC-UC, 339 Windermere Road, London, Ontario N6A 5A5, Canada.
| | - Danielle M Lapierre
- Department of Anesthesia and Perioperative Medicine, University of Western Ontario, LHSC-UC, 339 Windermere Road, London, Ontario N6A 5A5, Canada
| | - Ron Butler
- Department of Anesthesia and Perioperative Medicine, University of Western Ontario, LHSC-UC, 339 Windermere Road, London, Ontario N6A 5A5, Canada
| | - Janet Martin
- Department of Epidemiology and Biostatistics, University of Western Ontario, LHSC-UC, 339 Windermere Road, London, Ontario N6A 5A5, Canada
| | - Eyad Althenayan
- Critical Care & Neuro-Critical Care Medicine, Program in Critical Care, Department of Medicine, London Health Sciences Centre, University of Western Ontario, LHSC-UC, 339 Windermere Road, London, Ontario N6A 5A5, Canada
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14
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Schroeder DC, Guschlbauer M, Maul AC, Cremer DA, Becker I, de la Puente Bethencourt D, Paal P, Padosch SA, Wetsch WA, Annecke T, Böttiger BW, Sterner-Kock A, Herff H. Oesophageal heat exchangers with a diameter of 11mm or 14.7mm are equally effective and safe for targeted temperature management. PLoS One 2017; 12:e0173229. [PMID: 28291783 PMCID: PMC5349448 DOI: 10.1371/journal.pone.0173229] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/18/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Targeted temperature management (TTM) is widely used in critical care settings for conditions including hepatic encephalopathy, hypoxic ischemic encephalopathy, meningitis, myocardial infarction, paediatric cardiac arrest, spinal cord injury, traumatic brain injury, ischemic stroke and sepsis. Furthermore, TTM is a key treatment for patients after out-of-hospital cardiac-arrest (OHCA). However, the optimal cooling method, which is quick, safe and cost-effective still remains controversial. Since the oesophagus is adjacent to heart and aorta, fast heat-convection to the central blood-stream could be achieved with a minimally invasive oesophageal heat exchanger (OHE). To date, the optimal diameter of an OHE is still unknown. While larger diameters may cause thermal- or pressure-related tissue damage after long-term exposure to the oesophageal wall, smaller diameter (e.g., gastric tubes, up to 11mm) may not provide effective cooling rates. Thus, the objective of the study was to compare OHE-diameters of 11mm (OHE11) and 14.7mm (OHE14.7) and their effects on tissue and cooling capability. METHODS Pigs were randomized to OHE11 (N = 8) or OHE14.7 (N = 8). After cooling, pigs were maintained at 33°C for 1 hour. After 10h rewarming, oesophagi were analyzed by means of histopathology. The oesophagus of four animals from a separate study that underwent exactly the identical preparation and cooling protocol described above but received a maintenance period of 24h were used as histopathological controls. RESULTS Mean cooling rates were 2.8±0.4°C°C/h (OHE11) and 3.0±0.3°C °C/h (OHE14.7; p = 0.20). Occasional mild acute inflammatory transepithelial infiltrates were found in the cranial segment of the oesophagus in all groups including controls. Deviations from target temperature were 0.1±0.4°C (OHE11) and 0±0.1°C (OHE14.7; p = 0.91). Rewarming rates were 0.19±0.07°C °C/h (OHE11) and 0.20±0.05°C °C/h (OHE14.7; p = 0.75). CONCLUSIONS OHE with diameters of 11 mm and 14.7 mm achieve effective cooling rates for TTM and did not cause any relevant oesophageal tissue damage. Both OHE demonstrated acceptable deviations from target temperature and allowed for an intended rewarming rate (0.25°C/h).
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Affiliation(s)
- Daniel C. Schroeder
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany
| | - Maria Guschlbauer
- Department of Experimental Medicine, University Hospital of Cologne, Cologne, Germany
| | - Alexandra C. Maul
- Department of Experimental Medicine, University Hospital of Cologne, Cologne, Germany
| | - Daniel A. Cremer
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany
| | - David de la Puente Bethencourt
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany
| | - Peter Paal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust. Queen Mary University of London, London, United Kingdom
- Barmherzige Brüder Salzburg Hospital, Department of Anaesthesiology and Critical Care Medicine, Kajetanerplatz 2, Salzburg, Austria
| | - Stephan A. Padosch
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany
| | - Wolfgang A. Wetsch
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany
| | - Thorsten Annecke
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany
| | - Anja Sterner-Kock
- Department of Experimental Medicine, University Hospital of Cologne, Cologne, Germany
| | - Holger Herff
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany
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Naiman M, Shanley P, Garrett F, Kulstad E. Evaluation of advanced cooling therapy’s esophageal cooling device for core temperature control. Expert Rev Med Devices 2016; 13:423-33. [DOI: 10.1080/17434440.2016.1174573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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16
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Markota A, Fluher J, Kit B, Balažič P, Sinkovič A. The introduction of an esophageal heat transfer device into a therapeutic hypothermia protocol: A prospective evaluation. Am J Emerg Med 2016; 34:741-5. [DOI: 10.1016/j.ajem.2016.01.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/25/2016] [Indexed: 01/11/2023] Open
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17
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Hegazy AF, Lapierre DM, Butler R, Althenayan E. Temperature control in critically ill patients with a novel esophageal cooling device: a case series. BMC Anesthesiol 2015; 15:152. [PMID: 26481105 PMCID: PMC4615396 DOI: 10.1186/s12871-015-0133-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 10/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mild hypothermia and fever control have been shown to improve neurological outcomes post cardiac arrest. Common methods to induce hypothermia include body surface cooling and intravascular cooling; however, a new approach using an esophageal cooling catheter has recently become available. METHODS We report the first three cases of temperature control using an esophageal cooling device (ECD). The ECD was placed in a similar fashion to orogastric tubes. Temperature reduction was achieved by connecting the ECD to a commercially available external heat exchange unit (Blanketrol Hyperthermia - Hypothermia System). RESULTS The first patient, a 54 year-old woman (86 kg) was admitted after resuscitation from an out-of-hospital non-shockable cardiac arrest. Shortly after admission, she mounted a fever peaking at 38.3 °C despite administration of cold intravenous saline and application of cooling blankets. ECD utilization resulted in a temperature reduction to 35.7 °C over a period of 4 h. She subsequently recovered and was discharged home at day 23. The second patient, a 59 year-old man (73 kg), was admitted after successful resuscitation from a protracted out-of hospital cardiac arrest. His initial temperature was 35 °C, but slowly increased to 35.8 °C despite applying a cooling blanket and ice packs. The ECD was inserted and a temperature reduction to 34.8 °C was achieved within 3 h. The patient expired on day 3. The third patient, a 47 year-old man (95 kg) presented with a refractory fever secondary to necrotizing pneumonia in the postoperative period after coronary artery bypass grafting. His fever persisted despite empiric antibiotics, antipyretics, cooling blankets, and ice packs. ECD insertion resulted in a decrease in temperature from 39.5 to 36.5 °C in less than 5 h. He eventually made a favorable recovery and was discharged home after 59 days. In all 3 patients, device placement occurred in under 3 min and ease-of-use was reported as excellent by nursing staff and physicians. CONCLUSIONS The esophageal cooling device was found to be an effective temperature control modality in this small case series of critically ill patients. Preliminary data presented in this report needs to be confirmed in large randomized controlled trials comparing its efficacy and safety to standard temperature control modalities.
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Affiliation(s)
- Ahmed F Hegazy
- Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, N6A 5A5, ON, Canada.
| | - Danielle M Lapierre
- Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, N6A 5A5, ON, Canada.
| | - Ron Butler
- Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, N6A 5A5, ON, Canada.
| | - Eyad Althenayan
- Department of Medicine, Division of Critical Care, University of Western Ontario, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, N6A 5A5, ON, Canada.
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18
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Markota A, Kit B, Fluher J, Sinkovič A. Use of an oesophageal heat transfer device in therapeutic hypothermia. Resuscitation 2015; 89:e1-2. [DOI: 10.1016/j.resuscitation.2015.01.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
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19
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Vaity C, Al-Subaie N, Cecconi M. Cooling techniques for targeted temperature management post-cardiac arrest. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:103. [PMID: 25886948 PMCID: PMC4361155 DOI: 10.1186/s13054-015-0804-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
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20
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Kulstad EB, Naiman M, Shanley P, Garrett F, Haryu T, Waller D, Azarafrooz F, Courtney DM. Temperature modulation with an esophageal heat transfer device - a pediatric swine model study. BMC Anesthesiol 2015; 15:16. [PMID: 25685058 PMCID: PMC4327961 DOI: 10.1186/1471-2253-15-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/15/2015] [Indexed: 12/18/2022] Open
Abstract
Background An increasing number of conditions appear to benefit from control and modulation of temperature, but available techniques to control temperature often have limitations, particularly in smaller patients with high surface to mass ratios. We aimed to evaluate a new method of temperature modulation with an esophageal heat transfer device in a pediatric swine model, hypothesizing that clinically significant modulation in temperature (both increases and decreases of more than 1°C) would be possible. Methods Three female Yorkshire swine averaging 23 kg were anesthetized with inhalational isoflurane prior to placement of the esophageal device, which was powered by a commercially available heat exchanger. Swine temperature was measured rectally and cooling and warming were performed by selecting the appropriate external heat exchanger mode. Temperature was recorded over time in order to calculate rates of temperature change. Histopathology of esophageal tissue was performed after study completion. Results Average swine baseline temperature was 38.3°C. Swine #1 exhibited a cooling rate of 3.5°C/hr; however, passive cooling may have contributed to this rate. External warming blankets maintained thermal equilibrium in swine #2 and #3, demonstrating maximum temperature decrease of 1.7°C/hr. Warming rates averaged 0.29°C/hr. Histopathologic analysis of esophageal tissue showed no adverse effects. Conclusions An esophageal heat transfer device successfully modulated the temperature in a pediatric swine model. This approach to temperature modulation may offer a useful new modality to control temperature in conditions warranting temperature management (such as maintenance of normothermia, induction of hypothermia, fever control, or malignant hyperthermia).
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Affiliation(s)
- Erik B Kulstad
- Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL 60453 USA ; Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL 60612 USA
| | - Melissa Naiman
- Center for Advanced Design, Research, and Exploration (CADRE), University of Illinois at Chicago, 1737 W. Polk Street, Suite B14, Chicago, IL 60612 USA
| | - Patrick Shanley
- Advanced Cooling Therapy, 3440 S. Dearborn Street, #215-S, Chicago, IL 60616 USA
| | - Frank Garrett
- Garrett Technologies, 1955 Techny Road, Suite #1, Northbrook, IL 60062 USA
| | - Todd Haryu
- PreLabs, LLC, 33 Chicago Avenue, Oak Park, IL 60302 USA
| | - Donald Waller
- PreLabs, LLC, 33 Chicago Avenue, Oak Park, IL 60302 USA
| | - Farshid Azarafrooz
- Department of Comparative Medicine, Loyola University Medical Center, Maywood, IL 60153 USA
| | - Daniel Mark Courtney
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 211 E. Ontario suite 200, Chicago, IL 60611 USA
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