Brain temperature and limits on transcranial cooling in humans: quantitative modeling results

Nelson, David A.; Nunneley, Sarah A.

doi:10.1007/s004210050431

Cited by 122 publications

(97 citation statements)

References 29 publications

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“…In contrast to other studies [12,20,22], the brain temperature in our evaluation was not consistently higher than in the arterial blood or in the urinary bladder. Nevertheless, monitoring of the brain temperature with thermistors in the ventricular system or in the deep brain parenchyma (at least 2 cm below the cortical surface [13]) is essential to study the effectiveness of new devices for selective cerebral cooling.…”

Section: Discussioncontrasting

confidence: 99%

“…The idea to develop new devices for selective neuroprotective cooling of the brain parenchyma has already been published [12,[26][27][28][29][30][31][32]. In each of the studies, the device became more specific and smaller [33].…”

Section: Discussionmentioning

confidence: 99%

“…Compared to an intravascular cooling method, which is efficient and fast, but invasive and with several relevant side effects such as venous thrombosis or cause of infections, the advantage of a local cooling device becomes obvious. For specific cooling of the deep brain, head caps are not efficient [12][13][14], whereas neck pads covering bilateral the carotid triangle decrease the brain temperature in a mathematical simulation [13,15]. In a previous study, we simulated cerebral temperature behavior by applying different cooling devices [13].…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Resistant Fever: New Method of Local Cerebral Cooling

et al. 2010

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Background Fever in neurocritical care patients is common and has a negative impact on neurological outcome. The purpose of this prospective observational study was (1) to evaluate the practicability of cooling with newly developed neck pads in the daily setting of neurointensive care unit (NICU) patients and (2) to evaluate its effectiveness as a surrogate endpoint to indicate the feasibility of neck cooling as a new method for intractable fever. Methods Nine patients with ten episodes of intractable fever and aneurysmal subarachnoid hemorrhage were treated with one of two different shapes of specifically adapted cooling neck pads. Temperature values of the brain, blood, and urinary bladder were taken close meshed after application of the cooling neck pads up to hour 8.Results The brain, blood, and urinary bladder temperatures decreased significantly from hour 0 to a minimum in hour 5 (P < 0.01). After hour 5, instead of continuous cooling in all the patients, the temperature of all the three sites remounted. Conclusion This study showed the practicability of local cooling for intractable fever using the newly developed neck pads in the daily setting of NICU patients.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of Resistant Fever: New Method of Local Cerebral Cooling

et al. 2010

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“…Six different studies in the literature on human head heat transfer were examined (Nelson and Nunneley 1998, Fiala et al 1999, Xu et al 1999, Diao et al 2002, Dennis et al 2003 and mean value and range of geometry and tissue properties were determined. The mean values of these properties are used to define our standard head model (table 1).…”

Section: Methodsmentioning

confidence: 99%

Modelling of temperature and perfusion during scalp cooling

2005

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Hair loss is a feared side effect of chemotherapy treatment. It may be prevented by cooling the scalp during administration of cytostatics. The supposed mechanism is that by cooling the scalp, both temperature and perfusion are diminished, affecting drug supply and drug uptake in the hair follicle. However, the effect of scalp cooling varies strongly. To gain more insight into the effect of cooling, a computer model has been developed that describes heat transfer in the human head during scalp cooling. Of main interest in this study are the mutual influences of scalp temperature and perfusion during cooling. Results of the standard head model show that the temperature of the scalp skin is reduced from 34.4 • C to 18.3 • C, reducing tissue blood flow to 25%. Based upon variations in both thermal properties and head anatomies found in the literature, a parameter study was performed. The results of this parameter study show that the most important parameters affecting both temperature and perfusion are the perfusion coefficient Q 10 and the thermal resistances of both the fat and the hair layer. The variations in the parameter study led to skin temperature ranging from 10.1 • C to 21.8 • C, which in turn reduced relative perfusion to 13% and 33%, respectively.

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“…Noninvasive methods most commonly used are cooling caps and helmets. However, theoretical analyses (11,44,60) and empirical measurements (8,35) suggest that such measures are effective in reducing the temperature in the superficial cerebral regions, but not in deep brain structures.…”

mentioning

confidence: 99%

A theoretical model of selective cooling using intracarotid cold saline infusion in the human brain

Konstas¹,

Neimark²,

Laine³

et al. 2007

Journal of Applied Physiology

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Konstas AA, Neimark MA, Laine AF, Pile-Spellman J. A theoretical model of selective cooling using intracarotid cold saline infusion in the human brain. J Appl Physiol 102: 1329 -1340, 2007. First published December 14, 2006; doi:10.1152/japplphysiol.00805.2006.-A threedimensional mathematical model was developed to examine the transient and steady-state temperature distribution in the human brain during selective brain cooling (SBC) by unilateral intracarotid freezing-cold saline infusion. To determine the combined effect of hemodilution and hypothermia from the cold saline infusion, data from studies investigating the effect of these two parameters on cerebral blood flow (CBF) were pooled, and an analytic expression describing the combined effect of the two factors was derived. The Pennes bioheat equation used the thermal properties of the different cranial layers and the effect of cold saline infusion on CBF to propagate the evolution of brain temperature. A healthy brain and a brain with stroke (ischemic core and penumbra) were modeled. CBF and metabolic rate data were reduced to simulate the core and penumbra. Simulations using different saline flow rates were performed. The results suggested that a flow rate of 30 ml/min is sufficient to induce moderate hypothermia within 10 min in the ipsilateral hemisphere. The brain with stroke cooled to lower temperatures than the healthy brain, mainly because the stroke limited the total intracarotid blood flow. Gray matter cooled twice as fast as white matter. The continuously falling hematocrit was the main time-limiting factor, restricting the SBC to a maximum of 3 h. The study demonstrated that SBC by intracarotid saline infusion is feasible in humans and may be the fastest method of hypothermia induction. therapeutic hypothermia; ischemic stroke; spatial and temporal brain temperature distributions THE CENTRAL NERVOUS SYSTEM is vulnerable to focal and global ischemia resulting from acute ischemic stroke (63) and cardiac arrest (21). Therapeutic hypothermia has been repeatedly shown to be effective in limiting the damage of global and focal ischemia in animal models and clinical studies (6,21).In most clinical studies, hypothermia is induced by surface cooling. Although this is the simplest and most cost-effective option for inducing hypothermia (14), it has two major drawbacks. 1) Several hours are required to reach the target body core temperature. All studies report a 3-to 7-h period for cooling to 32-34°C (26, 52); however, endovascular systemic cooling may be able to accelerate the rate of cooling and improve the efficacy of hypothermia (15).2) The incidence of adverse effects, such as impaired immune function, decreased cardiac output, pneumonia, and cardiac arrhythmias/bradycardias, is high (14, 31). Selective brain cooling (SBC) without reducing body core temperature can theoretically address both problems of whole body cooling.Different methods for SBC have been reported (18). Noninvasive methods most commonly used are cooling caps and helmets. However, th...

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Brain temperature and limits on transcranial cooling in humans: quantitative modeling results

Cited by 122 publications

References 29 publications

Treatment of Resistant Fever: New Method of Local Cerebral Cooling

Treatment of Resistant Fever: New Method of Local Cerebral Cooling

Modelling of temperature and perfusion during scalp cooling

A theoretical model of selective cooling using intracarotid cold saline infusion in the human brain

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