Influence of intranasal and carotid cooling on cerebral temperature balance and oxygenation

Lars Nybo, Michael Wanscher, Niels H Secher, Lars Nybo, Michael Wanscher, Niels H Secher

Abstract

The present study evaluated the influence of intranasal cooling with balloon catheters, increased nasal ventilation, or percutaneous cooling of the carotid arteries on cerebral temperature balance and oxygenation in six healthy male subjects. Aortic arch and internal jugular venous blood temperatures were measured to assess the cerebral heat balance and corresponding paired blood samples were obtained to evaluate cerebral metabolism and oxygenation at rest, following 60 min of intranasal cooling, 5 min of nasal ventilation, and 15 min with carotid cooling. Intranasal cooling induced a parallel drop in jugular venous and arterial blood temperatures by 0.30 ± 0.08°C (mean ± SD), whereas nasal ventilation and carotid cooling failed to lower the jugular venous blood temperature. The magnitude of the arterio-venous temperature difference across the brain remained unchanged at -0.33 ± 0.05°C following intranasal and carotid cooling, but increased to -0.44 ± 0.11°C (P < 0.05) following nasal ventilation. Calculated cerebral capillary oxygen tension was 43 ± 3 mmHg at rest and remained unchanged during intranasal and carotid cooling, but decreased to 38 ± 2 mmHg (P < 0.05) following increased nasal ventilation. In conclusion, percutaneous cooling of the carotid arteries and intranasal cooling with balloon catheters are insufficient to influence cerebral oxygenation in normothermic subjects as the cooling rate is only 0.3°C per hour and neither intranasal nor carotid cooling is capable of inducing selective brain cooling.

Keywords: balloon catheter; brain temperature; cerebral oxygenation; cooling; hypothermia.

Figures

Figure 1
Figure 1
Arterial (open symbols) and jugular venous blood temperature (filled symbols) at rest (0 min) and during 60 min of nasal cooling with 1°C saline circulated through the nasal catheters at a flow rate of 200 ml/min. *Signifies that the value is lower compared to corresponding value at 0 min (P < 0.05). The jugular venous blood temperature was significantly higher than that of the arterial blood at all time points (P < 0.001).
Figure 2
Figure 2
Top panel. Average face skin (mean of cheek and forehead), neck skin over the carotid arteries, and intra-nasal temperatures at rest (baseline), during intranasal cooling, increased nasal ventilation and carotid cooling. Lower panel shows the delta difference between arterial (aortic arch) and internal jugular venous blood temperatures at rest during intranasal cooling, increased nasal ventilation and carotid cooling. *Indicates that the value is significantly different from corresponding value at rest (P < 0.05).
Figure 3
Figure 3
Arterial, jugular venous and mean capillary oxygen tension (lower panel) and saturation (top panel) at rest (baseline), following 1 h of intranasal cooling, after 5 min of increased nasal ventilation and 15 min of carotid cooling. *Indicates that the value is different from corresponding value at rest (P < 0.05).

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