Log in | Register

Brain temperature in volunteers subjected to intranasal cooling

L. Covaciu| J. Weis| C. Bengtsson| M. Allers| A. Lunderquist| H. Ahlström| S. Rubertsson
Original
Volume 37, Issue 8 / August , 2011

Pages 1277 - 1284

Abstract

Purpose

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

Methods

Intranasal balloons catheters circulated with saline at 20°C were applied for 60 min in ten awake volunteers. No sedation was used. Brain temperature changes were measured and mapped using MR spectroscopic imaging (MRSI) and phase-mapping techniques. Heart rate and blood pressure were monitored throughout the experiment. Rectal temperature was measured before and after the cooling. Mini Mental State Examination (MMSE) test and nasal inspection were done before and after the cooling. Questionnaires about the subjects’ personal experience were completed after the experiment.

Results

Brain temperature decrease measured by MRSI was −1.7 ± 0.8°C and by phase-mapping −1.8 ± 0.9°C (n = 9) at the end of cooling. Spatial distribution of temperature changes was relatively uniform. Rectal temperature decreased by −0.5 ± 0.3°C (n = 5). The physiological parameters were stable and no shivering was reported. The volunteers remained alert during cooling and no cognitive dysfunctions were apparent in the MMSE test. Postcooling nasal examination detected increased nasal secretion in nine of the ten volunteers. Volunteers’ acceptance of the method was good.

Conclusion

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

Keywords

References

  1. Polderman KH (2008) Induced hypothermia and fever control for prevention and treatment of neurological injuries. Lancet 371:1955–1969
    • View reference on PubMed
    • View reference on publisher's website
  2. Holzer M (2010) Targeted temperature management for comatose survivors of cardiac arrest. N Engl J Med 363:1256–1264
    • View reference on PubMed
    • View reference on publisher's website
  3. Sahuquillo J, Pérez-Bárcena J, Biestro A, Zavala E, Merino MA, Vilalta A, Poca MA, Garnacho A, Adalia R, Homar J, LLompart-Pou JA (2009) Intravascular cooling for rapid induction of moderate hypothermia in severely head-injured patients: results of a multicenter study (IntraCool). Intensive Care Med 35:890–898
  4. Wang H, Olivero W, Lanzino G, Elkins W, Rose J, Honings D, Rodde M, Burnham J, Wang D (2004) Rapid and selective cerebral hypothermia achieved using a cooling helmet. J Neurosurg 100:272–277
    • View reference on PubMed
    • View reference on publisher's website
  5. Harris BA, Andrews PJ, Murray GD (2007) Enhanced upper respiratory tract airflow and head fanning reduce brain temperature in brain-injured, mechanically ventilated patients: a randomized, crossover, factorial trial. Br J Anaesth 98:93–99
    • View reference on PubMed
    • View reference on publisher's website
  6. Castrén M, Nordberg P, Svensson L, Taccone F, Vincent JL, Desruelles D, Eichwede F, Mols P, Schwab T, Vergnion M, Storm C, Pesenti A, Pachl J, Guérisse F, Elste T, Roessler M, Fritz H, Durnez P, Busch HJ, Inderbitzen B, Barbut D (2010) Intra-arrest trans-nasal evaporative cooling: a randomized pre-hospital multicenter study PRINCE (pre-ROSC intra nasal cooling effectiveness). Circulation 122:729–736
    • View reference on PubMed
    • View reference on publisher's website
  7. Antonelli M, Azoulay E, Bonten M, Chastre J, Citerio G, Conti G, De Backer D, Lemaire F, Gerlach H, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Pugin J, Wernerman J, Zhang H (2010) Year in review in intensive care medicine 2009: II. Neurology, cardiovascular, experimental, pharmacology and sedation, communication and teaching. Intensive Care Med 36:412–427
  8. Dmello D, Cruz-Flores S, Matuschak GM (2010) Moderate hypothermia with intracranial pressure monitoring as a therapeutic paradigm for the management of acute liver failure: a systematic review. Intensive Care Med 36:210–213
  9. Harris BA, Andrews PJ, Marshall I, Robinson TM, Murray GD (2008) 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 100:365–372
    • View reference on PubMed
    • View reference on publisher's website
  10. Kuroda K (2005) Non-invasive MR thermography using the water proton chemical shift. Int J Hyperthermia 21:547–560
    • View reference on PubMed
    • View reference on publisher's website
  11. Viola R, Pauly KB (2008) MR thermometry. J Magn Reson Imaging 27:376–390
    • View reference on publisher's website
  12. Covaciu L, Allers M, Enblad P, Lunderquist A, Wieloch T, Rubertsson S (2008) Intranasal selective brain cooling in pigs. Resuscitation 76:83–88
    • View reference on PubMed
    • View reference on publisher's website
  13. Covaciu L, Allers M, Lunderquist A, Rubertsson S (2010) Intranasal cooling with or without intravenous cold fluids during and after cardiac arrest in pigs. Acta Anaesthesiol Scand 54:494–501
    • View reference on PubMed
    • View reference on publisher's website
  14. Weis J, Covaciu L, Rubertsson S, Allers M, Lunderquist A, Ahlström H (2009) Noninvasive monitoring of brain temperature during mild hypothermia. Magn Reson Imag 27:923–932
    • View reference on publisher's website
  15. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198. doi:10.1016/0022-3956(75)90026-6
    • View reference on PubMed
    • View reference on publisher's website
  16. Weis J, Ericsson A, Hemmingsson A (1999) Chemical shift artifact-free microscopy: spectroscopic microimaging of the human skin. Magn Reson Med 41:904–908
    • View reference on PubMed
    • View reference on publisher's website
  17. Marshall I, Karaszewski B, Wardlaw JM, Cvoro V, Wartolowska K, Armitage PA, Carpenter T, Bastin ME, Farrall A, Haga K (2006) Measurement of regional brain temperature using proton spectroscopic imaging: validation and application to acute ischemic stroke. Magn Reson Imaging 24:699–706
    • View reference on PubMed
    • View reference on publisher's website
  18. Zenker W, Kubik S (1996) Brain cooling in humans–anatomical considerations. Anat Embryol 193:1–13
    • View reference on PubMed
    • View reference on publisher's website
  19. Pretorius T, Gagnon DD, Giesbrecht GG (2010) Core cooling and thermal responses during whole-head, facial, and dorsal immersion in 17°C water. Appl Physiol Nutr Metab 35:627–634
    • View reference on PubMed
    • View reference on publisher's website
  20. Schaller BJ, Sandu N, Cornelius JF, Filis A, Perez-Pinzon MA, Trigemino-Cardiac-Reflex-Examination-Group (TCREG) (2009) Oxygen-conserving implications of the trigemino-cardiac reflex in the brain: the molecular basis of neuroprotection? Mol Med 15:125–126
    • View reference on PubMed
    • View reference on publisher's website
  21. Yarnitsky D, Goor-Aryeh I, Bajwa ZH, Ransil BI, Cutrer FM, Sottile A, Burstein R (2003) 2003 Wolff award: possible parasympathetic contributions to peripheral and central sensitization during migraine. Headache 43:704–714
    • View reference on PubMed
    • View reference on publisher's website
  22. Romanovsky AA (2004) Do fever and anapyrexia exist? Analysis of set point based definitions. Am J Physiol Regul Integr Comp Physiol 287:992–995
    • View reference on publisher's website
  23. Sund-Levander M, Forsberg C, Wahren LK (2002) Normal oral, rectal, tympanic and axillary body temperature in adult men and women: a systematic literature review. Scand J Caring Sci 16:122–128
    • View reference on PubMed
    • View reference on publisher's website
  24. Yablonskiy DA, Ackerman JJ, Raichle ME (2000) Coupling between changes in human brain temperature and oxidative metabolism during prolonged visual stimulation. Proc Natl Acad Sci U S A 97:7603–7608
    • View reference on PubMed
    • View reference on publisher's website
  25. Mellergard P (1995) Intracerebral temperature in neurosurgical patients: intracerebral temperature gradients and relationships to consciousness level. Surg Neurol 43:91–95
    • View reference on PubMed
    • View reference on publisher's website
  26. Sessler DI (2009) Defeating normal thermoregulatory defences: induction of therapeutic hypothermia. Stroke 40:e614–e621
    • View reference on PubMed
    • View reference on publisher's website
  27. Frank SM, Raja SN, Bulcao CF, Goldstein DS (1999) Relative contribution of core and cutaneous temperatures to thermal comfort and autonomic responses in humans. J Appl Physiol 86:1588–1593
    • View reference on PubMed
  28. Stone JG, Young WL, Smith CR, Solomon RA, Wald A, Ostapkovich N, Shrebnick DB (1995) Do standard monitoring sites reflect true brain temperature when profound hypothermia is rapidly induced and reversed? Anesthesiology 82:344–351
    • View reference on PubMed
    • View reference on publisher's website
  29. Fechir M, Schlereth T, Kritzmann S, Balon S, Pfeifer N, Geber C, Breimhorst M, Eberle T, Gamer M, Birklein F (2008) Stress and thermoregulation: different sympathetic responses and different effects on experimental pain. Eur J Pain 13:935–941
    • View reference on publisher's website
  30. Muehlhan M, Lueken U, Wittchen HU, Kirschbaum C (2010) The scanner as a stressor: evidence from subjective and neuroendocrine stress parameters in the time course of a functional magnetic resonance imaging session. Int J Psychophysiol 79(2):118–126
    • View reference on PubMed
    • View reference on publisher's website
  31. Rubinstein EH, Sessler DI (1990) Skin-surface temperature gradients correlate with fingertip blood flow in humans. Anesthesiology 73:541–545
    • View reference on PubMed
    • View reference on publisher's website
  32. Coleshaw SR, Van Someren RN, Wolff AH, Davis HM, Keatinge WR (1983) Impaired memory registration and speed of reasoning caused by low body temperature. J Appl Physiol 55:27–31
    • View reference on PubMed
  33. Shellock FG (2000) Radiofrequency energy-induced heating during MR procedures: a review. J Magn Reson Imaging 12:30–36
    • View reference on PubMed
    • View reference on publisher's website

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement