Techniques for temperature management

Temperature management has gained increased interest in the context of neurological diseases. This presentation will focus on techniques, possible areas of application and advantages/disadvantages. In fever management, application of ice-cold wet blankets and rubbing upper body with alcohol solution may typically be used in awake patients. In the intensive care setting application of ice-packs can be added when the patient is sedated. Main draw-backs are difficulties in regulating the degree of temperature lowering, high need of staff to apply physical cooling and patient discomfort.

Control of shivering still represents a major challenge as well as the problem of sedating a patient who has a neurological condition.

Cooling techniques can be divided in three categories: rapid induction of cooling, surface cooling and invasive cooling. Induction of cooling is of particular interest in neurological emergencies. Even small changes in temperature may be of importance for pathophysiological mechanisms. Induction with ice-cold saline is used in brain jury after cardiac arrest and has also been described in stroke patients. Other methods are application of frozen pads. Intranasal cooling with a closed-water circuit is currently under development and a flow system where a perfluorocarbon gas is injected in the nasal cavity has been approved for use in humans.

Surface cooling is non-invasive and has been used in both anesthetized and awake patients. Two main principles have been developed. Blowing cold air directly over the patient's skin under a blanket system can effectively lower body temperature but implies difficulties in other medical management. Gel pads containing water channels connected to a cooling device is used in cardiac arrest patients and is under study in stroke patients. It has also been used in protocols for management of fever in neuro-intensive care patients.

Invasive cooling with a catheter that is placed in the vena cava has also been used in neurological patients. It has the advantage of cooling patients at a high speed and allows a temperature regulation with only minimal fluctuations. The invasive approach implies a risk for infections and local hemorrhage and may be problematic in long-term temperature management.

Several techniques are available for temperature management in neurological patients. Choice of technique varies depending on indications and the local clinical setting.