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Table 4 Studies performing target temperature management in acute neurologic diseases

From: Insight into the use of tympanic temperature during target temperature management in emergency and critical care: a scoping review

Study Disease Population Cooling approach Setting Tympanic TM device Core TM site Other TM sites Main results
Location Protocol Feasibility Comparability
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 TTy 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 TTy reacted similarly to relative changes of brain T during cold infusion, albeit with slightly different absolute values. TTy correlated well with brain T changes induced by cold infusion, but overestimated brain cooling by naso-pharyngeal cooling (p = 0.005). TTy 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, TTy 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. TTy 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 TTy decreased significantly after 1 h of cooling (from 36.8 °C at baseline to 36.4 °C, p = 0.002). The lowest TTy was achieved after 6 h (35.5 °C, p = 0.001 vs baseline). A strong correlation was observed between rectal T and TTy.
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 TTy 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 TTy (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 TTy - toe T gradient was significantly associated with the occurrence of shivering (p < 0.01). The TTy - 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).
  1. Data are numbers (N), percentages (%), mean ± standard deviation, median (interquartile range) or [range], as available. *Hypothermia was performed for neuroprotection only in 6 patients
  2. CH, cerebral haematoma; IRTT, infrared tympanic thermometer; ICH, intracerebral haemorrage; ICP, intracranial pressure; IS, ischemic stroke; NICU, neurointensive care unit; NIHSS, National Institutes of Health Stroke Scale; NR, not reported; rtPA, recombinant tissue-type plasminogen activator; SAH, subarachnoid hemorrhage; SSS, Scandinavian Stroke Scale (SSS) score; SU, stroke unit; T, temperature; TH, therapeutic hypothermia; TM, temperature measurement; TTM, target temperature management; TTy, tympanic temperature; TBI, traumatic brain injury; y, years