Core Cooling by Central Venous Infusion of Ice-cold (4°C and 20°C) Fluid

2000 ◽  
Vol 93 (3) ◽  
pp. 629-637 ◽  
Author(s):  
Angela Rajek ◽  
Robert Greif ◽  
Daniel I. Sessler ◽  
James Baumgardner ◽  
Sonja Laciny ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Core Temperature ◽  
Heat Balance ◽  
Heat Content ◽  
Partial Recovery ◽  
Central Venous ◽  
Metabolic Heat ◽  
Cold Fluid ◽  
Venous Infusion ◽  
Body Heat

Background Central venous infusion of cold fluid may be a useful method of inducing therapeutic hypothermia. The aim of this study was to quantify systemic heat balance and regional distribution of body heat during and after central infusion of cold fluid. Methods The authors studied nine volunteers, each on two separate days. Anesthesia was maintained with use of isoflurane, and on each day 40 ml/kg saline was infused centrally over 30 min. On one day, the fluid was 20 degrees C and on the other it was 4 degrees C. By use of a tympanic membrane probe core (trunk and head) temperature and heat content were evaluated. Peripheral compartment (arm and leg) temperature and heat content were estimated with use of fourth-order regressions and integration over volume from 18 intramuscular thermocouples, nine skin temperatures, and "deep" hand and foot temperature. Oxygen consumption and cutaneous heat flux estimated systemic heat balance. Results After 30-min infusion of 4 degrees C or 20 degrees C fluid, core temperature decreased 2.5 +/- 0.4 degrees C and 1.4 +/- 0.2 degrees C, respectively. This reduction in core temperature was 0.8 degrees C and 0.4 degrees C more than would be expected if the change in body heat content were distributed in proportion to body mass. Reduced core temperature resulted from three factors: (1) 10-20% because cutaneous heat loss exceeded metabolic heat production; (2) 50-55% from the systemic effects of the cold fluid per se; and (3) approximately 30% because the reduction in core heat content remained partially constrained to core tissues. The postinfusion period was associated with a rapid and spontaneous recovery of core temperature. This increase in core temperature was not associated with a peripheral-to-core redistribution of body heat because core temperature remained warmer than peripheral tissues even at the end of the infusion. Instead, it resulted from constraint of metabolic heat to the core thermal compartment. Conclusions Central venous infusion of cold fluid decreases core temperature more than would be expected were the reduction in body heat content proportionately distributed. It thus appears to be an effective method of rapidly inducing therapeutic hypothermia. When the infusion is complete, there is a spontaneous partial recovery in core temperature that facilitates rewarming to normothermia.

Human heat balance during postexercise recovery: separating metabolic and nonthermal effects

2008 ◽  
Vol 294 (5) ◽  
pp. R1586-R1592 ◽  
Author(s):  
Ollie Jay ◽  
Daniel Gagnon ◽  
Michel B. DuCharme ◽  
Paul Webb ◽  
Francis D. Reardon ◽  
...  
Keyword(s):  
Heat Loss ◽  
Core Temperature ◽  
Heat Production ◽  
Heat Balance ◽  
Heat Content ◽  
Total Heat ◽  
Whole Body ◽  
Active Recovery ◽  
Total Heat Loss ◽  
Body Heat

Previous studies report greater postexercise heat loss responses during active recovery relative to inactive recovery despite similar core temperatures between conditions. Differences have been ascribed to nonthermal factors influencing heat loss response control since elevations in metabolism during active recovery are assumed to be insufficient to change core temperature and modify heat loss responses. However, from a heat balance perspective, different rates of total heat loss with corresponding rates of metabolism are possible at any core temperature. Seven male volunteers cycled at 75% of V̇o2peak in the Snellen whole body air calorimeter regulated at 25.0°C, 30% relative humidity (RH), for 15 min followed by 30 min of active (AR) or inactive (IR) recovery. Relative to IR, a greater rate of metabolic heat production (Ṁ − Ẇ) during AR was paralleled by a greater rate of total heat loss (ḢL) and a greater local sweat rate, despite similar esophageal temperatures between conditions. At end-recovery, rate of body heat storage, that is, [(Ṁ − Ẇ) − ḢL] approached zero similarly in both conditions, with Ṁ − Ẇ and ḢL elevated during AR by 91 ± 26 W and 93 ± 25 W, respectively. Despite a higher Ṁ − Ẇ during AR, change in body heat content from calorimetry was similar between conditions due to a slower relative decrease in ḢL during AR, suggesting an influence of nonthermal factors. In conclusion, different levels of heat loss are possible at similar core temperatures during recovery modes of different metabolic rates. Evidence for nonthermal influences upon heat loss responses must therefore be sought after accounting for differences in heat production.

Heat Flow and Distribution during Induction of General Anesthesia 

1995 ◽  
Vol 82 (3) ◽  
pp. 662-673 ◽  
Author(s):  
Takashi Matsukawa ◽  
Daniel I. Sessler ◽  
Andrew M. Sessler ◽  
Marc Schroeder ◽  
Makoto Ozaki ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Heat Loss ◽  
Core Temperature ◽  
Heat Balance ◽  
Thermal Flux ◽  
Control Period ◽  
Internal Heat ◽  
Heat Content ◽  
Change In Mean ◽  
Body Heat

Background Core hypothermia after induction of general anesthesia results from an internal core-to-peripheral redistribution of body heat and a net loss of heat to the environment. However, the relative contributions of each mechanism remain unknown. The authors evaluated regional body heat content and the extent to which core hypothermia after induction of anesthesia resulted from altered heat balance and internal heat redistribution. Methods Six minimally clothed male volunteers in an approximately 22 degrees C environment were evaluated for 2.5 control hours before induction of general anesthesia and for 3 subsequent hours. Overall heat balance was determined from the difference between cutaneous heat loss (thermal flux transducers) and metabolic heat production (oxygen consumption). Arm and leg tissue heat contents were determined from 19 intramuscular needle thermocouples, 10 skin temperatures, and "deep" foot temperature. To separate the effects of redistribution and net heat loss, we multiplied the change in overall heat balance by body weight and the specific heat of humans. The resulting change in mean body temperature was subtracted from the change in distal esophageal (core) temperature, leaving the core hypothermia specifically resulting from redistribution. Results Core temperature was nearly constant during the control period but decreased 1.6 +/- 0.3 degree C in the first hour of anesthesia. Redistribution contributed 81% to this initial decrease and required transfer of 46 kcal from the trunk to the extremities. During the subsequent 2 h of anesthesia, core temperature decreased an additional 1.1 +/- 0.3 degree C, with redistribution contributing only 43%. Thus, only 17 kcal was redistributed during the second and third hours of anesthesia. Redistribution therefore contributed 65% to the entire 2.8 +/- 0.5 degree C decrease in core temperature during the 3 h of anesthesia. Proximal extremity heat content decreased slightly after induction of anesthesia, but distal heat content increased markedly. The distal extremities thus contributed most to core cooling. Although the arms constituted only a fifth of extremity mass, redistribution increased arm heat content nearly as much as leg heat content. Distal extremity heat content increased approximately 40 kcal during the first hour of anesthesia and remained elevated for the duration of the study. Conclusions The arms and legs are both important components of the peripheral thermal compartment, but distal segments contribute most. Core hypothermia during the first hour after induction resulted largely from redistribution of body heat, and redistribution remained the major cause even after 3 h of anesthesia.

Efficacy of Two Methods for Reducing Postbypass Afterdrop

2000 ◽  
Vol 92 (2) ◽  
pp. 447-447 ◽  
Author(s):  
Angela Rajek ◽  
Rainer Lenhardt ◽  
Daniel I. Sessler ◽  
Gabriele Brunner ◽  
Markus Haisjackl ◽  
...  
Keyword(s):  
Sodium Nitroprusside ◽  
Core Temperature ◽  
Heat Content ◽  
Tissue Temperature ◽  
Control Group ◽  
Peripheral Tissues ◽  
The Core ◽  
Forced Air Warming ◽  
Forced Air ◽  
Body Heat

Background Afterdrop, defined as the precipitous reduction in core temperature after cardiopulmonary bypass, results from redistribution of body heat to inadequately warmed peripheral tissues. The authors tested two methods of ameliorating afterdrop: (1) forced-air warming of peripheral tissues and (2) nitroprusside-induced vasodilation. Methods Patients were cooled during cardiopulmonary bypass to approximately 32 degrees C and subsequently rewarmed to a nasopharyngeal temperature near 37 degrees C and a rectal temperature near 36 degrees C. Patients in the forced-air protocol (n = 20) were assigned randomly to forced-air warming or passive insulation on the legs. Active heating started with rewarming while undergoing bypass and was continued for the remainder of surgery. Patients in the nitroprusside protocol (n = 30) were assigned randomly to either a control group or sodium nitroprusside administration. Pump flow during rewarming was maintained at 2.5 l x m(-2) x min(-1) in the control patients and at 3.0 l x m(-2) x min(-1) in those assigned to sodium nitroprusside. Sodium nitroprusside was titrated to maintain a mean arterial pressure near 60 mm Hg. In all cases, a nasopharyngeal probe evaluated core (trunk and head) temperature and heat content. Peripheral compartment (arm and leg) temperature and heat content were estimated using fourth-order regressions and integration over volume from 18 intramuscular needle thermocouples, nine skin temperatures, and "deep" hand and foot temperature. Results In patients warmed with forced air, peripheral tissue temperature was higher at the end of warming and remained higher until the end of surgery. The core temperature afterdrop was reduced from 1.2+/-0.2 degrees C to 0.5+/-0.2 degrees C by forced-air warming. The duration of afterdrop also was reduced, from 50+/-11 to 27+/-14 min. In the nitroprusside group, a rectal temperature of 36 degrees C was reached after 30+/-7 min of rewarming. This was only slightly faster than the 40+/-13 min necessary in the control group. The afterdrop was 0.8+/-0.3 degrees C with nitroprusside and lasted 34+/-10 min which was similar to the 1.1+/-0.3 degrees C afterdrop that lasted 44+/-13 min in the control group. Conclusions Cutaneous warming reduced the core temperature afterdrop by 60%. However, heat-balance data indicate that this reduction resulted primarily because forced-air heating prevented the typical decrease in body heat content after discontinuation of bypass, rather than by reducing redistribution. Nitroprusside administration slightly increased peripheral tissue temperature and heat content at the end of rewarming. However, the core-to-peripheral temperature gradient was low in both groups. Consequently, there was little redistribution in either case.

Temperature gradients in pigs during whole-body hyperthermia at 42 degrees C

1979 ◽  
Vol 47 (4) ◽  
pp. 712-717 ◽  
Author(s):  
J. A. Dickson ◽  
A. McKenzie ◽  
K. McLeod
Keyword(s):  
Core Temperature ◽  
Brain Temperature ◽  
Heat Content ◽  
Temperature Gradients ◽  
Whole Body ◽  
Induction Phase ◽  
Equilibrium Conditions ◽  
Repeated Heating ◽  
Deep Body ◽  
Body Heat

Temperature was simultaneously measured by thermistors in multiple deep-body and peripheral sites in adult pigs heated continuously at 42 degrees C (rectal) and above for 4–24 h. During hyperthermia, the relations between different body temperatures were maintained and up to 1.0 degrees C separated temperature measurements at sites such as liver and bone marrow. These persistent temperature gradients must be borne in mind when evaluating tumor response in patients subjected to whole-body heating for disseminated cancer. Temperatures recorded by rectal, deep esophageal, or tympanic membrane sensors provided a reliable index of core temperature (including brain temperature) under equilibrium conditions at 42 degrees C, but only esophageal and tympanic sensors could safely be used to monitor the induction phase of hyperthermia and the adjustive changes in body-heat content required to stabilize core temperature during sustained hyperthermia. Pigs withstood repeated heating at 42 degrees C for 6 h, and recovered rapidly, but died after 24 h of hyperthermia. Pigs subjected to unrestrained heating died at 45 degrees C (esophagus).

Increasing Mean Skin Temperature Linearly Reduces the Core- temperature Thresholds for Vasoconstriction and Shivering in Humans 

1995 ◽  
Vol 82 (5) ◽  
pp. 1160-1168 ◽  
Author(s):  
Christi Cheng ◽  
Takashi Matsukawa ◽  
Daniel I. Sessler ◽  
Ozaki Makoto ◽  
Andrea Kurz ◽  
...  
Keyword(s):  
Skin Temperature ◽  
Core Temperature ◽  
Central Venous ◽  
Men And Women ◽  
Ringer’S Solution ◽  
The Core ◽  
Temperature Thresholds ◽  
Venous Infusion ◽  
Lactated Ringer's Solution ◽  
Skin Temperatures

Background The contribution of mean skin temperature to the thresholds for sweating and active precapillary vasodilation has been evaluated in numerous human studies. In contrast, the contribution of skin temperature to the control of cold responses such as arteriovenous shunt vasoconstriction and shivering is less well established. Accordingly, the authors tested the hypothesis that mean skin and core temperatures are linearly related at the vasoconstriction and shivering thresholds in men. Because the relation between skin and core temperatures might vary by gender, the cutaneous contribution to thermoregulatory control also was determined in women. Methods In the first portion of the study, six men participated on 5 randomly ordered days, during which mean skin temperatures were maintained near 31, 34, 35, 36, and 37 degrees C. Core hypothermia was induced by central venous infusion of cold lactated Ringer's solution sufficient to induce peripheral vasoconstriction and shivering. The core-temperature thresholds were then plotted against skin temperature and a linear regression fit to the values. The relative skin and core contributions to the control of each response were calculated from the slopes of the regression equations. In the second portion of the study, six women participated on three randomly ordered days, during which mean skin temperatures were maintained near 31, 35, and 37 degrees C. At each designated skin temperature, core hypothermia sufficient to induce peripheral vasoconstriction and/or shivering was again induced by central venous infusion of cold lactated Ringer's solution. The cutaneous contributions to control of each response were then calculated from the skin- and core-temperature pairs at the vasoconstriction and shivering thresholds. Results There was a linear relation between mean skin and core temperatures at the response thresholds in the men: r = 0.90 +/- 0.06 for vasoconstriction and r = 0.94 +/- 0.07 for shivering. Skin temperature contributed 20 +/- 6% to vasoconstriction and 19 +/- 8% to shivering. Skin temperature in the women contributed to 18 +/- 4% to vasoconstriction and 18 +/- 7% to shivering, values not differing significantly from those in men. There was no apparent correlation between the cutaneous contributions to vasoconstriction and shivering in individual volunteers. Conclusions These data indicate that skin and core temperatures contribute linearly to the control of vasoconstriction and shivering in men and that the cutaneous contributions average approximately 20% in both men and women. The same coefficients thus can be used to compensate for experimental skin temperature manipulations in men and women. However, the cutaneous contributions to each response vary among volunteers; furthermore, the contributions to the two responses vary within volunteers.

Temperature Regulation and Heat Balance in Flying White-necked Ravens, Corvus Cryptoleucus

1981 ◽  
Vol 90 (1) ◽  
pp. 267-281 ◽  
Author(s):  
DENNIS M. HUDSON ◽  
MARVIN H. BERNSTEIN
Keyword(s):  
Steady State ◽  
Body Temperature ◽  
Wind Tunnel ◽  
Body Surface ◽  
Heat Balance ◽  
Metabolic Heat ◽  
Steady State Levels ◽  
Cutaneous Evaporation ◽  
Body Heat ◽  
Respiratory Evaporation

During level flight at 10 m.s−1 in a wind tunnel, white-necked ravens (Corvus cryptoleucus, mass 0·48 kg) exhibited an increase in body temperature to steady-state levels as high as 45°C, exceeding resting levels by nearly 3°C. This reflects the storage of up to half of the metabolic heat produced (Hp) during 5 min of flight. During steady-state flight, body heat was dissipated in part by respiratory evaporation and convection (13–40% of Hp) evoked by increases in ventilation proportional to body temperature. Remaining heat was lost by cutaneous evaporation (10% of Hp) as well as by radiation and convection from the external body surface. The results suggest strategies that might be used by ravens during flight under desert conditions.

Exercise-rest cycles do not alter local and whole body heat loss responses

2011 ◽  
Vol 300 (4) ◽  
pp. R958-R968 ◽  
Author(s):  
Daniel Gagnon ◽  
Glen P. Kenny
Keyword(s):  
Heat Loss ◽  
Core Temperature ◽  
Intermittent Exercise ◽  
Sweat Rate ◽  
Heat Content ◽  
Whole Body ◽  
Evaporative Heat Loss ◽  
Esophageal Temperature ◽  
Direct Calorimetry ◽  
Body Heat

Previous studies have suggested that greater core temperatures during intermittent exercise (Ex) are due to attenuated sweating [upper back sweat rate (SR)] and skin blood flow (SkBF) responses. We evaluated the hypothesis that heat loss is not altered during exercise-rest cycles (ER). Ten male participants randomly performed four 120-min trials: 1) 60-min Ex and 60-min recovery (60ER); 2) 3 × 20-min Ex separated by 20-min recoveries (20ER); 3) 6 × 10-min Ex separated by 10-min recoveries (10ER), or 4) 12 × 5-min Ex separated by 5-min recoveries (5ER). Exercise was performed at a workload of 130 W at 35°C. Whole body heat exchange was determined by direct calorimetry. Core temperature, SR (by ventilated capsule), and SkBF (by laser-doppler) were measured continuously. Evaporative heat loss (EHL) progressively increased with each ER, such that it was significantly greater ( P ≤ 0.05) at the end of the last compared with the first Ex for 5ER (299 ± 39 vs. 440 ± 41 W), 10ER (425 ± 51 vs. 519 ± 45 W), and 20ER (515 ± 63 vs. 575 ± 74 W). The slope of the EHL response against esophageal temperature significantly increased from the first to the last Ex within the 10ER (376 ± 56 vs. 445 ± 89 W/°C, P ≤ 0.05) and 20ER (535 ± 85 vs. 588 ± 28 W/°C, P ≤ 0.05) conditions, but not during 5ER (296 ± 96 W/°C vs. 278 ± 95 W/°C, P = 0.237). In contrast, the slope of the SkBF response against esophageal temperature did not significantly change from the first to the last Ex (5ER: 51 ± 23 vs. 54 ± 19%/°C, P = 0.848; 10ER: 53 ± 8 vs. 56 ± 21%/°C, P = 0.786; 20ER: 44 ± 20 vs. 50 ± 27%/°C, P = 0.432). Overall, no differences in body heat content and core temperature were observed. These results suggest that altered local and whole body heat loss responses do not explain the previously observed greater core temperatures during intermittent exercise.

SHORT-TERM THERMAL AND METABOLIC RESPONSES OF SHEEP TO RUMINAL COOLING: EFFECTS OF LEVEL OF COOLING AND PHYSIOLOGICAL STATE

1990 ◽  
Vol 70 (3) ◽  
pp. 833-843 ◽  
Author(s):  
A. M. NICOL ◽  
B. A. YOUNG
Keyword(s):  
Heat Loss ◽  
Heat Production ◽  
Physiological State ◽  
Heat Content ◽  
Metabolic Heat Production ◽  
Mean Body Temperature ◽  
Metabolic Heat ◽  
Reduced Body ◽  
Cooling Effects ◽  
Body Heat

In a series of studies to simulate the ingestion of cold food, the rumen of adult sheep was cooled by 0–400 kJ over 1 h. Ruminal cooling reduced body heat content, increased rate of metabolic heat production and reduced apparent rate of heat loss to the environment. On average, each 100 kJ of cooling reduced heat content by 46 kJ, increased heat production by 20 kJ and reduced heat loss by 70 kJ. Precooling thermal status of the sheep affected the magnitude of the responses to cooling. A 0.1 °C higher precooling mean body temperature decreased the response in metabolic heat production by 6 kJ and increased the reduction in body heat content by 4.6 kJ. The heat production associated with eating reduced the heat loss response to ruminal cooling but did not affect the change in heat content. Well-insulated sheep were less affected by ruminal cooling. Key words: Sheep, rumen, cooling, heat production, temperature

Heat Balance and Distribution during the Core-Temperature Plateau in Anesthetized Humans

1995 ◽  
Vol 83 (3) ◽  
pp. 491-499. ◽  
Author(s):  
Andrea Kurz ◽  
Daniel I. Sessler ◽  
Richard Christensen ◽  
Martha Dechert
Keyword(s):  
Heat Loss ◽  
Core Temperature ◽  
Heat Production ◽  
Heat Balance ◽  
Thermal Flux ◽  
The Body ◽  
Metabolic Heat Production ◽  
The Core ◽  
Metabolic Heat ◽  
Temperature Plateau

Background Once triggered, intraoperative thermoregulatory vasoconstriction is remarkably effective in preventing further hypothermia. Protection results from both vasoconstriction-induced decrease in cutaneous heat loss and altered distribution of body heat. However, the independent contributions of each mechanism have not been quantified. Accordingly, we evaluated overall heat balance and distribution of heat within the body during the core-temperature plateau. Methods Nine minimally clothed male volunteers were anesthetized with propofol and isoflurane and maintained in an approximately 22 degrees C environment. They were monitored for approximately 2 h before vasoconstriction and for 3 h subsequently. Overall heat balance was determined from the difference between cutaneous heat loss (thermal flux transducers) and metabolic heat production (oxygen consumption). Arm and leg tissue heat contents were determined from 19 intramuscular temperatures, ten skin temperatures, and "deep" foot temperature. Heat constrained by vasoconstriction to the trunk and head was calculated by subtracting the expected change in that region (overall heat balance multiplied by the fractional weight of the trunk and head) from the actual change (change in distal esophageal temperature multiplied by the specific heat of human tissue and the weight of the trunk and head); the result represents the amount by which core heat exceeded that which would be expected based on overall heat balance, assuming that the change was evenly distributed throughout the body. Results Vasoconstriction and passive tissue cooling decreased heat loss but not to the level of heat production. Consequently, heat loss exceeded metabolic heat production throughout the study. Core temperature decreased approximately 1.3 C during the 2-h prevasoconstriction period; however, core temperature remained virtually constant during the subsequent 3 h. In the 3 h after vasoconstriction, arm and leg heat content decreased 57 +/- 9 kcal, and vasoconstriction constrained 22 +/- 8 kcal to the trunk and head. Conclusions These results confirm the efficacy of thermo-regulatory vasoconstriction in preventing additional core hypothermia. Decreased cutaneous heat loss and constraint of metabolic heat to the core thermal compartment contributed to the plateau.

RECOVERY OF NEONATAL LAMBS FROM HYPOTHERMIA WITH THERMAL ASSISTANCE

1988 ◽  
Vol 68 (1) ◽  
pp. 183-190 ◽  
Author(s):  
J. B. ROBINSON ◽  
B. A. YOUNG
Keyword(s):  
Core Temperature ◽  
Heat Production ◽  
Substantial Reduction ◽  
Heat Content ◽  
Metabolic Heat Production ◽  
Warm Water ◽  
Body Core Temperature ◽  
Cotton Cloth ◽  
Metabolic Heat ◽  
Neonatal Lambs

Metabolic heat production and body core temperature were measured in 12 newborn lambs (4.7 ± 0.2 kg) prior to and during the induction of acute hypothermia (Tc = 30 °C), as well as during recovery to euthermia. Hypothermia was induced by immersion in 14–28 °C water. Rewarming was achieved by one of three procedures: (A) immersion of the lambs in warm water (38 °C); (B) exposure of the lambs in an air environment to a 250-watt infrared heat lamp; or (C) wrapping the lambs in a cotton cloth. Prehypothermia resting heat production was 4.3 ± 0.2 W kg−1. During the induction of hypothermia, summit metabolic heat production was 20.9 ± 0.5 W kg−1; however, as core temperature decreased from 35 to 31 °C, maximum metabolic rate declined by 1.33 W kg−1 per °C decline in core temperature. Recovery of the lambs to an euthermic state was achieved in 28, 38 and 50 ± 1.8 min in the warm water, infrared lamp and cotton cloth rewarming treatments with metabolic costs during recovery of 21.2, 33.2 and 40.6 ± 0.8 kJ kg−1, respectively. Recovery of hypothermic lambs in 38 °C water resulted in a thermal contribution to body heat content from the water and a substantial reduction in recovery time and in metabolic effort by the lambs. Key words: Hypothermia, rewarming, metabolic heat, supplemental heat, neonates, lambs

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