Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 4/2007

Open Access 01-08-2007 | Research

Comparison of cooling methods to induce and maintain normo- and hypothermia in intensive care unit patients: a prospective intervention study

Authors: Cornelia W Hoedemaekers, Mustapha Ezzahti, Aico Gerritsen, Johannes G van der Hoeven

Published in: Critical Care | Issue 4/2007

Login to get access

Abstract

Background

Temperature management is used with increased frequency as a tool to mitigate neurological injury. Although frequently used, little is known about the optimal cooling methods for inducing and maintaining controlled normo- and hypothermia in the intensive care unit (ICU). In this study we compared the efficacy of several commercially available cooling devices for temperature management in ICU patients with various types of neurological injury.

Methods

Fifty adult ICU patients with an indication for controlled mild hypothermia or strict normothermia were prospectively enrolled. Ten patients in each group were assigned in consecutive order to conventional cooling (that is, rapid infusion of 30 ml/kg cold fluids, ice and/or coldpacks), cooling with water circulating blankets, air circulating blankets, water circulating gel-coated pads and an intravascular heat exchange system. In all patients the speed of cooling (expressed as°C/h) was measured. After the target temperature was reached, we measured the percentage of time the patient's temperature was 0.2°C below or above the target range. Rates of temperature decline over time were analyzed with one-way analysis of variance. Differences between groups were analyzed with one-way analysis of variance, with Bonferroni correction for multiple comparisons. A p < 0.05 was considered statistically significant.

Results

Temperature decline was significantly higher with the water-circulating blankets (1.33 ± 0.63°C/h), gel-pads (1.04 ± 0.14°C/h) and intravascular cooling (1.46 ± 0.42°C/h) compared to conventional cooling (0.31 ± 0.23°C/h) and the air-circulating blankets (0.18 ± 0.2°C/h) (p < 0.01). After the target temperature was reached, the intravascular cooling device was 11.2 ± 18.7% of the time out of range, which was significantly less compared to all other methods.

Conclusion

Cooling with water-circulating blankets, gel-pads and intravascular cooling is more efficient compared to conventional cooling and air-circulating blankets. The intravascular cooling system is most reliable to maintain a stable temperature.
Appendix
Available only for authorised users
Literature
1.
Holzer M, The Hypothermia After Cardiac Arrest Study Group: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002, 346: 549-556. 10.1056/NEJMoa012689.CrossRef
2.
Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K: Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002, 346: 557-563. 10.1056/NEJMoa003289.CrossRefPubMed
3.
Holzer M, Bernard SA, Hachimi-Idrissi S, Roine RO, Sterz F, Mullner M: Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis. Crit Care Med. 2005, 33: 414-418. 10.1097/01.CCM.0000153410.87750.53.CrossRefPubMed
4.
Clifton GL, Miller ER, Choi SC, Levin HS, McCauley S, Smith KR, Muizelaar JP, Wagner FC, Marion DW, Luerssen TG, et al: Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med. 2001, 344: 556-563. 10.1056/NEJM200102223440803.CrossRefPubMed
5.
Polderman KH, Tjong Tjin Joe R, Peerdeman SM, Vandertop WP, Girbes AR: Effects of therapeutic hypothermia on intracranial pressure and outcome in patients with severe head injury. Intensive Care Med. 2002, 28: 1563-1573. 10.1007/s00134-002-1511-3.CrossRefPubMed
6.
Zhi D, Zhang S, Lin X: Study on therapeutic mechanism and clinical effect of mild hypothermia in patients with severe head injury. Surg Neurol. 2003, 59: 381-385. 10.1016/S0090-3019(03)00148-4.CrossRefPubMed
7.
McIntyre LA, Fergusson DA, Hebert PC, Moher D, Hutchison JS: Prolonged therapeutic hypothermia after traumatic brain injury in adults: a systematic review. JAMA. 2003, 289: 2992-2999. 10.1001/jama.289.22.2992.CrossRefPubMed
8.
Alderson P, Gadkary C, Signorini DF: Therapeutic hypothermia for head injury. Cochrane Database Syst Rev. 2004, CD001048-4
9.
Kilpatrick MM, Lowry DW, Firlik AD, Yonas H, Marion DW: Hyperthermia in the neurosurgical intensive care unit. Neurosurgery. 2000, 47: 850-855. 10.1097/00006123-200010000-00011.CrossRefPubMed
10.
Diringer MN, Reaven NL, Funk SE, Uman GC: Elevated body temperature independently contributes to increased length of stay in neurologic intensive care unit patients. Crit Care Med. 2004, 32: 1489-1495. 10.1097/01.CCM.0000129484.61912.84.CrossRefPubMed
11.
Polderman KH: Application of therapeutic hypothermia in the intensive care unit. Opportunities and pitfalls of a promising treatment modality – Part 2: Practical aspects and side effects. Intensive Care Med. 2004, 30: 757-769. 10.1007/s00134-003-2151-y.CrossRefPubMed
12.
Mayer SA, Kowalski RG, Presciutti M, Ostapkovich ND, McGann E, Fitzsimmons BF, Yavagal DR, Du YE, Naidech AM, Janjua NA, et al: Clinical trial of a novel surface cooling system for fever control in neurocritical care patients. Crit Care Med. 2004, 32: 2508-2515. 10.1097/01.CCM.0000147441.39670.37.CrossRefPubMed
13.
Carhuapoma JR, Gupta K, Coplin WM, Muddassir SM, Meratee MM: Treatment of refractory fever in the neurosciences critical care unit using a novel, water-circulating cooling device. A single-center pilot experience. J Neurosurg Anesthesiol. 2003, 15: 313-318. 10.1097/00008506-200310000-00004.CrossRefPubMed
14.
Zweifler RM, Voorhees ME, Mahmood MA, Parnell M: Magnesium sulfate increases the rate of hypothermia via surface cooling and improves comfort. Stroke. 2004, 35: 2331-2334. 10.1161/01.STR.0000141161.63181.f1.CrossRefPubMed
15.
Keller E, Imhof HG, Gasser S, Terzic A, Yonekawa Y: Endovascular cooling with heat exchange catheters: a new method to induce and maintain hypothermia. Intensive Care Med. 2003, 29: 939-943.PubMed
16.
Bernard S, Buist M, Monteiro O, Smith K: Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation. 2003, 56: 9-13. 10.1016/S0300-9572(02)00276-9.CrossRefPubMed
17.
Rajek A, Greif R, Sessler DI, Baumgardner J, Laciny S, Bastanmehr H: Core cooling by central venous infusion of ice-cold (4 degrees C and 20 degrees C) fluid: isolation of core and peripheral thermal compartments. Anesthesiology. 2000, 93: 629-637. 10.1097/00000542-200009000-00010.CrossRefPubMed
18.
Virkkunen I, Yli-Hankala A, Silfvast T: Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer's solution: a pilot study. Resuscitation. 2004, 62: 299-302. 10.1016/j.resuscitation.2004.04.003.CrossRefPubMed
19.
Polderman KH, Rijnsburger ER, Peerdeman SM, Girbes AR: Induction of hypothermia in patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluid. Crit Care Med. 2005, 33: 2744-2751. 10.1097/01.CCM.0000190427.88735.19.CrossRefPubMed
20.
Diringer MN: Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system. Crit Care Med. 2004, 32: 559-564. 10.1097/01.CCM.0000108868.97433.3F.CrossRefPubMed
21.
Dixon SR, Whitbourn RJ, Dae MW, Grube E, Sherman W, Schaer GL, Jenkins JS, Baim DS, Gibbons RJ, Kuntz RE, et al: Induction of mild systemic hypothermia with endovascular cooling during primary percutaneous coronary intervention for acute myocardial infarction. J Am Coll Cardiol. 2002, 40: 1928-1934. 10.1016/S0735-1097(02)02567-6.CrossRefPubMed
22.
Kliegel A, Losert H, Sterz F, Kliegel M, Holzer M, Uray T, Domanovits H: Cold simple intravenous infusions preceding special endovascular cooling for faster induction of mild hypothermia after cardiac arrest – a feasibility study. Resuscitation. 2005, 64: 347-351. 10.1016/j.resuscitation.2004.09.002.CrossRefPubMed
23.
Mayer S, Commichau C, Scarmeas N, Presciutti M, Bates J, Copeland D: Clinical trial of an air-circulating cooling blanket for fever control in critically ill neurologic patients. Neurology. 2001, 56: 292-298.CrossRefPubMed
24.
Mayer SA, Kowalski RG, Presciutti M, Ostapkovich ND, McGann E, Fitzsimmons BF, Yavagal DR, Du YE, Naidech AM, Janjua NA, et al: Clinical trial of a novel surface cooling system for fever control in neurocritical care patients. Crit Care Med. 2004, 32: 2508-2515. 10.1097/01.CCM.0000147441.39670.37.CrossRefPubMed
25.
Erickson RS, Kirklin SK: Comparison of ear-based, bladder, oral, and axillary methods for core temperature measurement. Crit Care Med. 1993, 21: 1528-1534. 10.1097/00003246-199310000-00022.CrossRefPubMed
26.
Giuliano KK, Scott SS, Elliot S, Giuliano AJ: Temperature measurement in critically ill orally intubated adults: a comparison of pulmonary artery core, tympanic, and oral methods. Crit Care Med. 1999, 27: 2188-2193. 10.1097/00003246-199910000-00020.CrossRefPubMed
27.
Lilly JK, Boland JP, Zekan S: Urinary bladder temperature monitoring: a new index of body core temperature. Crit Care Med. 1980, 8: 742-744. 10.1097/00003246-198012000-00010.CrossRefPubMed
28.
Robinson J, Charlton J, Seal R, Spady D, Joffres MR: Oesophageal, rectal, axillary, tympanic and pulmonary artery temperatures during cardiac surgery. Can J Anaesth. 1998, 45: 317-323.CrossRefPubMed
29.
Lefrant JY, Muller L, de La Coussaye JE, Benbabaali M, Lebris C, Zeitoun N, Mari C, Saissi G, Ripart J, Eledjam JJ: Temperature measurement in intensive care patients: comparison of urinary bladder, oesophageal, rectal, axillary, and inguinal methods versus pulmonary artery core method. Intensive Care Med. 2003, 29: 414-418.PubMed
Metadata
Title
Comparison of cooling methods to induce and maintain normo- and hypothermia in intensive care unit patients: a prospective intervention study
Authors
Cornelia W Hoedemaekers
Mustapha Ezzahti
Aico Gerritsen
Johannes G van der Hoeven
Publication date
01-08-2007
Publisher
BioMed Central
Published in
Critical Care / Issue 4/2007
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc6104

Other articles of this Issue 4/2007

Critical Care 4/2007 Go to the issue

Review

Clinical review: Sleep measurement in critical care patients: research and clinical implications

Commentary

Staffing level: a determinant of late-onset ventilator-associated pneumonia

Research

Involvement of Akt and endothelial nitric oxide synthase in ventilation-induced neutrophil infiltration: a prospective, controlled animal experiment

Review

Ethics review: 'Living wills' and intensive care – an overview of the American experience

Commentary

Why aren't we practising homogenized medicine?

Research

Staffing level: a determinant of late-onset ventilator-associated pneumonia