| Title |
Rapid Induction of COOLing in Stroke Patients (iCOOL1): a randomised pilot study comparing cold infusions with nasopharyngeal cooling
|
|---|---|
| Published in |
Critical Care, October 2014
|
| DOI | 10.1186/s13054-014-0582-1 |
| Pubmed ID | |
| Authors |
Sven Poli, Jan Purrucker, Miriam Priglinger, Matthias Ebner, Marek Sykora, Jennifer Diedler, Cem Bulut, Erik Popp, André Rupp, Christian Hametner |
| Abstract |
IntroductionInduction methods for therapeutic cooling are under investigated. We compared the effectiveness and safety of cold infusions (CI) and nasopharyngeal cooling (NPC) used for cooling induction in stroke patients.MethodsA prospective, open-label, randomised (1:1), single-centre pilot trial with partially blinded safety endpoint assessment was conducted at the neurointensive care unit of Heidelberg University. Intubated stroke patients with an indication for therapeutic cooling and an intracranial pressure (ICP)/temperature brain probe were randomly assigned to CI (4°C, 2L at 4L/h) or NPC (60L/min for 1 h). Previous data suggested a maximum decrease of tympanic temperature for CI (2.1L within 35 min) after 52 min. Therefore the study period was 1-hour (15 min subperiods I-IV). The brain temperature course was the primary endpoint. Secondary measures included continuous monitoring of neurovital parameters and extracerebral temperatures. Statistical analysis based on repeated-measures analysis of variance.ResultsOf 221 patients screened, 20 were randomized within 5 months. Infusion time of 2L CI was 33¿±¿4 min in 10 patients and 10 patients received NPC for 60 min. During the first 30 min of active treatment with CI, brain temperature decreased faster than during NPC (I: ¿0.31¿±¿0.2 versus ¿0.12¿±¿0.1°C, P =0.008; II: ¿1.0¿±¿0.3 versus ¿0.49¿±¿0.3°C, P =0.001). In the CI-group, after the infusion was finished, the intervention no longer decreased brain temperature, which increased after 3.5¿±¿3.3 min. Oesophageal temperature correlated best with brain temperature during CI and NPC. Tympanic temperature reacted similarly to relative changes of brain temperature during CI, but absolute values slightly differed. CI provoked three severe adverse events during subperiods II-IV (two systolic arterial pressure (SAP), one shivering) compared with four in the NPC-group, all during subperiod I (three SAP, one ICP). Classified as possible intervention-related, two cases of ventilator failure occurred during NPC.ConclusionsIn intubated stroke patients, brain cooling is faster during CI than during NPC. Importantly, contrary to previous expectations, brain cooling stopped soon after CI cessation. Oesophageal but neither bladder nor rectal temperature is suited as surrogate for brain temperature during CI and NPC. Several severe adverse events in CI and in NPC demand further studying of safety.Trial registrationClinicalTrials.gov NCT01573117. Registered 31 March 2012. |
X Demographics
The data shown below were collected from the profiles of 6 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 2 | 33% |
| Italy | 1 | 17% |
| Unknown | 3 | 50% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Practitioners (doctors, other healthcare professionals) | 2 | 33% |
| Scientists | 2 | 33% |
| Science communicators (journalists, bloggers, editors) | 1 | 17% |
| Members of the public | 1 | 17% |
Mendeley readers
The data shown below were compiled from readership statistics for 65 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Czechia | 1 | 2% |
| Brazil | 1 | 2% |
| Unknown | 63 | 97% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 13 | 20% |
| Student > Bachelor | 9 | 14% |
| Other | 6 | 9% |
| Student > Master | 6 | 9% |
| Student > Ph. D. Student | 5 | 8% |
| Other | 13 | 20% |
| Unknown | 13 | 20% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 28 | 43% |
| Nursing and Health Professions | 4 | 6% |
| Neuroscience | 4 | 6% |
| Engineering | 3 | 5% |
| Psychology | 2 | 3% |
| Other | 9 | 14% |
| Unknown | 15 | 23% |
Attention Score in Context
This research output has an Altmetric Attention Score of 3. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 29 October 2014.
All research outputs
#8,535,472
of 25,374,917 outputs
Outputs from Critical Care
#4,397
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Outputs of similar age
#91,639
of 273,629 outputs
Outputs of similar age from Critical Care
#99
of 164 outputs
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