Universität zu Köln

Schroeder, Daniel C., Guschlbauer, Maria ORCID: 0000-0002-5401-4542, Maul, Alexandra C., Cremer, Daniel A., Becker, Ingrid ORCID: 0000-0001-5829-3553, Bethencourt, David de la Puente, Paal, Peter, Padosch, Stephan A., Wetsch, Wolfgang A., Annecke, Thorsten ORCID: 0000-0002-2496-4432, Boettiger, Bernd W., Sterner-Kock, Anja and Herff, Holger (2017). Oesophageal heat exchangers with a diameter of 11mm or 14.7mm are equally effective and safe for targeted temperature management. PLoS One, 12 (3). SAN FRANCISCO: PUBLIC LIBRARY SCIENCE. ISSN 1932-6203

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Abstract

Background Targeted temperature management (TTM) is widely used in critical care settings for conditions including hepatic encephalopathy, hypoxic ischemic encephalopathy, meningitis, myocardial infarction, paediatric cardiac arrest, spinal cord injury, traumatic brain injury, ischemic stroke and sepsis. Furthermore, TTM is a key treatment for patients after out-of-hospital cardiac-arrest (OHCA). However, the optimal cooling method, which is quick, safe and cost-effective still remains controversial. Since the oesophagus is adjacent to heart and aorta, fast heat-convection to the central blood-stream could be achieved with a minimally invasive oesophageal heat exchanger (OHE). To date, the optimal diameter of an OHE is still unknown. While larger diameters may cause thermal-or pressure-related tissue damage after long-term exposure to the oesophageal wall, smaller diameter (e.g., gastric tubes, up to 11mm) may not provide effective cooling rates. Thus, the objective of the study was to compare OHE-diameters of 11mm (OHE11) and 14.7mm (OHE14.7) and their effects on tissue and cooling capability. Methods Pigs were randomized to OHE11 (N = 8) or OHE14.7 (N = 8). After cooling, pigs were maintained at 33 degrees C for 1 hour. After 10h rewarming, oesophagi were analyzed by means of histopathology. The oesophagus of four animals from a separate study that underwent exactly the identical preparation and cooling protocol described above but received a maintenance period of 24h were used as histopathological controls. Results Mean cooling rates were 2.8 +/- 0.4 degrees C degrees C/h (OHE11) and 3.0 +/- 0.3 degrees C degrees C/h (OHE14.7; p = 0.20). Occasional mild acute inflammatory transepithelial infiltrates were found in the cranial segment of the oesophagus in all groups including controls. Deviations from target temperature were 0.1 +/- 0.4 degrees C (OHE11) and 0 +/- 0.1 degrees C (OHE14.7; p = 0.91). Rewarming rates were 0.19 +/- 0.07 degrees C degrees C/h (OHE11) and 0.20 +/- 0.05 degrees C degrees C/h (OHE14.7; p = 0.75). Conclusions OHE with diameters of 11 mm and 14.7 mm achieve effective cooling rates for TTM and did not cause any relevant oesophageal tissue damage. Both OHE demonstrated acceptable deviations from target temperature and allowed for an intended rewarming rate (0.25 degrees C/h).

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schroeder, Daniel C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Guschlbauer, Maria UNSPECIFIED orcid.org/0000-0002-5401-4542 UNSPECIFIED Maul, Alexandra C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cremer, Daniel A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Becker, Ingrid UNSPECIFIED orcid.org/0000-0001-5829-3553 UNSPECIFIED Bethencourt, David de la Puente UNSPECIFIED UNSPECIFIED UNSPECIFIED Paal, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Padosch, Stephan A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wetsch, Wolfgang A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Annecke, Thorsten UNSPECIFIED orcid.org/0000-0002-2496-4432 UNSPECIFIED Boettiger, Bernd W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sterner-Kock, Anja UNSPECIFIED UNSPECIFIED UNSPECIFIED Herff, Holger UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-236645
DOI:	10.1371/journal.pone.0173229
Journal or Publication Title:	PLoS One
Volume:	12
Number:	3
Date:	2017
Publisher:	PUBLIC LIBRARY SCIENCE
Place of Publication:	SAN FRANCISCO
ISSN:	1932-6203
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language THERAPEUTIC HYPOTHERMIA; INTRACRANIAL HYPERTENSION; TRANSFER DEVICE; RESUSCITATION; ASSOCIATION; PREVENTION; GUIDELINES; INDUCTION Multiple languages Multidisciplinary Sciences Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/23664