Schroeder Daniel C, Maul Alexandra C, Guschlbauer Maria, Finke Simon-Richard, de la Puente Bethencourt David, Neumann Tobias, Padosch Stephan A, Annecke Thorsten, Böttiger Bernd W, Sterner-Kock Anja, Herff Holger
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
Department of Experimental Medicine, University Hospital of Cologne, Cologne, Germany.
Ther Hypothermia Temp Manag. 2019 Dec;9(4):251-257. doi: 10.1089/ther.2018.0054. Epub 2019 Mar 20.
To date, the optimal cooling device for targeted temperature management (TTM) remains unclear. Water-circulating cooling blankets are broadly available and quickly applied but reveal inaccuracy during maintenance and rewarming period. Recently, esophageal heat exchangers (EHEs) have been shown to be easily inserted, revealed effective cooling rates (0.26-1.12°C/h), acceptable deviations from target core temperature (<0.5°C), and rewarming rates between 0.2 and 0.4°C/h. The aim of this study was to compare cooling rates, accuracy during maintenance, and rewarming period as well as side effects of EHEs with water-circulating cooling blankets in a porcine TTM model. Mean core temperature of domestic pigs ( = 16) weighing 83.2 ± 3.6 kg was decreased to a target core temperature of 33°C by either using EHEs or water-circulating cooling blankets. After 8 hours of maintenance, rewarming was started at a goal rate of 0.25°C/h. Mean cooling rates were 1.3 ± 0.1°C/h (EHE) and 3.2 ± 0.5°C/h (blanket, < 0.0002). Mean difference to target core temperature during maintenance ranged between ±1°C. Mean rewarming rates were 0.21 ± 0.01°C/h (EHE) and 0.22 ± 0.02°C/h (blanket, n.s.). There were no differences with regard to side effects such as brady- or tachycardia, hypo- or hyperkalemia, hypo- or hyperglycemia, hypotension, shivering, or esophageal tissue damage. Target temperature can be achieved faster by water-circulating cooling blankets. EHEs and water-circulating cooling blankets were demonstrated to be reliable and safe cooling devices in a prolonged porcine TTM model with more variability in EHE group.
迄今为止，用于目标温度管理（TTM）的最佳冷却设备仍不明确。水循环冷却毯广泛可得且应用迅速，但在维持和复温期间显示出不准确。最近，食管热交换器（EHE）已被证明易于插入，显示出有效的冷却速率（0.26 - 1.12°C/小时）、与目标核心温度的可接受偏差（<0.5°C）以及0.2至0.4°C/小时的复温速率。本研究的目的是在猪TTM模型中比较EHE与水循环冷却毯的冷却速率、维持期间的准确性、复温期以及副作用。通过使用EHE或水循环冷却毯，将体重83.2±3.6千克的家猪（n = 16）的平均核心温度降至目标核心温度33°C。维持8小时后，以0.25°C/小时的目标速率开始复温。平均冷却速率为1.3±0.1°C/小时（EHE）和3.2±0.5°C/小时（冷却毯，P < 0.0002）。维持期间与目标核心温度的平均差异在±1°C之间。平均复温速率为0.21±0.01°C/小时（EHE）和0.22±0.02°C/小时（冷却毯，无显著性差异）。在诸如心动过缓或心动过速、低钾血症或高钾血症、低血糖或高血糖、低血压、寒战或食管组织损伤等副作用方面没有差异。水循环冷却毯能更快地达到目标温度。在一个延长的猪TTM模型中，EHE和水循环冷却毯被证明是可靠且安全的冷却设备，EHE组的变异性更大。
