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

Authors
  • de Paiva, Bernardo Lembo Conde1, 2
  • Bor-Seng-Shu, Edson1, 2
  • Silva, Eliezer3
  • Barreto, Ícaro Barros Miranda2
  • de Lima Oliveira, Marcelo1, 2
  • Ferreira, Raphael Einsfeld Simões2, 4
  • Cavalcanti, Alexandre Biasi5
  • Teixeira, Manoel Jacobsen1
  • 1 University of São Paulo, Avenida Moema, 170, Cj. 83 – Moema, São Paulo, SP, CEP: 04077-020, Brazil , São Paulo (Brazil)
  • 2 Hospital Santa Paula, São Paulo, SP, Brazil , São Paulo (Brazil)
  • 3 Hospital Israelita Albert Einstein, São Paulo, Brazil , São Paulo (Brazil)
  • 4 Centro Universitário São Camilo, São Paulo, SP, Brazil , São Paulo (Brazil)
  • 5 Hospital do Coração (HCor), São Paulo, SP, Brazil , São Paulo (Brazil)
Type
Published Article
Journal
Neurocritical Care
Publisher
Springer US
Publication Date
Jul 17, 2019
Volume
32
Issue
2
Pages
564–574
Identifiers
DOI: 10.1007/s12028-019-00789-2
Source
Springer Nature
Keywords
License
Yellow

Abstract

BackgroundAcute 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.MethodsIn 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.ResultsNasopharyngeal 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.ConclusionsIn 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.

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