Brain hypothermia induced by cold spinal fluid using a torso cooling pad: theoretical analyses

Brain hypothermia induced by a temperature reduction of the spinal fluid using a torso-cooling pad is evaluated as a cooling alternative for traumatic injury patients. A theoretical model of the human head is developed to include its tissue structures and their contribution to local heat transfer. The Pennes bioheat equation and finite element analysis are used to predict the temperature distribution in the head region. The energy balance in the cerebrospinal fluid (CSF) layer surrounding the brain during mixing of the CSF and cold spinal fluid is also formulated to predict the CSF temperature reduction. Results show that the presence of cooled CSF around the brain provides mild cooling (~1°C) to the grey matter within 3000 s (50 min) with a cooling capacity of approximately 22 W. However, large temperature variations (~3.5°C) still occur in the grey matter. This approach is more effective during ischemia because it promotes deeper cooling penetration and results in larger temperature reductions; the average grey matter temperature decreases to 35.4°C. Cooling in the white matter is limited and only occurs under ischemic conditions. The non-invasive nature of the torso-cooling pad and its ability to quickly induce hypothermia to the brain tissue are beneficial to traumatic injury patients.     

Does wet hair in cold weather cause sinus headache and posterior eye pain? A possible mechanism through selective brain cooling system

As a general observation, wet hair in cold weather seems to be a predisposing factor for sinus headache and posterior eye pain. We offer a mechanism through selective brain cooling system for this observation. Selective brain cooling (SBC) is a mechanism to protect brain from hyperthermia. Components of SBC are head skin and upper respiratory tract (nose and paranasal sinuses). Cool venous blood from head skin and mucous membranes of nose and paranasal sinuses drains to intracranial dural sinuses and provide brain cooling. Brain will be cooled very much when head skin exposes to hypothermia such a condition like wet hair in cold weather. We suggest that, in order to reduce brain cooling activity, some alterations are being occurred within paranasal sinuses. For this purpose, sinus ostiums may close and mucus may accumulate to reduce air within sinuses. Also there may be some vasomotor changes to prevent heat loss. We hypothesize that this possible alterations may occur within paranasal sinuses as a control mechanism for brain temperature control during exposure of head skin to hypothermia. Paranasal sinuses may also cool brain directly by a very thin layer of bone separates the posterior ethmoid air sinus from the subarachnoid space and only thin plates of bone separate the sphenoidal sinuses from internal carotid artery and cavernous sinuses. Because of their critical role in the SBC, posterior ethmoid air sinus and sphenoidal sinuses may be affected from this alterations more than other paranasal sinuses. This situation may cause posterior eye pain. This mechanism can explain why a person who expose to hypothermia with wet hair or a person who don’t use a beret or a hat during cold weather gets sinus headache and posterior eye pain. These symptoms could lead to an incorrect diagnosis of sinusitis.     

Electroencephalographic changes during general hypothermia and regional cooling of the head

Two series of experiments were carried out on dogs. In series I (80 experiments) the animals were subjected to deep general hypothermia by covering the whole body with finely crushed ice. In series II (29 experiments) isolated deep hypothermia was produced in the head alone by means of a femoral-carotid arterial by-pass and cooling the blood in a heat exchanger. In both series the brain temperature of the animals was reduced to 18–22°C. Comparison of the electroencephalographic changes in the two series showed that cooling the brain leads to a reduction in its electrical activity evenly distributed among all frequencies in the EEG. Predominance of slow waves in the series with generalized hypothermia was not due to the effect of the low brain temperature, as other workers have previously but erroneously maintained, but to the reduction in the cerebral blood flow resulting from the decrease in the minute volume of the circulation accompanying general hypothermia, as other experiments carried out by the writers confirmed.     

Tympanic temperatures during hemiface cooling

Summary In adult men the left half of the head was covered with thick heat insulation, and the right hemiface was cooled by spraying a mist of water, and vigorous fanning. The subjects were immersed up to the waist in warm water (42°) to achieve hyperthermia. In control sessions the subjects were rendered slightly hypothermic by preliminary exposure to cold.Under the hypothermic condition during right skin cooling, the right Tty remained low as compared with oesophageal temperature, while the left Tty was raised. Under the hyperthermic condition right hemiface cooling maintained not only the right Tty lower than oesophageal but also, to a lesser extent the left Tty, while the skin on the left side was close to core temperature. This latter result cannot be explained by conductive cooling from the skin to the tympanic membrane and implies a vascular cooling of the left Tty originating from the other side of the head.It is concluded that selective cooling of the brain takes place during hyperthermia. The main mechanism is forced vascular convection, but conductive cooling also occurs.     

Targeted brain hypothermia induced by an interstitial cooling device in human neck: theoretical analyses

In this study, the feasibility of a newly developed interstitial cooling device inserted into the neck muscle and placed on the surface of the common carotid artery is evaluated. A combination of vascular model and continuum model is developed to simulate the temperature fields in both the neck and brain regions. Parametric studies are conducted to test the sensitivity of various factors on the temperature distribution. It has been shown that the length of the device, temperature of the device, and the tissue gap between the device and the blood vessel are the dominant factors that determine the effectiveness of this cooling approach. Under the current design parameters, the device is capable of inducing a temperature drop of 2.8°C along the common carotid artery and it results in a total of 90 W of heat carried away from the arterial blood. Although the degree of the cooling in the arterial blood is inversely proportional to the blood flow rate of the arteries, the total heat loss from the arterial blood does not vary significantly if the blood flow rate changes during the cooling. After the cold arterial blood is supplied to the brain hemisphere, temperature reduction in the brain tissue is almost uniform and up to 3.1°C temperature drop is achieved within 1 hour. In addition to the possible benefits of brain hypothermia for stroke or head injury patients, the device has the potential to control fever as well as to improve patients’ outcome during open neck and head surgery.     

Temperature distribution and blood perfusion response in rat brain during selective brain cooling

A rat model was used in this study to examine the transient temperature distribution and blood flow response in the brain during selective brain cooling (SBC) and rewarming. SBC was induced by a head cooling helmet with circulating water of 18 degrees C or 0 degrees C. It has been shown that the brain temperature reductions were 1.7+/-0.2 degrees C (5 mm beneath the brain surface) and 3.2+/-1.1 degrees C (2 mm beneath the brain surface) when the temperature of the water was 18 degrees C (moderate cooling). The cooling of the brain tissue was more evident when the circulating water was colder (0 degrees C, deep cooling). The characteristic time that it took for the tissue temperatures to reach a new steady state after the initiation of cooling varied from 5 to more than 35 min and it depended strongly on the blood flow response to the cooling. We used an ultrasound flow meter to measure continuously the blood flow rate in the common carotid artery during the cooling and rewarming. The blood flow rate dropped by up to 22% and 44% during the cooling from its baseline in the moderate cooling group and in the deep cooling group, respectively. Although all brain temperatures recovered to their baseline values 50 min after the helmet was removed, the blood flow rate only recovered to 92% and 77% of its baseline values after the moderate and deep cooling, respectively, implying a possible mismatch between the blood perfusion and metabolism in the brain. The current experimental results can be used to study the feasibility of inducing brain hypothermia by SBC if the blood flow responses in the rat are applicable to humans. The simultaneous recordings of temperature and blood flow rate in the rat brain can be used in the future to validate the theoretical model developed previously.     

Threshold and slope of selective brain cooling

Experiments (n=50) in three conscious goats were performed in a thermoneutral environment to determine the threshold (i.e. the point at which the brain temperature is equal to the carotid blood temperature) and slope (i.e. the difference between brain and carotid blood temperatures as a function of carotid blood temperature) of selective brain cooling (SBC) and analyse the thermal inputs affecting them. Prior to the experiments the animals received carotid loops and an arteriovenous shunt to manipulate head and trunk temperatures independently of each other. The mean SBC threshold was 38.75° C T _carotis and independent of T _trunk. When body core temperature was increased from a hypo- to a moderately hyperthermic level, the SBC threshold was passed before metabolic rate had reached its minimum and before cutaneous vasodilation occurred. The mean SBC slope was 0.78 and rose with increasing T_trunk. The degree of SBC was principally independent of respiratory heat loss: high levels of heat loss were found without SBC, and large degrees of SBC were observed at low levels of heat loss. The effect of SBC in and around normothermia is to smooth the onset of shivering or panting and to establish a range of internal temperature within which metabolic rate and respiratory heat loss are simultaneously at low levels.     

Unilateral selective brain cooling

In species with a carotid rete the arterial blood flowing to the brain can be cooled by passing the carotid rete. The mechanism is termed selective brain cooling (SBC). The aim of the study was to evaluate whether SBC could be induced unilaterally. 27 experiments were performed in 2 conscious goats which were prepared with carotid loops to manipulate the blood temperature of the left and right carotid artery independently of each other. The temperature of the left and right hemisphere of the brain was controlled by means of extracorporeal heat exchangers acting on the carotid blood while trunk temperature was clamped at 39.5 °C by a heat exchanger in an arteriovenous shunt. Unilateral warming of the brain induced ipsilateral SBC only, and was accompanied by a bilateral increase of the ear skin temperature. The results demonstrate the precise control of brain temperature by SBC since even unilateral temperature deviations of the brain can be reduced by SBC. In conclusion SBC regulates the temperature of single hemispheres rather than the mean brain temperature.     

Does wet hair in cold weather cause sinus headache and posterior eye pain? A possible mechanism through selective brain cooling system

As a general observation, wet hair in cold weather seems to be a predisposing factor for sinus headache and posterior eye pain. We offer a mechanism through selective brain cooling system for this observation. Selective brain cooling (SBC) is a mechanism to protect brain from hyperthermia. Components of SBC are head skin and upper respiratory tract (nose and paranasal sinuses). Cool venous blood from head skin and mucous membranes of nose and paranasal sinuses drains to intracranial dural sinuses and provide brain cooling. Brain will be cooled very much when head skin exposes to hypothermia such a condition like wet hair in cold weather. We suggest that, in order to reduce brain cooling activity, some alterations are being occurred within paranasal sinuses. For this purpose, sinus ostiums may close and mucus may accumulate to reduce air within sinuses. Also there may be some vasomotor changes to prevent heat loss. We hypothesize that this possible alterations may occur within paranasal sinuses as a control mechanism for brain temperature control during exposure of head skin to hypothermia. Paranasal sinuses may also cool brain directly by a very thin layer of bone separates the posterior ethmoid air sinus from the subarachnoid space and only thin plates of bone separate the sphenoidal sinuses from internal carotid artery and cavernous sinuses. Because of their critical role in the SBC, posterior ethmoid air sinus and sphenoidal sinuses may be affected from this alterations more than other paranasal sinuses. This situation may cause posterior eye pain. This mechanism can explain why a person who expose to hypothermia with wet hair or a person who don’t use a beret or a hat during cold weather gets sinus headache and posterior eye pain. These symptoms could lead to an incorrect diagnosis of sinusitis.     

Mathematical analysis of haemodilution's direct effect on rate of brain cooling during cardiopulmonary bypass

Cerebral hypothermia is the principal means of providing neurologic protection during cardiac surgery. Better understanding is needed of ways to improve brain cooling during bypass. The goal of this study is to find whether haemodilution has a significant direct effect on the rate of brain cooling, from changes in the blood's thermal properties. The brain is cooled during hypothermic cardiopulmonary bypass, almost exclusively, by the colder blood. We use the corresponding component of the bioheat transport model to predict the proportional direct effect of changing blood density and specific heat on the amplitude of the rate of brain cooling. We find that haemodilution can significantly change blood density and specific heat. For example, haemodilution with the fluorocarbon emulsion AF0104 from a haematocrit at 45% to a haematocrit at 22% increases blood density by 18%, and decreases specific heat by 21%. Nevertheless, the mathematical model predicts that the direct effect of haemodilution on the rate of brain cooling by the cold blood is small; +7%, +6% and −7% for normal saline, 5 g dl⁻¹ albumin in normal saline, and AF0104 fluorocarbon emulsion, respectively. We conclude that, within the haemotocrit range used clinically during bypass, haemodilution with these substances has only a small direct effect on the rate of brain cooling.     

Tympanic temperature is not suited to indicate selective brain cooling in humans: a re-evaluation of the thermophysiological basics

Selective brain cooling in humans, with venous blood returning from the head surface as the relevant heat sink, was proposed more than two decades ago as a mechanism protecting the brain against damage in hyperthermic conditions. Brain cooling was inferred from decreases of tympanic temperature under the premise that it reflected brain temperature closely, even in conditions of external head cooling. In mammals with a well-developed carotid rete selective brain cooling and its quantitative relevance are experimentally well established by directly monitoring brain temperature. For humans, however, the dispute about the existence and physiological relevance of selective brain cooling has remained unsettled, especially, as far as arguments have been exchanged on the basis of thermophysiological data and model calculations considering brain metabolism, brain hemodynamics and the anatomical preconditions for arterio-venous heat exchange. In this essay two seminal studies in support of the existence of human selective brain cooling in the condition of exercise hyperthermia, with and without dehydration, are re-examined from two points of view: first the stringency of the working hypotheses underlying data evaluation and their subsequent fate. Second the minimum theoretical requirements for data interpretation. The working hypotheses supporting data interpretation in favor of selective brain cooling in humans were heuristic and/or had become questionable at the dates of their application; today, they may be considered as outdated. Data interpretation becomes most conclusive, if tympanic temperature simply is not taken into account.     

Enhanced brain protection during passive hyperthermia in humans

Summary Selective brain cooling during hyperthermia by emissary venous pathways from the skin of the head to the brain has been reported both in animals and humans. Heat protection of the brain extends tolerance to high deep body temperature in animals, and may be enhanced in humans if the head is cooled. In order to quantify to what extent brain protection could be obtained by face fanning, 9 non-anesthetized human volunteers were placed in ambient conditions as close as possible to those of passive therapeutic hyperthermia. Face-fanning maintained tympanic temperature 0.57° C lower than esophageal temperature, and improved comfort. External head cooling techniques enhancing physiological brain cooling can therefore be useful for the protection of the human brain during heat stress or passive therapeutic hyperthermia.     

Cooling and Rewarming for Brain Ischemia or Injury: Theoretical Analysis

A three-dimensional model is developed in this study to examine the transient and steady state temperature distribution in the brain during selective brain cooling (SBC) and subsequent rewarming. Selective brain cooling is induced through either wearing a cooling helmet or packing the head with ice. The ischemic region of the brain is simulated through reducing the blood perfusion rate to 20% of its normal value. The geometric and thermal properties and physiological characteristics for each layer, as well as the arterial blood temperature, are used as the input to the Pennes bioheat equation. Our data suggest that rapid cooling of the brain gray matter can be achieved by SBC on the head surface (26 min for adults versus 15 min for infants). Suboptimal thermal contact between the head surface and the coolant in most commercially available cooling helmets is suspected to be the main reason for delayed cooling in SBC as compared to the ice packing. The study has also demonstrated that the simulated 3 °C/h passive rewarming rate by exposing the head to room temperature after removing the source of cooling may be too rapid. © 2003 Biomedical Engineering Society. PAC2003: 8710+e, 8719La, 8719Pp, 8719Uv     

Theoretical simulation of temperature distribution in the brain during mild hypothermia treatment for brain injury

Mild or moderate hypothermia (>30°C) has been proposed for clinical use as a therapeutic option for achieving protection from cerebral ischaemia in brain injury patients. In this research, a theoretical model was developed to examine the brain temperature gradients during selective cooling of the brain surface after head injury. The head was modelled as a hemisphere consisting of several layers, representing the scalp, skull and brain tissue, respectively. The dimensions, physical properties and physiological characteristics for each layer, as well as the arterial blood temperature, were used as the input to the Pennes bioheat transfer equation to simulate the steady-state temperature distribution within the brain. Depending on the head surface temperature, a temperature gradient of up to 13°C exists in the brain tissue. The results have shown that the volumetric-averaged brain tissue temperature T_{bt, avg} for adults and infants can be 1.7 and 4.3°C, respectively, lower than the temperature of the arterial blood supplied to the brain tissue. The location where the probe should be placed to measure T_{bt, avg} was also determined by the simulation. The calculation suggests that the temperature sensor should be placed 7.5mm and 5.9 mm beneath the brain tissue surface for adults and infants, respectively, to monitor T_{bt, avg} continuously.     

Selective brain cooling in mammals and birds

Artiodactyls and felids have a carotid rete that can cool the blood destined for the brain and consequently the brain itself if the cavernous sinus receives cool blood returning from the nose. This condition is usually fulfilled in resting and moderately hyperthermic animals. During severe exercise hyperthermia, however, the venous return from the nose bypasses the cavernous sinus so that brain cooling is suppressed. This is irreconcilable with the assumption that the purpose of selective brain cooling (SBC) is to protect the brain from thermal damage. Alternatively, SBC is seen as a mechanism engaging the thermoregulatory system in a water-saving economy mode in which evaporative heat loss is inhibited by the effects of SBC on brain temperature sensors. In nonhuman mammals that do not have a carotid rete, no evidence exists of whole-brain cooling. However, the surface of the cavernous sinus is in close contact with the base of the brain and is the likely source of unregulated regional cooling of the rostral brain stem in some species. In humans, the cortical regions next to the inner surface of the cranium are very likely to receive some regional cooling via the scalp-sinus pathway, and the rostral base of the brain can be cooled by conduction to the nearby respiratory tract; mechanisms capable of cooling the brain as a whole have not been found. Studies using conventional laboratory techniques suggest that SBC exists in birds and is determined by the physical conditions of heat transfer from the head to the environment instead of physiological control mechanisms. Thus except for species possessing a carotid rete, neither a coherent pattern of SBC nor a unifying concept of its biological significance in mammals and birds has evolved.     

Limitations on arteriovenous cooling of the blood supply to the human brain

Arteriovenous heat transfer (AVHT) is a thermoregulatory phenomenon which enhances tolerance to thermal stress in a variety of animals. Several authors have speculated that human responses to thermal stress reflect AVHT in the head and neck, even though primates lack the specialized vascular arrangements which characterize AVHT in other animals. We modeled heat transfer based on the anatonmical relationships and blood flows for the carotid artery and associated venous channels in the human neck and cavernous sinus. Heat transfer rate was predicted using the effectiveness-number of transfer units method for heat exchanger analysis. Modeling showed that AVHT is critically dependent upon (1) heat exchanger effectiveness and (2) arteriovenous inlet temperature difference. Predicted heat exchanger effectiveness is less than 5.5% for the neck and 0.3% for the cavernous sinus. These very low values reflect both the small arteriovenous interface for heat exchange and the high flow rate in the carotid artery. In addition, humans lack the strong venous temperature depression required to drive heat exchange; both the cavernous sinus and the internal jugular vein carry a large proportion of venous blood warmed by its passage through the brain as well as a small contribution from the face and scalp, whose temperature varies with environmental conditions. Under the most optimistic set of assumptions, carotid artery temperature would be lowered by less than 0.1° C during its passage from the aorta to the base of the brain. Physiologically significant cooling of the blood supply to the brain cannot occur in the absence of a suitably scaled site specialized for heat exchange.     

Brain and body temperature homeostasis during sodium pentobarbital anesthesia with and without body warming in rats

High-speed, multi-site thermorecording offers the ability to follow the dynamics of heat production and flow in an organism. This approach was used to study brain-body temperature homeostasis during the development of general anesthesia induced by sodium pentobarbital (50 mg/kg, ip) in rats. Animals were chronically implanted with thermocouple probes in two brain areas, the abdominal cavity, and subcutaneously, and temperatures were measured during anesthesia both with and without (control) body warming. In control conditions, temperature in all sites rapidly and strongly decreased (from 36-37 degrees C to 32-33 degrees C, or 3.5-4.5 degrees C below baselines). Relative to body core, brain hypothermia was greater (by 0.3-0.4 degrees C) and skin hypothermia was less (by approximately 0.7 degrees C). If the body was kept warm with a heating pad, brain hypothermia was three-fold weaker ( approximately 1.2 degrees C), but the brain-body difference was significantly augmented (-0.6 degrees C). These results suggest that pentobarbital-induced inhibition of brain metabolic activity is a major factor behind brain hypothermia and global body hypothermia during general anesthesia. These data also indicate that body warming is unable to fully compensate for anesthesia-induced brain hypothermia and enhances the negative brain-body temperature differentials typical of anesthesia. Since temperature strongly affects various underlying parameters of neuronal activity, these findings are important for electrophysiological studies performed in anesthetized animal preparations.     

Analytical method for determination of temperature distribution in the human head during craniocerebral hypothermia induced by “Kholod-2F” apparatus

Conclusions 1. We have developed a graphical method for determination of the temperature of the different parts of the brain during craniocerebral cooling by means of the “Kholod-2F” apparatus; the method requires no direct placement of thermocouples in the brain, and indications are obtained from temperature measurements within the ear or body of the patient. 2. We have drawn up nomograms for use with craniocerebral cooling; they enable the temperature of any part of the brain to be determined, as well as the time required to cool that part to a given level. They also enable temperature distribution in the head to be determined without measurement if the patient's weight and time of cooling are known. 3. We have determined the relationship (Fig. 3) of esophageal to rectal temperatures during craniocerebral cooling. 4. Results show that use of craniocerebral hypothermia induced by “Kholod-2F” enables rapid cooling of the human cerebral cortex to be obtained (1–1.5° per min at the start of cooling) by application of a heat conductor at a temperature of 0.5–2°; body temperature remained within safe limits. The temperature of the external auditory meatus measured at the ear drum does not indicate the temperature of the medulla but corresponds to the brain temperature at a depth of about 25 mm (34 mm from surface of head). The temperatures of the deep layers of the brain depend chiefly on body temperature, and are 1–1.5° lower than it. Further body cooling does not alter temperature distribution within the head, but only reduces the cooling time. 5. A relationship has been obtained (Fig. 2) which enables the experimenter using “Kholod-2F” in experiments to follow temperature changes in the relevant parts of the brain and esophagus by measurement of rectal temperature only. Moscow. Translated from Meditsinskaya Tekhnika, No. 4, pp. 17–24, July–August, 1970.     

A thermoregulation model for hypothermic treatment of neonates

This paper presents a thermoregulation finite element model (FEM) to simulate hypothermia procedures for the treatment of encephalopathy hypoxic-ischemia (EHI) in neonates, a dangerous ischemic condition that can cause neurological damages and even death. Therapeutic hypothermia is the only recommended technique to reduce sequels caused by EHI in neonates; intervention with moderate cooling for neural rescue in newborns with hypoxic-ischemic brain injury is the culmination of a series of clinical research studies spanning decades. However, the direct monitoring of brain cooling is difficult and can lead to additional tissue damage. Therefore, the measurement of efficiency during clinical trials of hypothermia treatment is still challenging. The use of computational methods can aid clinicians to observe the continuous temperature of tissues and organs during cooling procedures without the need for invasive techniques, and can thus be a valuable tool to assist clinical trials simulating different cooling options that can be used for treatment. The use of low cost methods such as cooling blankets can open the possibility of using brain cooling techniques in hospitals and clinics that cannot currently afford the available expensive equipment and techniques. In this work, we developed a FEM package using isoparametric linear three-dimensional elements which is applied to the solution of the continuum bioheat Pennes equation. Blood temperature changes were considered using a blood pool approach. The results of the FEM model were compared to those obtained through the implementation of a user-defined function (UDF) in the commercial finite volume software FLUENT and validated with experimental tests. Numerical analyses were performed using a three-dimensional mesh based on a complex geometry obtained from MRI scan medical images.