Inducing Brain Cooling Without Core Temperature Reduction in Pigs Using a Novel Nasopharyngeal Method: An Effectiveness and Safety Study.

Autor: de Paiva BLC; Neurology Department, School of Medicine, University of São Paulo, Avenida Moema, 170, Cj. 83 - Moema, São Paulo, SP, CEP: 04077-020, Brazil. bernardo@floecorp.com.; Neurocritical Care Unit, Hospital Santa Paula, São Paulo, SP, Brazil. bernardo@floecorp.com., Bor-Seng-Shu E; Neurology Department, School of Medicine, University of São Paulo, Avenida Moema, 170, Cj. 83 - Moema, São Paulo, SP, CEP: 04077-020, Brazil.; Neurocritical Care Unit, Hospital Santa Paula, São Paulo, SP, Brazil., Silva E; Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil., Barreto ÍBM; Neurocritical Care Unit, Hospital Santa Paula, São Paulo, SP, Brazil., de Lima Oliveira M; Neurology Department, School of Medicine, University of São Paulo, Avenida Moema, 170, Cj. 83 - Moema, São Paulo, SP, CEP: 04077-020, Brazil.; Neurocritical Care Unit, Hospital Santa Paula, São Paulo, SP, Brazil., Ferreira RES; Neurocritical Care Unit, Hospital Santa Paula, São Paulo, SP, Brazil.; Research Centre, Centro Universitário São Camilo, São Paulo, SP, Brazil., Cavalcanti AB; Research Institute, Hospital do Coração (HCor), São Paulo, SP, Brazil., Teixeira MJ; Neurology Department, School of Medicine, University of São Paulo, Avenida Moema, 170, Cj. 83 - Moema, São Paulo, SP, CEP: 04077-020, Brazil.
Jazyk: angličtina
Zdroj: Neurocritical care [Neurocrit Care] 2020 Apr; Vol. 32 (2), pp. 564-574.
DOI: 10.1007/s12028-019-00789-2
Abstrakt: Background: Acute brain lesions constitute an alarming public health concern. Neuroprotective therapies have been implemented to stabilize, prevent, or reduce brain lesions, thus improving neurological outcomes and survival rates. Hypothermia is the most effective approach, mainly attributed to the reduction in cellular metabolic activity. Whole-body cooling is currently implemented by healthcare professionals; however, adverse events are frequent, limiting the potential benefits of therapeutic hypothermia. Therefore, selective methods have been developed to reduce adverse events while delivering neuroprotection. Nasopharyngeal approaches are the safest and most effective methods currently considered. Our primary objective was to determine the effects of a novel nasopharyngeal catheter on the brain temperature of pigs.
Methods: In this prospective, non-randomized, interventional experimental trial, 10 crossbred pigs underwent nasopharyngeal cooling for 60 min followed by 15 min of rewarming. Nasopharyngeal catheters were inserted into the left nostril and properly positioned at the nasopharyngeal cavity.
Results: Nasopharyngeal cooling was associated with a decrease in brain temperature, which was more significant in the left cerebral hemisphere (p = 0.01). There was a reduction of 1.47 ± 0.86 °C in the first 5 min (p < 0.001), 2.45 ± 1.03 °C within 10 min (p < 0.001), and 4.45 ± 1.36 °C after 1 h (p < 0.001). The brain-core gradient was 4.57 ± 0.87 °C (p < 0.001). Rectal, esophageal, and pulmonary artery temperatures and brain and systemic hemodynamic parameters, remained stable during the procedure. Following brain cooling, values of oxygen partial pressure in brain tissue significantly decreased. No mucosal lesions were detected during nasal, pharyngeal, or oral inspection after nasopharyngeal catheter removal.
Conclusions: In this study, a novel nasopharyngeal cooling catheter effectively induced and maintained exclusive brain cooling when combined with effective counter-warming methods. Exclusive brain cooling was safe with no device-related local or systemic complications and may be desired in selected patient populations.
Databáze: MEDLINE
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