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Feasibility and Safety of Transnasal High Flow Air to Reduce Core Body Temperature in Febrile Neurocritical Care Patients: A Pilot Study. Neurocrit Care 2020; 31:280-287. [PMID: 30919302 DOI: 10.1007/s12028-019-00702-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Fever is an important determinant of prognosis following acute brain injury. Current non-pharmacologic techniques to reduce fever are limited and induce a shivering response. We investigated the safety and efficacy of a novel transnasal unidirectional high flow air device in reducing core body temperature in the neurocritical care unit (NCCU) setting. METHODS This pilot study included seven consecutive patients in the NCCU who were febrile (> 37.5 °C) for > 24 h despite standard non-pharmacologic and first-line antipyretic agents. Medical grade high flow air was delivered transnasally using a standard continuous positive airway pressure machine with a positive pressure of 20 cmH2O for 2 h. Core esophageal and tympanic temperature were continuously monitored. RESULTS Mean age was 40 ± 14 yo, and 72% (5/7 patients) were men. Five patients had intracerebral or intraventricular hemorrhage, one subject had transverse myelitis, and the remaining patient had anoxic brain injury due to a cardiac arrest. After 2 h of cooling, core temperature was significantly lower than the baseline pre-cooling temperature (37.3 ± 0.5 °C vs. 38.4 ± 0.6 °C; p < 0.002). Mean transnasal airflow rate was 57.5 ± 6.5 liters per minute. Five of the seven subjects were normothermic at the end of the 2-h period. One subject with severe hyperthermia (39.7 °C) and the other with multiple interruptions to therapy due to technical reasons did not cool. The core temperature within 30 min of cessation of airflow increased and was similar to the pre-cooling baseline temperature (38.3 ± 0.4 °C vs. 38.4 ± 0.6 °C, p = NS). Rate of core cooling was 0.6 ± 0.15 °C per hour at this flow rate. No shivering response was observed. No protocol-related adverse events occurred. CONCLUSIONS High flow transnasal air in a unidirectional fashion lowers core body temperature in febrile patients in the NCCU setting. No adverse events were seen, and the process showed no signs of shivering or any other serious side effects during short-term exposure. This pilot study should inform further investigation.
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Ziai W, Geocadin R, Tandri H. Commentary: Feasibility and Safety of Transnasal High Flow Air to Reduce Core Body Temperature. Neurocrit Care 2019; 31:444-445. [PMID: 31342449 DOI: 10.1007/s12028-019-00794-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Wendy Ziai
- Departments of Neurology and Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Romergryko Geocadin
- Departments of Neurology and Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Harikrishna Tandri
- Departments of Neurology and Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA
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Zhu L. Hypothermia Used in Medical Applications for Brain and Spinal Cord Injury Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1097:295-319. [PMID: 30315552 DOI: 10.1007/978-3-319-96445-4_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite more than 80 years of animal experiments and clinical practice, efficacy of hypothermia in improving treatment outcomes in patients suffering from cell and tissue damage caused by ischemia is still ongoing. This review will first describe the history of utilizing cooling in medical treatment, followed by chemical and biochemical mechanisms of cooling that can lead to neuroprotection often observed in animal studies and some clinical studies. The next sections will be focused on current cooling approaches/devices, as well as cooling parameters recommended by researchers and clinicians. Animal and clinical studies of implementing hypothermia to spinal cord and brain tissue injury patients are presented next. This section will review the latest outcomes of hypothermia in treating patients suffering from traumatic brain injury (TBI), spinal cord injury (SCI), stroke, cardiopulmonary surgery, and cardiac arrest, followed by a summary of available evidence regarding both demonstrated neuroprotection and potential risks of hypothermia. Contributions from bioengineers to the field of hypothermia in medical treatment will be discussed in the last section of this review. Overall, an accumulating body of clinical evidence along with several decades of animal research and mathematical simulations has documented that the efficacy of hypothermia is dependent on achieving a reduced temperature in the target tissue before or soon after the injury-precipitating event. Mild hypothermia with temperature reduction of several degrees Celsius is as effective as modest or deep hypothermia in providing therapeutic benefit without introducing collateral/systemic complications. It is widely demonstrated that the rewarming rate must be controlled to be lower than 0.5 °C/h to avoid mismatch between local blood perfusion and metabolism. In the past several decades, many different cooling methods and devices have been designed, tested, and used in medical treatments with mixed results. Accurately designing treatment protocols to achieve specific cooling outcomes requires collaboration among engineers, researchers, and clinicians. Although this problem is quite challenging, it presents a major opportunity for bioengineers to create methods and devices that quickly and safely produce hypothermia in targeted tissue regions without interfering with routine medical treatment.
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Affiliation(s)
- Liang Zhu
- Department of Mechanical Engineering, University of Maryland Baltimore County, Baltimore, MD, USA.
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Abstract
BACKGROUND Mild hypothermia is an effective neuroprotective strategy for a variety of acute brain injuries. Cooling the nasopharynx may offer the capability to cool the brain selectively due to anatomic proximity of the internal carotid artery to the cavernous sinus. This study investigated the feasibility and efficiency of nasopharyngeal brain cooling by continuously blowing room temperature or cold air at different flow rates into the nostrils of normal newborn piglets. METHODS Experiments were conducted on thirty piglets (n = 30, weight = 2.7 ± 1.5 kg). Piglets were anesthetized with 1–2% isoflurane and were randomized to receive one of four different nasopharyngeal cooling treatments: I. Room temperature at a flow rate of 3–4 L min(−1) (n = 6); II. −1 ± 2 °C at a flow rate of 3–4 L min(−1) (n = 6); III. Room temperature at a flow rate of 14–15 L min(−1) (n = 6); IV. −8 ± 2 °C at a flow rate of 14–15 L min(−1) (n = 6). To control for the normal thermal regulatory response of piglets without nasopharyngeal cooling, a control group of piglets (n = 6) had their brain temperature monitored without nasopharyngeal cooling. The duration of treatment was 60 min, with additional 30 min of observation. RESULTS In group I, median cooling rate was 1.7 ± 0.9 °C/h by setting the flow rate of room temperature air to 3–4 L min(−1). Results of comparing different temperatures and flow rates in the nasopharyngeal cooling approach reveal that the brain temperature could be reduced rapidly at a rate of 5.5 ± 1.1 °C/h by blowing −8 ± 2 °C air at a flow rate of 14–15 L min(−1). CONCLUSIONS Nasopharyngeal cooling via cooled insufflated air can lower the brain temperature, with higher flows and lower temperatures of insufflated air being more effective.
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Effect of wearing an N95 filtering facepiece respirator on superomedial orbital infrared indirect brain temperature measurements. J Clin Monit Comput 2016; 31:67-73. [PMID: 26759336 DOI: 10.1007/s10877-016-9828-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 01/06/2016] [Indexed: 11/27/2022]
Abstract
To determine any effect of wearing a filtering facepiece respirator on brain temperature. Subjects (n = 18) wore a filtering facepiece respirator (FFR) for 1 h at rest while undergoing infrared thermography measurements of the superomedial periobital region of the eye, a non-invasive indirect method of brain temperature measurements we termed the superomedial orbital infrared indirect brain temperature (SOIIBT) measurement. Temperature of the facial skin covered by the FFR, infrared temperature measurements of the tympanic membrane and superficial temporal artery region were concurrently measured, and subjective impressions of thermal comfort obtained simultaneously. The temperature of the skin under the FFR and subjective impressions of thermal discomfort both increased significantly. The mean tympanic membrane temperature did not increase, and the superficial temporal artery region temperature decreased significantly. The SOIIBT values did not change significantly, but subjects who switched from nasal to oronasal breathing during the study (n = 5) experienced a slight increase in the SOIIBT measurements. Wearing a FFR for 1 h at rest does not have a significant effect on brain temperatures, as evaluated by the SOIIBT measurements, but a change in the route of breathing may impact these measurements. These findings suggest that subjective impressions of thermal discomfort from wearing a FFR under the study conditions are more likely the result of local dermal sensations rather than brain warming.
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Ice slurry ingestion reduces both core and facial skin temperatures in a warm environment. J Therm Biol 2015; 51:105-9. [DOI: 10.1016/j.jtherbio.2015.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 11/21/2022]
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Han Z, Liu X, Luo Y, Ji X. Therapeutic hypothermia for stroke: Where to go? Exp Neurol 2015; 272:67-77. [PMID: 26057949 DOI: 10.1016/j.expneurol.2015.06.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/16/2015] [Accepted: 06/04/2015] [Indexed: 01/08/2023]
Abstract
Ischemic stroke is a major cause of death and long-term disability worldwide. Thrombolysis with recombinant tissue plasminogen activator is the only proven and effective treatment for acute ischemic stroke; however, therapeutic hypothermia is increasingly recognized as having a tissue-protective function and positively influencing neurological outcome, especially in cases of ischemia caused by cardiac arrest or hypoxic-ischemic encephalopathy in newborns. Yet, many aspects of hypothermia as a treatment for ischemic stroke remain unknown. Large-scale studies examining the effects of hypothermia on stroke are currently underway. This review discusses the mechanisms underlying the effect of hypothermia, as well as trends in hypothermia induction methods, methods for achieving optimal protection, side effects, and therapeutic strategies combining hypothermia with other neuroprotective treatments. Finally, outstanding issues that must be addressed before hypothermia treatment is implemented at a clinical level are also presented.
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Affiliation(s)
- Ziping Han
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Xiangrong Liu
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Yumin Luo
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing 100053, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100053, China
| | - Xunming Ji
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing 100053, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100053, China; Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China.
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Abstract
Brain injuries caused by stroke are common and costly in human and resource terms. The result of stroke is a cascade of molecular and physiological derangement, cell death, damage and inflammation in the brain. This, together with infection, if present, commonly results in patients having an increased temperature, which is associated with worse outcome. The usual clinical goal in stroke is therefore to reduce temperature to normal, or below normal (hypothermia) to reduce swelling if brain pressure is increased. However, research evidence does not yet conclusively show whether or not cooling patients after stroke improves their longer-term outcome (reduces death and disability). It is possible that complications of cooling outweigh the benefits. Cooling therapy may reduce damage and potentially improve outcome, and head cooling targets the site of injury and may have fewer side effects than systemic cooling, but the evidence base is unclear.
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Affiliation(s)
- Bridget A Harris
- />NHS Lothian and University of Edinburgh, Critical Care Unit, Western General Hospital, Edinburgh, EH4 2XU UK
| | - Peter JD Andrews
- />Department of Anaesthesia and Critical Care, University of Edinburgh and NHS Lothian, Western General Hospital, Edinburgh, EH4 2XU UK
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Saxena M, Andrews PJD, Cheng A, Deol K, Hammond N. Modest cooling therapies (35ºC to 37.5ºC) for traumatic brain injury. Cochrane Database Syst Rev 2014; 2014:CD006811. [PMID: 25135381 PMCID: PMC7389311 DOI: 10.1002/14651858.cd006811.pub3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Animal models of traumatic brain injury suggest that induced normothermia (36.5 or 37 ºC), compared to induced hyperthermia (39 ºC), improves histopathological and neurobehavioural outcomes. Observational clinical studies of patients with TBI suggest an association between raised body temperature and unfavourable outcome, although this relationship is inconsistent. OBJECTIVES To assess the effects of modest cooling therapies (defined as any drug or physical therapy aimed at maintaining body temperature between 35 ºC and 37.5 ºC) when applied to patients in the first week after traumatic brain injury. SEARCH METHODS The most recent search was run on 23(rd) September 2013. We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library (CENTRAL), MEDLINE (OvidSP), Embase (OvidSP), ISI WOS: SCI-EXPANDED (1970) & CPCI-S (1990), PubMed and trials registries together with reference checking. SELECTION CRITERIA All completed randomised, controlled and placebo-controlled trials published or unpublished, where modest cooling therapies were applied in the first week after traumatic brain injury. DATA COLLECTION AND ANALYSIS Two authors independently applied the selection criteria to relevant trials. MAIN RESULTS We were unable to find any randomised controlled trials of modest cooling therapies after traumatic brain injury. AUTHORS' CONCLUSIONS In order to further explore the preliminary findings provided by animal models and observational clinical studies that suggests there may be a beneficial effect of modest cooling for TBI, randomised trials designed to explore the effect of these interventions on patient-centred outcomes are needed.
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Affiliation(s)
- Manoj Saxena
- St George HospitalIntensive Care UnitGray StKogarahSydneyNSWAustralia2217
| | - Peter JD Andrews
- Lead Clinician, Critical Care Services, Western General Hospital, LUHDIntensive Care & Pain Medicine, University of EdinburghEdinburghUK
| | - Andrew Cheng
- St George HospitalIntensive Care UnitGray StKogarahSydneyNSWAustralia2217
| | - Kiran Deol
- St George HospitalIntensive Care UnitGray StKogarahSydneyNSWAustralia2217
| | - Naomi Hammond
- The George Institute for Global HealthCritical Care and Trauma DivisionLevel 7, 341 George StSydneyNSWAustralia2000
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Esposito E, Ebner M, Ziemann U, Poli S. In cold blood: intraarteral cold infusions for selective brain cooling in stroke. J Cereb Blood Flow Metab 2014; 34:743-52. [PMID: 24517972 PMCID: PMC4013766 DOI: 10.1038/jcbfm.2014.29] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/19/2013] [Accepted: 01/19/2014] [Indexed: 12/29/2022]
Abstract
Hypothermia is a promising therapeutic option for stroke patients and an established neuroprotective treatment for global cerebral ischemia after cardiac arrest. While whole body cooling is a feasible approach in intubated and sedated patients, its application in awake stroke patients is limited by severe side effects: Strong shivering rewarms the body and potentially worsens ischemic conditions because of increased O2 consumption. Drugs used for shivering control frequently cause sedation that increases the risk of aspiration and pneumonia. Selective brain cooling by intraarterial cold infusions (IACIs) has been proposed as an alternative strategy for patients suffering from acute ischemic stroke. Preclinical studies and early clinical experience indicate that IACI induce a highly selective brain temperature decrease within minutes and reach targeted hypothermia 10 to 30 times faster than conventional cooling methods. At the same time, body core temperature remains largely unaffected, thus systemic side effects are potentially diminished. This review critically discusses the limitations and side effects of current cooling techniques for neuroprotection from ischemic brain damage and summarizes the available evidence regarding advantages and potential risks of IACI.
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Affiliation(s)
- Elga Esposito
- Department Neurology & Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Matthias Ebner
- Department Neurology & Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ulf Ziemann
- Department Neurology & Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Sven Poli
- Department Neurology & Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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In Reply:. Anesthesiology 2013; 118:469-70. [DOI: 10.1097/aln.0b013e31827e3c53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Springborg JB, Springborg KK, Romner B. First Clinical Experience with Intranasal Cooling for Hyperthermia in Brain-Injured Patients. Neurocrit Care 2013; 18:400-5. [DOI: 10.1007/s12028-012-9806-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gallup AC, Eldakar OT. The thermoregulatory theory of yawning: what we know from over 5 years of research. Front Neurosci 2013; 6:188. [PMID: 23293583 PMCID: PMC3534187 DOI: 10.3389/fnins.2012.00188] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 12/06/2012] [Indexed: 01/24/2023] Open
Abstract
Over the past 5 years numerous reports have confirmed and replicated the specific brain cooling and thermal window predictions derived from the thermoregulatory theory of yawning, and no study has found evidence contrary to these findings. Here we review the comparative research supporting this model of yawning among homeotherms, while highlighting a recent report showing how the expression of contagious yawning in humans is altered by seasonal climate variation. The fact that yawning is constrained to a thermal window of ambient temperature provides unique and compelling support in favor of this theory. Heretofore, no existing alternative hypothesis of yawning can explain these results, which have important implications for understanding the potential functional role of this behavior, both physiologically and socially, in humans and other animals. In discussion we stress the broader applications of this work in clinical settings, and counter the various criticisms of this theory.
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Affiliation(s)
- Andrew C. Gallup
- Department of Ecology and Evolutionary Biology, Princeton UniversityPrinceton, NJ, USA
| | - Omar T. Eldakar
- Center for Insect Science, University of ArizonaTucson, AZ, USA
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Gupta S, Carmichael C, Simpson C, Clarke MJ, Allen C, Gao Y, Chan EYY, Murray V. Electric fans for reducing adverse health impacts in heatwaves. Cochrane Database Syst Rev 2012; 2012:CD009888. [PMID: 22786530 PMCID: PMC6457598 DOI: 10.1002/14651858.cd009888.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Heatwaves are hot weather events, which breach regional or national thresholds, that last for several days. They are likely to occur with increasing frequency in some parts of the world. The potential consequences were illustrated in Europe in August 2003 when there were an estimated 30,000 excess deaths due to a heatwave. Electric fans might be used with the intention of reducing the adverse health effects of a heatwave. Fans do not cool the ambient air but can be used to draw in cooler air from outside when placed at an open window. The aim of the fans would be to increase heat loss by increasing the efficiency of all normal methods of heat loss, but particularly by evaporation and convection methods. However, it should be noted that increased sweating can lead to dehydration and electrolyte imbalances if these fluids and electrolytes are not replaced quickly enough. Research has also identified important gaps in knowledge about the use of fans, which might lead to their inappropriate use. OBJECTIVES To determine whether the use of electric fans contributes to, or impedes, heat loss at high ambient temperatures during a heatwave, and to contribute to the evidence base for the public health impacts of heatwaves. SEARCH METHODS We sought unpublished and published studies that had been published in any language. The review team were able to assess studies reported in English, Chinese, Dutch, French and German; and reports in other languages would have been translated into English as necessary. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, the Indian biomedical literature (IndMED and MedIND) and databases of Chinese literature (Chinese Journal Net and Digital Periodical of WanFang Data). The most recent electronic searches were done in April 2012. We also checked the reference lists of relevant articles and the websites of relevant national and international organisations, and consulted with researchers and policy makers with experience in strategies to manage heatwaves to identify additional studies. The titles and abstracts from each search were checked independently by two review authors. The full text articles that we retrieved were checked independently by at least two authors for their relevance and for references to potentially eligible studies. SELECTION CRITERIA Randomised trials and other experimental designs, such as interrupted time series and controlled before-and-after studies, comparing the use of electric fans with no fans during a heatwave were eligible for this review. The electric fans could be hand-held (battery operated), portable or mounted on the wall or ceiling, or in a window. We sought interventions delivered to anyone for whom a heatwave was likely to have serious adverse health impacts. This would include people of all ages but with a particular focus on some groups (for example older people). Populations from high-, middle- and low-income countries were eligible for the review. DATA COLLECTION AND ANALYSIS If we had identified eligible studies, they would have been assessed independently by at least two review authors and data would have been extracted on the characteristics of the study, its participants and interventions, as well as the effects on health outcomes. The primary outcomes were mortality, hospital admission and other contacts with healthcare services. MAIN RESULTS We did not identify any eligible studies despite the extensive searching and correspondence with several experts in this topic area. We identified retrospective, observational studies, usually with a case-control design, that investigated the association between the use of electric fans and health outcomes, including death. The results of these studies were mixed. Some studies found that the use of fans was associated with better health outcomes, others found the reverse. AUTHORS' CONCLUSIONS The evidence we identified does not resolve uncertainties about the health effects of electric fans during heatwaves. Therefore, this review does not support or refute the use of electric fans during a heatwave. People making decisions about electric fans should consider the current state of the evidence base, and they might also wish to make themselves aware of local policy or guidelines when making a choice about whether or not to use or supply electric fans. The main implication of this review is that high quality research is needed to resolve the long standing and ongoing uncertainty about the benefits and harms of using electric fans during a heatwave, for example randomised trials comparing the health effects in people with electric fans to those in people without them.
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Affiliation(s)
- Saurabh Gupta
- Ambition Health Private LimitedPublic Health, Epidemiology and Biostatistics120, Good Earth City CentreSector 50GurgaonIndia122018
| | - Catriona Carmichael
- Centre for Radiation, Chemicals and Environmental HazardsExtreme Events and Health Protection SectionHealth Protection Agency151 Buckingham Palace RoadLondonUKSW1W 9SZ
| | - Christina Simpson
- Health CanadaClimate Change and Health Office269 Laurier Ave. WRoom 9‐077OttawaONCanadaK1A 0K9
| | - Mike J Clarke
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences, Block B, Royal Victoria HospitalGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Claire Allen
- Evidence Aid1st Floor, Gibson Building (c/o CEBM)Radcliffe Observatory QuarterOxfordUKOX2 6GG
| | - Yang Gao
- Hong Kong Baptist UniversityDepartment of Physical EducationKowloonHong Kong
| | - Emily Y Y Chan
- The Chinese University of Hong KongCERT‐CUHK‐Oxford University Centre for Disaster and Medical Humanitarian ResponseCERT‐CUHK‐Oxford UniversitySchool of Public Health and Primary CareShatinNew TerritoriesHong Kong
| | - Virginia Murray
- Centre for Radiation, Chemicals and Environmental HazardsExtreme Events and Health Protection SectionHealth Protection Agency151 Buckingham Palace RoadLondonUKSW1W 9SZ
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Teunissen LPJ, de Haan A, de Koning JJ, Clairbois HE, Daanen HAM. Limitations of temperature measurement in the aural canal with an ear mould integrated sensor. Physiol Meas 2011; 32:1403-16. [DOI: 10.1088/0967-3334/32/9/004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Covaciu L, Weis J, Bengtsson C, Allers M, Lunderquist A, Ahlström H, Rubertsson S. Brain temperature in volunteers subjected to intranasal cooling. Intensive Care Med 2011; 37:1277-84. [DOI: 10.1007/s00134-011-2264-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 05/07/2011] [Indexed: 02/05/2023]
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Gupta D. Transnasal cooling: a Pandora's box of transnasal patho-physiology. Med Hypotheses 2011; 77:275-7. [PMID: 21600699 DOI: 10.1016/j.mehy.2011.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 04/11/2011] [Accepted: 04/28/2011] [Indexed: 11/18/2022]
Abstract
The innovative concept of transnasal evaporative cooling for therapeutic hypothermia in cardio-pulmonary-cerebro-resuscitation has therapeutic implications with evidence of rapid and selective brain cooling; however, this author wants to elicit that this concept may hold answers for many physiological phenomena which have not been explored or completely understood up till now. To affirm the physiological role of transnasal cooling, the innovative non-invasive brain temperature monitoring can help the investigators to explore and understand the following transnasal pathophysiological phenomena: (1) understanding correlation of brain temperature and sinus headache secondary to nasal blockade, (2) exploring the therapeutic role of nasal oxygen for prevention of delirium in intubated patients, (3) realizing the impact of controlled enclosed environments on the mood and affect of the inhabitants, (4) understanding the etio-pathogenesis of claustrophobia after excluding the confounding factors of morbid obesity, severe cardiopulmonary disease and incapacitating musculoskeletal diseases, (5) exploring the anthropological role of male pattern of moustache, beard and hair loss, and (6) possible development of a coolant moustache as proposed by the author. In summary, transnasal pathophysiology offers many promising lines of fruitful research to explore the non-olfactory physiological functions of nose in human beings.
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Affiliation(s)
- Deepak Gupta
- Department of Anesthesiology, Wayne State University/Detroit Medical Center, School of Medicine, Box No. 162, 3990 John R, Detroit, MI 48201, USA.
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Doll H, Maegele M, Bohl J, Störkel S, Kipfmueller F, Schaefer U, Angelov D, Wirth S, Truebel H. Pharyngeal selective brain cooling is associated with reduced CNS cortical lesion after experimental traumatic brain injury in rats. J Neurotrauma 2011; 27:2245-54. [PMID: 20939694 DOI: 10.1089/neu.2010.1505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Therapeutic hypothermia (TH) is still being explored as a therapeutic option after traumatic brain injury (TBI) but clinical data has not supported its efficacy. Experimental approaches were promising, but clinical data did not support its efficacy in the treatment of TBI. A novel approach of pharyngeal selective brain cooling (pSBC), recently introduced by our group, has been accompanied by superior neurofunctional, sensorimotor, and cognitive outcomes. This work is now extended by data on histomorphological and physical outcomes after pSBC in a model of experimental TBI. Male Sprague-Dawley rats were subjected to lateral fluid-percussion (LFP) brain injury, and randomized to the following experimental groups: (1) TBI with pSBC, (2) TBI without pSBC, and (3) sham animals. On day post-injury (DPI) 14, the animals were sacrificed and their brains were harvested for immunohistochemistry using the following antibodies: (1) glial fibrillary acidic protein (GFAP), (2) neurofilament (NF), and (3) synaptophysin (SY). In pSBC animals brain temperature was selectively lowered to 33 ± 0.5°C within 15 min post-injury, and maintained for 180 min after induction, while keeping rectal temperatures at physiological levels. Animals that had undergone pSBC showed a significantly faster recovery of body weight starting on DPI 3, and had gained substantially more weight than TBI-only animals on DPI 14 (p < 0.001), indicating superior physical recovery. Areas of cortical damage were significantly smaller in pSBC animals compared to TBI-only animals (p < 0.01). pSBC was associated with preservation of cortical tissue ipsilateral to the lesion, and superior physical recovery after experimental TBI. These results complement earlier reports in which pSBC was associated with superior neurofunctional and cognitive outcomes using the same experimental model.
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Affiliation(s)
- Hinnerk Doll
- Institute for Research in Operative Medicine (IFOM), University of Witten-Herdecke, Cologne, Germany.
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Wei G, Lu XCM, Shear DA, Yang X, Tortella FC. Neuroprotection of Selective Brain Cooling After Penetrating Ballistic-like Brain Injury in Rats. Ther Hypothermia Temp Manag 2011; 1:33-42. [DOI: 10.1089/ther.2010.0007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Guo Wei
- Department of Applied Neurobiology, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Xi-Chun M. Lu
- Department of Applied Neurobiology, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Deborah A. Shear
- Department of Applied Neurobiology, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Xiaofang Yang
- Department of Applied Neurobiology, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Frank C. Tortella
- Department of Applied Neurobiology, Walter Reed Army Institute of Research, Silver Spring, Maryland
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21
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Shoup-Knox ML, Gallup AC, Gallup GG, McNay EC. Yawning and stretching predict brain temperature changes in rats: support for the thermoregulatory hypothesis. FRONTIERS IN EVOLUTIONARY NEUROSCIENCE 2010; 2:108. [PMID: 21031034 PMCID: PMC2965053 DOI: 10.3389/fnevo.2010.00108] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 08/18/2010] [Indexed: 12/02/2022]
Abstract
Recent research suggests that yawning is an adaptive behavior that functions to promote brain thermoregulation among homeotherms. To explore the relationship between brain temperature and yawning we implanted thermocoupled probes in the frontal cortex of rats to measure brain temperature before, during and after yawning. Temperature recordings indicate that yawns and stretches occurred during increases in brain temperature, with brain temperatures being restored to baseline following the execution of each of these behaviors. The circulatory changes that accompany yawning and stretching may explain some of the thermal similarities surrounding these events. These results suggest that yawning and stretching may serve to maintain brain thermal homeostasis.
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White MD, Greiner JG, McDonald PLL. Point: humans do demonstrate selective brain cooling during hyperthermia. J Appl Physiol (1985) 2010; 110:569-71; discussion 581-2. [PMID: 20798268 DOI: 10.1152/japplphysiol.00992.2010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Matthew D White
- Laboratory for Exercise and Environmental Physiology, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia.
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23
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Gallup AC. Excessive yawning and thermoregulatory dysfunction. Sleep Breath 2010; 15:271-3. [PMID: 20495962 DOI: 10.1007/s11325-010-0365-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 04/28/2010] [Accepted: 05/05/2010] [Indexed: 11/26/2022]
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24
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Doll H, Truebel H, Kipfmueller F, Schaefer U, Neugebauer EAM, Wirth S, Maegele M. Pharyngeal selective brain cooling improves neurofunctional and neurocognitive outcome after fluid percussion brain injury in rats. J Neurotrauma 2009; 26:235-42. [PMID: 19196073 DOI: 10.1089/neu.2008.0741] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Therapeutic hypothermia (TH) after cardiac arrest reduces mortality and improves neurological outcome. Experimental TH after traumatic brain injury (TBI) indicated similar effects, but benefits were not reproducible in large clinical trials. Therefore, a novel approach of pharyngeal selective brain cooling (pSBC) was tested in respect to neurological outcome in a model of experimental TBI. Male Sprague-Dawley rats were subjected to lateral fluid percussion (LFP) brain injury and received pSBC for 3h post-injury. All animals were examined for neuromotor and sensorimotor dysfunction and coordination: before and after injury, and during recovery on day post-injury (DPI) 7 and 14 using (i) the standardized Composite Neuroscore (NS) test and (ii) the Rotarod test. Recovery of cognitive function was assessed on days 10-14 using (iii) the Barnes Circular Maze (BCM). In pSBC-animals, brain temperature was selectively lowered to 33 +/- 0.5 degrees C at 15 min post-injury, keeping rectal temperature at a physiologic level. All animals subjected to TBI via LFP showed an identical pattern of severe neurofunctional impairment at 24 h after injury. In the time course of the experiment, pSBC-animals showed superior neurofunctional recovery on DPI 7 (p = 0.03) and 14 (p = 0.002). Similarly, distance, time, and maximum speed on the Rota-Rod were significantly increased in pSBC-animals on DPI 7 (p < 0.01) and 14 (p < 0.01), as well as latency, distance, and mean number of errors in the BCM on DPI 14 (p < 0.01). The novel approach of pSBC was associated with improved neuromotor, sensormotor, and neurocognitive outcome after experimental TBI.
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Affiliation(s)
- Hinnerk Doll
- Institute for Research in Operative Medicine (IFOM), University of Witten-Herdecke, Cologne, Germany
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25
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Gallup AC, Miller ML, Clark AB. Yawning and thermoregulation in budgerigars: science as an incremental process. Anim Behav 2009. [DOI: 10.1016/j.anbehav.2009.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Gallup AC, Gallup GG. Medical implications of excessive yawning in relation to thermoregulatory dysfunction. Eur J Neurol 2009; 16:e120. [PMID: 19475752 DOI: 10.1111/j.1468-1331.2009.02638.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Gallup GG, Gallup AC. Excessive yawning and thermoregulation: two case histories of chronic, debilitating bouts of yawning. Sleep Breath 2009; 14:157-9. [PMID: 19657685 DOI: 10.1007/s11325-009-0287-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Accepted: 07/22/2009] [Indexed: 01/24/2023]
Abstract
BACKGROUND This report details the case histories of two women who suffer from chronic and debilitating episodes of excessive yawning in the absence of sleep problems. METHODS Each woman independently provided information and answered questions about their excessive yawning symptoms and medical histories. RESULTS Both women show signs of thermoregulatory dysfunction, and each reports symptom relief and/or the postponement of yawning attacks through means of behavioral cooling. One woman recorded her body temperature before and after bouts of yawning, revealing a significant drop in temperature following each episode (p < 0.05). CONCLUSIONS The trigger for yawning in these patients appears to be related to increases in body/brain temperature. These cases are consistent with growing evidence showing that recurrent episodes of excessive yawning are not necessarily associated with a sleep disorder, but rather may be indicative of thermoregulatory dysfunction.
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Christian E, Zada G, Sung G, Giannotta SL. A review of selective hypothermia in the management of traumatic brain injury. Neurosurg Focus 2008; 25:E9. [DOI: 10.3171/foc.2008.25.10.e9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
| | | | - Gene Sung
- 2Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Saxena M, Andrews PJD, Cheng A. Modest cooling therapies (35 degrees C to 37.5 degrees C) for traumatic brain injury. Cochrane Database Syst Rev 2008:CD006811. [PMID: 18646169 DOI: 10.1002/14651858.cd006811.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A recent retrospective study suggested that after traumatic brain injury, patients with a raised body temperature have an unfavourable outcome compared to patients that have a normal body temperature. OBJECTIVES To assess the effects of modest cooling therapies (defined as any drug or physical therapy aimed at maintaining body temperature between 35 degrees C and 37.5 degrees C) when applied to patients in the first week after traumatic brain injury. SEARCH STRATEGY We searched the Cochrane Injuries Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 3), MEDLINE (1950 to 2008), EMBASE (1980 to 2008), the National Research Register, Zetoc and the Current Controlled Trials MetaRegister of controlled trials. We also contacted investigators, pharmaceutical companies and the manufacturers of cooling equipment. The searches were conducted August to September 2007 and updated in April 2008. SELECTION CRITERIA All completed randomised, controlled or placebo-controlled trials published or unpublished, where modest cooling therapies were applied in the first week after traumatic brain injury. DATA COLLECTION AND ANALYSIS Two authors independently searched for relevant trials. MAIN RESULTS We were unable to find any randomised, placebo-controlled trials of modest cooling therapies after traumatic brain injury. AUTHORS' CONCLUSIONS There is no evidence that interventions aimed at reducing body temperature to between 35 degrees C and 37.5 degrees C in the first week after TBI improves patient outcomes. Trials designed to explore the effect of these interventions on patient-centred outcomes are needed.
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Affiliation(s)
- Manoj Saxena
- Intensive Care, St George Hospital, Gray St, Kogarah, Sydney, NSW, Australia, 2217.
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Harris B, Andrews P. Intranasal selective brain cooling in pigs. Resuscitation 2008; 78:102-3. [PMID: 18482791 DOI: 10.1016/j.resuscitation.2008.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 02/26/2008] [Indexed: 10/22/2022]
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Therapeutic hypothermia for global and focal ischemic brain injury--a cool way to improve neurologic outcomes. Neurologist 2008; 13:331-42. [PMID: 18090711 DOI: 10.1097/nrl.0b013e318154bb79] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Therapeutic hypothermia (TH) has been employed as a neuroprotective strategy for a wide array of clinical problems since the late 1940s. Animal studies have determined that the neuroprotective effect of hypothermia is pleiotropic, impacting many steps in both the ischemic cascade and reperfusion injury. Interest in the neuroprotective effects of TH for ischemic brain injury has been resurgent, fueled by both recent positive and negative clinical trials. A review of preclinical and clinical reports on TH in adult patients is provided in this article. REVIEW SUMMARY Animal data and several large clinical studies of mild to moderate TH (32 degrees C-34 degrees C) for global cerebral ischemia describe favorable neurologic outcomes, with few adverse effects. However, clinical implementation for global ischemia remains poor. Some animal data support a role for TH in focal cerebral ischemia, if instituted soon after the onset of ischemia, and in the setting of reperfusion. Clinical studies of TH for focal cerebral ischemia have so far been equivocal. The available data suggest that, despite sharing some common components in the ischemic cascade, focal and global cerebral ischemia are pathophysiologically disparate, and may respond to different neuroprotective strategies. CONCLUSION TH is a safe, effective neuroprotective strategy for global cerebral ischemia. Because of the neuroprotective efficacy of TH in adult comatose survivors of cardiac arrest, neurologists should advocate the implementation of this strategy. TH for focal ischemia is a promising therapeutic option, but requires more basic and clinical investigation.
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Harris B, Andrews P, Marshall I, Robinson T, Murray G. Forced convective head cooling device reduces human cross-sectional brain temperature measured by magnetic resonance: a non-randomized healthy volunteer pilot study. Br J Anaesth 2008; 100:365-72. [DOI: 10.1093/bja/aem405] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cooling Therapies after Neuronal Injury: Direct Brain Cooling and Systemic Hypothermia. Intensive Care Med 2007. [DOI: 10.1007/978-0-387-49518-7_63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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