Table 4 Studies performing target temperature management in acute neurologic diseases

Abou-Chebl et al. [61]

TBI, IS, ICH

N: 15*

Age: 50 ± 17 y

Male: 40%

NIHSS: 26.7 ± 6.7

Naso-pharingeal cooling

Administration rate of 80 L/min for 1 h.

NICU

NR

Bladder, or rectal, or esophageal, or

pulmonary artery.

Brain

None

T_Ty decreased by 2.2 ± 2 °C during induction, with a drop of 0.65 ± 0.39 °C within 15 min (two outliers excluded).

During induction, T decreased by 1.4 ± 0.4 °C (by 0.53 ± 0.24 °C at 15 min) at the brain and by 1.1 ± 0.6 °C (by 0.43 ± 0.35 °C at 15 min) at core sites (bladder, rectal esophageal, or pulmonary artery).

Poli et al. [62]

IS, ICH, SAH

Intervention 1:

N: 10

Age: 65 ± 7 y

Male: 60%

Intervention 2:

N: 10

Age: 56 ± 12 y

Male: 50%

Overall NIHSS: 14.5 (6.75-24.75)

Intervention 1: Whole body cooling by cold saline infusion (4 °C).

Intervention 2:

Naso-pharingeal cooling

Intervention 1: Infusion flow rate of 4 L/h for 33 ± 4 min.

Intervention 2:

rate of 60 L/min for 1 h.

NICU

NR

Bladder, rectal, and esophageal.

ICP/T brain probe (>3 cm below the cortical surface)

None

T_Ty reacted similarly to relative changes of brain T during cold infusion, albeit with slightly different absolute values.

T_Ty correlated well with brain T changes induced by cold infusion, but overestimated brain cooling by naso-pharyngeal cooling (p = 0.005). T_Ty was slightly lower than brain T even at baseline (37.1 ± 0.7 °C vs 37.5 ± 0.7 °C, p < 0.001).

Poli et al. [63]

IS, ICH, SAH

N: 11

Age: 58 ± 15 y

Male: 73%

NIHSS: 22.9 ± 13.2

Head and neck cooling (4 °C); subsequent

whole-body surface cooling if requested.

Device applied if body core T > 37.1 °C.

Drugs: If body core T > 37.1 °C after 1 h of cooling or initial body core T > 38.0 °C, administration of acetaminophen or metamizole and whole-body surface cooling.

NICU

Thermistor thermometer, TTS 400, Smiths Medical, USA

Bladder.

ICP/T brain probe, (>3 cm below the cortical surface)

None

After 1 h of cooling, T_Ty was reduced by −1.69 ± 1.19 °C (p < 0.001), with a maximum decrease of −1.79 ± 1.19 °C after 37 ± 16 min.

T_Ty at baseline and during cooling was significantly lower (p <0.001) than brain T. After 1 h of cooling, brain T was reduced by −0.32 ± 0.2 °C (p <0.001), and bladder T by −0.18 ± 0.15 °C (p = 0.003). The maximal decrease of brain T was −0.36 ± 0.22 °C after 49 ± 17 min, and of bladder T −0.25 ± 0.15 °C after 48 ± 19 min.

Kammersgaard et al. [64]

IS, ICH

Intervention:

N: 17

Age: 69 ± 16 y

Male: 71%

SSS: 25.8 (11.5)

Control:

N: 56

Age: 70 ± 10 y

Male: 77%

SSS: 28 (11.5).

Intervention:

whole-body cooling by “forced air” method.

Control:

standard care.

Intervention: device applied for 6 h.

SU

IRTT, Diatek Model 9000, Diatek Inc, USA

Rectal

None

The mean T_Ty decreased significantly after 1 h of cooling (from 36.8 °C at baseline to 36.4 °C, p = 0.002). The lowest T_Ty was achieved after 6 h (35.5 °C, p = 0.001 vs baseline).

A strong correlation was observed between rectal T and T_Ty.

Kollmar et al. [65]

IS

N: 10 (9 receiving rtPA)

Age: 67 ± 13 y

Male: NR

NIHSS: 5.5 [4-12].

Whole body cooling by cold saline infusion (4 °C, 25 mL/kg body weight)

Administration for 123 ± 20 min after symptom onset and 17 ± 11 min after rt-PA treatment start.

Drugs: pethidine/ buspirone for preventing shivering.

NR

NR

None

None

T_Ty decreased from a baseline of 37.1 ± 0.7 °C by a maximum of 1.6 ± 0.3 °C (p < 0.005). The lowest measured T_Ty (35.4 ± 0.7 °C) was reached 52 ± 16 min after cold infusion start.

NR

Sund-Levander and Wahren 2000 [66]

SAH, CH, TBI

N: 7

Age: 57 ± 11 y

Male: 29%

Whole body cooling, or wrists, ankles, or groin cooling.

Body surface sponged with cool water or alcohol; or alcohol-saturated wraps on wrists, ankles, or groin. Additional cooling with a fan.

NICU

IRTT, Genius 3000 A, Sherwood Medical, UK

None

Skin surface at the toe tip

An increased T_Ty - toe T gradient was significantly associated with the occurrence of shivering (p < 0.01).

The T_Ty - toe T gradient decreased more during the intervention when the arms and legs were covered (9.1 ± 5.7 °C) than uncovered (11.7 ± 4.2 °C, p < 0.001).