Rapid induction of COOLing in stroke patients: A randomised pilot study comparing cold infusions with nasopharyngeal cooling. Critical Care, Oct. 2014, 18:582
Poli, S., et al.
http://ccforum.com/content/pdf/s13054-014-0582-1.pdf
Induction methods for therapeutic cooling are under investigated. We compared the effectiveness and safety of cold infusions (CI) and nasopharyngeal cooling (NPC) used for cooling induction in stroke patients. A prospective, open-label, randomised (1:1), single-centre pilot trial with partially blinded safety endpoint assessment was conducted at the neurointensive care unit of Heidelberg University. Intubated stroke patients with an indication for therapeutic cooling and an intracranial pressure (ICP)/temperature brain probe were randomly assigned to CI (4?C, 2L at 4L/h) or NPC (60L/min for 1?h). Results: Of 221 patients screened, 20 were randomized within 5 months. Conclusions: In intubated stroke patients, brain cooling is faster during CI than during NPC. Importantly, contrary to previous expectations, brain cooling stopped soon after CI cessation. Oesophageal but neither bladder nor rectal temperature is suited as surrogate for brain temperature during CI and NPC. Several severe adverse events in CI and in NPC demand further studying of safety.
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