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Inducing Brain Cooling Without Core Temperature Reduction in Pigs Using a Novel Nasopharyngeal Method: An Effectiveness and Safety Study.
de Paiva, Bernardo Lembo Conde; Bor-Seng-Shu, Edson; Silva, Eliezer; Barreto, Ícaro Barros Miranda; de Lima Oliveira, Marcelo; Ferreira, Raphael Einsfeld Simões; Cavalcanti, Alexandre Biasi; Teixeira, Manoel Jacobsen.
Afiliação
  • 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.
  • Bor-Seng-Shu E; Neurocritical Care Unit, Hospital Santa Paula, São Paulo, SP, Brazil. bernardo@floecorp.com.
  • Silva E; Neurology Department, School of Medicine, University of São Paulo, Avenida Moema, 170, Cj. 83 - Moema, São Paulo, SP, CEP: 04077-020, Brazil.
  • Barreto ÍBM; Neurocritical Care Unit, Hospital Santa Paula, São Paulo, SP, Brazil.
  • de Lima Oliveira M; Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Ferreira RES; Neurocritical Care Unit, Hospital Santa Paula, São Paulo, SP, Brazil.
  • Cavalcanti AB; Neurology Department, School of Medicine, University of São Paulo, Avenida Moema, 170, Cj. 83 - Moema, São Paulo, SP, CEP: 04077-020, Brazil.
  • Teixeira MJ; Neurocritical Care Unit, Hospital Santa Paula, São Paulo, SP, Brazil.
Neurocrit Care ; 32(2): 564-574, 2020 04.
Article em En | MEDLINE | ID: mdl-31317319
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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Temperatura Corporal / Encéfalo / Nasofaringe / Hipotermia Induzida Limite: Animals Idioma: En Revista: Neurocrit Care Assunto da revista: NEUROLOGIA / TERAPIA INTENSIVA Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Temperatura Corporal / Encéfalo / Nasofaringe / Hipotermia Induzida Limite: Animals Idioma: En Revista: Neurocrit Care Assunto da revista: NEUROLOGIA / TERAPIA INTENSIVA Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos