Feasibility and Safety of Transnasal High Flow Air to Reduce Core Body Temperature in Febrile Neurocritical Care Patient
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ORIGINAL WORK
Feasibility and Safety of Transnasal High Flow Air to Reduce Core Body Temperature in Febrile Neurocritical Care Patients: A Pilot Study Wendy C. Ziai1*, Dhaval Shah2, Fabrizio R. Assis3, Harikrishna Tandri3 and Romergryko G. Geocadin2 © 2019 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background: Fever is an important determinant of prognosis following acute brain injury. Current non-pharmacologic techniques to reduce fever are limited and induce a shivering response. We investigated the safety and efficacy of a novel transnasal unidirectional high flow air device in reducing core body temperature in the neurocritical care unit (NCCU) setting. Methods: This pilot study included seven consecutive patients in the NCCU who were febrile (> 37.5 °C) for > 24 h despite standard non-pharmacologic and first-line antipyretic agents. Medical grade high flow air was delivered transnasally using a standard continuous positive airway pressure machine with a positive pressure of 20 cmH2O for 2 h. Core esophageal and tympanic temperature were continuously monitored. Results: Mean age was 40 ± 14 yo, and 72% (5/7 patients) were men. Five patients had intracerebral or intraventricular hemorrhage, one subject had transverse myelitis, and the remaining patient had anoxic brain injury due to a cardiac arrest. After 2 h of cooling, core temperature was significantly lower than the baseline pre-cooling temperature (37.3 ± 0.5 °C vs. 38.4 ± 0.6 °C; p 37.5 °C) despite standard of care fever management which included antipyretic treatment with T ylenol® (acetaminophen) with or without a surface cooling blanket (Cincinnati Sub-Zero Products, LLC). Patients could have temporary control of fever after standard management, but could not be enrolled until 24 h from the start of fever to ensure that the standard of care was practiced and patients were enrolled only if they failed the standard of care. Patients were identified by the intensive care physician and included in the study after meeting the study criteria. The detailed inclusion and exclusion criteria are shown in Table 1. Briefly, febrile patients with an indication for normothermia and no history of facial trauma or contraindications for hypothermia were included in the study. An esophageal temperature probe (400 Series, Smiths Medical, OH, USA) was placed by an experienced
Table 1 Study inclusion/exclusion criteria Inclusion criteria
Exclusion criteria
Admitted to NCCU
Skull base or facial fracture
Core temperature > 37.5 °C for > 24 h despite antipyretic agents
Deviated nasal septum
Age between 18 and 80 years
Cryoglobulinemia Sickle cell disease Serum cold agglutinins Coagulopathy or on anticoagulation therapy Pregnant Participating in another clinical study
NCCU neurocritical care unit
intensive care physician to monitor the core temperature. The position of the esophageal temperature probe was determined to be appropriate by visual inspection of the oropharynx to avoid coiling of the pr
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