Coppler Patrick J, Marill Keith A, Okonkwo David O, Shutter Lori A, Dezfulian Cameron, Rittenberger Jon C, Callaway Clifton W, Elmer Jonathan
1 Department of Emergency Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.
2 Department of Physician Assistant Studies, University of the Sciences , Philadelphia, Pennsylvania.
Ther Hypothermia Temp Manag. 2016 Dec;6(4):194-197. doi: 10.1089/ther.2016.0010. Epub 2016 Jun 1.
Comatose patients after cardiac arrest should receive active targeted temperature management (TTM), with a goal core temperature of 32-36°C for at least 24 hours. Small variations in brain temperature may confer or mitigate a substantial degree of neuroprotection, which may be lost at temperatures near 37°C. The purpose of this study was to define the relationship between brain and core temperature after cardiac arrest through direct, simultaneous measurement of both. We placed intracranial monitors in a series of consecutive patients hospitalized for cardiac arrest at a single tertiary care facility within 12 hours of return of spontaneous circulation to guide postcardiac arrest care. We compared the absolute difference between brain and core (esophageal or rectal) temperature measurements every hour for the duration of intracranial monitoring and tested for a lag between brain and core temperature using the average square difference method. Overall, 11 patients underwent simultaneous brain and core temperature monitoring for a total of 906 hours of data (Median 95; IQR: 15-118 hours per subject). On average, brain temperature was 0.34C° (95% confidence interval [CI] 0.31-0.37) higher than core temperature. In 7% of observations, brain temperature exceeded the measured core temperature ≥1°C. Brain temperature lagged behind core temperature by 0.45 hours (95% CI = -0.27-1.27 hours). Brain temperature averages 0.34°C higher than core temperature after cardiac arrest, and is more than 1°C higher than core temperature 7% of the time. This phenomenon must be considered when carrying out TTM to a goal core temperature of <36°C.
心脏骤停后的昏迷患者应接受积极的目标温度管理（TTM），目标核心温度为32 - 36°C，持续至少24小时。脑温的微小变化可能带来或减轻相当程度的神经保护作用，而在接近37°C的温度下这种保护作用可能会丧失。本研究的目的是通过直接同时测量心脏骤停后脑温和核心温度来确定两者之间的关系。我们在一家三级医疗机构对一系列因心脏骤停住院的连续患者在自主循环恢复后12小时内放置颅内监测器，以指导心脏骤停后护理。在颅内监测期间，我们每小时比较脑温和核心（食管或直肠）温度测量值的绝对差值，并使用平均方差法测试脑温和核心温度之间的滞后情况。总体而言，11名患者同时进行了脑温和核心温度监测，共获得906小时的数据（中位数95；四分位间距：每位受试者15 - 118小时）。平均而言，脑温比核心温度高0.34°C（95%置信区间[CI] 0.31 - 0.37）。在7%的观察中，脑温超过测量的核心温度≥1°C。脑温比核心温度滞后0.45小时（95% CI = -0.27 - 1.27小时）。心脏骤停后脑温平均比核心温度高0.34°C，并且在7%的时间里比核心温度高1°C以上。在将TTM目标核心温度设定为<36°C时，必须考虑这一现象。
