Non-invasive Monitoring of Brain Temperature during Rapid Selective Brain Cooling by Zero-Heat-Flux Thermometry
Introduction: Selective brain cooling can minimize systemic complications associated with whole body cooling but maximize neuroprotection. Recently, we developed a non-invasive, portable and inexpensive system for selectively cooling the brain rapidly and demonstrated its safety and efficacy in porcine models. However, the widespread application of this technique in the clinical setting requires a reliable, non-invasive and accurate method for measuring local brain temperature so that cooling and rewarming rates can be controlled during targeted temperature management. In this study, we evaluate the ability of a zero-heat-flux SpotOn sensor, mounted on three different locations, to measure brain temperature during selective brain cooling in a pig model. Computed Tomography (CT) was used to determine the position of the SpotOn patches relative to the brain at different placement locations.
Methods and Results: Experiments were conducted on two juvenile pigs. Body temperature was measured using a rectal temperature probe while brain temperature with an intraparenchymal thermocouple probe. A SpotOn patch was taped to the pig’s head at three different locations: 1-2 cm posterior (Location #1, n=1), central forehead (Location #2, n=1); and 1-2 cm anterior and lateral to the bregma i.e., above the eye on the forehead (Location #3, n=1). This cooling system was able to rapidly cool the brain temperature to 33.7 ± 0.2°C within 15 minutes, and maintain the brain temperature within 33-34°C for 4-6 hours before slowly rewarming to 34.8 ± 1.1°C from 33.7 ± 0.2°C, while maintaining the core body temperature (as per rectal temperature probe) above 36°C. We measured a mean bias of -1.1°C, -0.2°C and 0.7°C during rapid cooling in induction phase, maintenance and rewarming phase, respectively. Amongst the three locations, location #2 had the highest correlation (R2 = 0.8) between the SpotOn sensor and the thermocouple probe.Conclusions: This SBC method is able to tightly control the rewarming rate within 0.52 ± 0.20°C/h. The SpotOn sensor placed on the center of the forehead provides a good measurement of brain temperature in comparison to the invasive needle probe.
Arrich, Jasmin, Michael Holzer, Christof Havel, Marcus Müllner, and Harald Herkner. “Hypothermia for Neuroprotection in Adults after Cardiopulmonary Resuscitation.” Cochrane Database of Systematic Reviews (February 15, 2016). doi:10.1002/14651858.cd004128.pub4.
Dietrich, W. Dalton, and Helen M. Bramlett. “Therapeutic Hypothermia and Targeted Temperature Management in Traumatic Brain Injury: Clinical Challenges for Successful Translation.” Brain Research 1640 (June 2016): 94–103. doi:10.1016/j.brainres.2015.12.034.
Schubert, Armin. “Side Effects of Mild Hypothermia.” Journal of Neurosurgical Anesthesiology 7, no. 2 (April 1995): 139–147. doi:10.1097/00008506-199504000-00021.
Fazel Bakhsheshi, Mohammad, Yong Wang, Lynn Keenliside, and Ting-Yim Lee. “A New Approach to Selective Brain Cooling by a Ranque-Hilsch Vortex Tube.” Intensive Care Medicine Experimental 4, no. 1 (September 29, 2016). doi:10.1186/s40635-016-0102-5.
Raboel, P. H., J. Bartek, M. Andresen, B. M. Bellander, and B. Romner. “Intracranial Pressure Monitoring: Invasive Versus Non-Invasive Methods—A Review.” Critical Care Research and Practice 2012 (2012): 1–14. doi:10.1155/2012/950393.
Eshraghi, Yashar, Vivian Nasr, Ivan Parra-Sanchez, Albert Van Duren, Mark Botham, Thomas Santoscoy, and Daniel I. Sessler. “An Evaluation of a Zero-Heat-Flux Cutaneous Thermometer in Cardiac Surgical Patients.” Anesthesia & Analgesia 119, no. 3 (September 2014): 543–549. doi:10.1213/ane.0000000000000319.
Iden, T., E.P. Horn, B. Bein, R. Bohm, J. Beese, and J. Hocker, “Intraoperative temperature monitoring with zero heat flux technology (3M SpotOn sensor) in comparison with sublingual and nasopharyngeal temperature: An observational study.” Eur J Anaesthesiol, 32, no. 6 (Oct 2015): 387-91. doi:10.1097/eja.0000000000000344.
Guschlbauer, Maria, Alexandra C. Maul, Xiaowei Yan, Holger Herff, Thorsten Annecke, Anja Sterner-Kock, Bernd W. Böttiger, and Daniel C. Schroeder. “Zero-Heat-Flux Thermometry for Non-Invasive Measurement of Core Body Temperature in Pigs.” Edited by Ulrike Gertrud Munderloh. PLOS ONE 11, no. 3 (March 3, 2016): e0150759. doi:10.1371/journal.pone.0150759.
Brajkovic, Dragan, and Michel B. Ducharme. “Confounding Factors in the Use of the Zero-Heat-Flow Method for Non-Invasive Muscle Temperature Measurement.” European Journal of Applied Physiology 94, no. 4 (April 28, 2005): 386–391. doi:10.1007/s00421-005-1336-1.
Martin Bland, J., and DouglasG. Altman. “Statistical Methods for Assessing Agreement between Two Methods of Clinical Measurement.” The Lancet 327, no. 8476 (February 1986): 307–310. doi:10.1016/s0140-6736(86)90837-8.
Mcilvoy, Laura. “Comparison of Brain Temperature to Core Temperature.” Journal of Neuroscience Nursing 36, no. 1 (February 2004): 23–31. doi:10.1097/01376517-200402000-00004.
Rumana, Christopher S., Shankar P. Gopinath, Masahiko Uzura, Alex B. Valadka, and Claudia S. Robertson. “Brain Temperature Exceeds Systemic Temperature in Head-Injured Patients.” Critical Care Medicine 26, no. 3 (March 1998): 562–567. doi:10.1097/00003246-199803000-00032.
Bakhsheshi, Mohammad Fazel, Mamadou Diop, Keith St. Lawrence, and Ting-Yim Lee. “Monitoring Brain Temperature by Time-Resolved Near-Infrared Spectroscopy: Pilot Study.” Journal of Biomedical Optics 19, no. 5 (May 9, 2014): 057005. doi:10.1117/1.jbo.19.5.057005.
Chung, S H, A E Cerussi, S I Merritt, J Ruth, and B J Tromberg. “Non-Invasive Tissue Temperature Measurements Based on Quantitative Diffuse Optical Spectroscopy (DOS) of Water.” Physics in Medicine and Biology 55, no. 13 (June 15, 2010): 3753–3765. doi:10.1088/0031-9155/55/13/012.
Weis, Jan, Lucian Covaciu, Sten Rubertsson, Mats Allers, Anders Lunderquist, Francisco Ortiz-Nieto, and Håkan Ahlström. “Phase-Difference and Spectroscopic Imaging for Monitoring of Human Brain Temperature During Cooling.” Magnetic Resonance Imaging 30, no. 10 (December 2012): 1505–1511. doi:10.1016/j.mri.2012.06.004.
Fatar, Marc, Mark Stroick, Martin Griebe, Angelika Alonso, Michael G. Hennerici, and Michael Daffertshofer. “Brain Temperature During 340-kHz Pulsed Ultrasound Insonation.” Stroke 37, no. 7 (July 2006): 1883–1887. doi:10.1161/01.str.0000226737.47319.aa.
Karathanasis, Konstantinos T., Ioannis A. Gouzouasis, Irene S. Karanasiou, George Stratakos, and Nikolaos K. Uzunoglu. “Passive Focused Monitoring and Non-Invasive Irradiation of Head Tissue Phantoms at Microwave Frequencies.” 2008 8th IEEE International Conference on BioInformatics and BioEngineering (October 2008). doi:10.1109/bibe.2008.4696770.
Yamakage, Michiaki, and Akiyoshi Namiki. “Deep Temperature Monitoring Using a Zero-Heat-Flow Method.” Journal of Anesthesia 17, no. 2 (May 1, 2003): 108–115. doi:10.1007/s005400300026.
Levick, A, D Land, and J Hand. “Validation of Microwave Radiometry for Measuring the Internal Temperature Profile of Human Tissue.” Measurement Science and Technology 22, no. 6 (May 13, 2011): 065801. doi:10.1088/0957-0233/22/6/065801.
Kirk, Danielle, Timothy Rainey, Andy Vail, and Charmaine Childs. “Infra-Red Thermometry: The Reliability of Tympanic and Temporal Artery Readings for Predicting Brain Temperature after Severe Traumatic Brain Injury.” Critical Care 13, no. 3 (2009): R81. doi:10.1186/cc7898.
Kitamura, Kei-Ichiro, Xin Zhu, Wenxi Chen, and Tetsu Nemoto. “Development of a New Method for the Noninvasive Measurement of Deep Body Temperature Without a Heater.” Medical Engineering & Physics 32, no. 1 (January 2010): 1–6. doi:10.1016/j.medengphy.2009.09.004.
van der Linden, J, R Ekroth, C Lincoln, W Pugsley, M Scallan, and H Tyden. “Is Cerebral Blood Flow/metabolic Mismatch during Rewarming a Risk Factor after Profound Hypothermic Procedures in Small Children?” European Journal of Cardio-Thoracic Surgery 3, no. 3 (1989): 209–215. doi:10.1016/1010-7940(89)90068-7.
Enomoto, Sakae, Bradley J. Hindman, Franklin Dexter, Tom Smith, and Johann Cutkomp. “Rapid Rewarming Causes an Increase in the Cerebral Metabolic Rate for Oxygen That Is Temporarily Unmatched by Cerebral Blood Flow.” Anesthesiology 84, no. 6 (June 1996): 1392–1400. doi:10.1097/00000542-199606000-00016.
Shiozaki, Tadahiko, Hisashi Sugimoto, Mamoru Taneda, Hiroyoshi Yoshida, Atsushi Iwai, Toshiharu Yoshioka, and Tsuyoshi Sugimoto. “Effect of Mild Hypothermia on Uncontrollable Intracranial Hypertension after Severe Head Injury.” Survey of Anesthesiology 38, no. 4 (August 1994): 212. doi:10.1097/00132586-199408000-00021.
Povlishock, John T., and Enoch P. Wei. “Posthypothermic Rewarming Considerations Following Traumatic Brain Injury.” Journal of Neurotrauma 26, no. 3 (March 2009): 333–340. doi:10.1089/neu.2008.0604.
Rittenberger, Jon C., Stuart Friess, and Kees H. Polderman. “Emergency Neurological Life Support: Resuscitation Following Cardiac Arrest.” Neurocritical Care 23, no. S2 (October 5, 2015): 119–128. doi:10.1007/s12028-015-0171-4.
Peberdy, M. A., C. W. Callaway, R. W. Neumar, R. G. Geocadin, J. L. Zimmerman, M. Donnino, A. Gabrielli, et al. “Part 9: Post-Cardiac Arrest Care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.”Circulation 122, no. 18_suppl_3 (October 17, 2010): S768–S786. doi:10.1161/circulationaha.110.971002.
Fazel Bakhsheshi, Mohammad, Lynn Keenliside, and Ting-Yim Lee. “Rapid and Selective Brain Cooling Method Using Vortex Tube: A Feasibility Study.” The American Journal of Emergency Medicine 34, no. 5 (May 2016): 887–894. doi:10.1016/j.ajem.2016.02.001.
Cavallaro, Giacomo, Luca Filippi, Genny Raffaeli, Gloria Cristofori, Federico Schena, Elisa Agazzani, Ilaria Amodeo, et al. “Heart Rate and Arterial Pressure Changes During Whole-Body Deep Hypothermia.” ISRN Pediatrics 2013 (2013): 1–6. doi:10.1155/2013/140213.
Tortorici, Michael A., Patrick M. Kochanek, and Samuel M. Poloyac. “Effects of Hypothermia on Drug Disposition, Metabolism, and Response: A Focus of Hypothermia-Mediated Alterations on the Cytochrome P450 Enzyme System.” Critical Care Medicine 35, no. 9 (September 2007): 2196–2204. doi:10.1097/01.ccm.0000281517.97507.6e.
Rittenberger, Jon C., Kees H. Polderman, Wade S. Smith, and Scott D. Weingart. “Emergency Neurological Life Support: Resuscitation Following Cardiac Arrest.” Neurocritical Care 17, no. S1 (August 30, 2012): 21–28. doi:10.1007/s12028-012-9750-9.
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