Induction of Mild Hypothermia by Noninvasive Body Cooling in Healthy,Unanesthetized Subjects: Editorial Commentary on Bandschapp et al.,2011

Induced hypothermia has been incorporated in guidelines for treatment of asphyxia of newborns and for treatment of comatose patients after cardiac arrest; although, some doubt remains for the latter (Nielsen et al., 2010). Several aspects of temperature management after brain or other organ injury still need to be addressed and explored, not least regarding the awake patient. The recurrent questions, to which we do not yet have answers, are how fast, how deep, and for how long should temperature be reduced and controlled in a specific clinical setting. Therefore, in parallel with randomized controlled trials investigating those questions, basic research exploring the clinical efficacy of different methods to reduce core temperature and the physiological responses to these interventions need to be investigated.

In a recent study by Bandschapp and coworkers (Bandschapp et al., 2011a) and in previous studies from the same group (Bandschapp and Iaizzo, 2011a), these important questions were highlighted. In one of the studies (Bandschapp et al., 2011b), the efficacy of several topical cooling methods, and combinations thereof, was tested in healthy volunteers. The aim was to show that noninvasive methods, which may be applied in the prehospital setting, are feasible and have the potential to be clinically valuable in reducing core temperature early after an insult. The authors showed that the use of topical cooling with simultaneous counterwarming of the face reduced core temperatures at a rate of approximately 0.8°C per hour, with acceptable patient comfort. The addition of cold fluids, light sedatives to prevent shivering, and warming of the feet and hands, would probably add further to the temperature drop, as speculated by the authors. Although cumbersome to apply in the prehospital setting, some of these methods are already in use in some centers, and other methods are being tested (Castrén et al. 2010). More high-quality research in the field is warranted in order to optimize temperature management in the expanding field of caring for awake patients, for instance those with stroke or acute myocardial infarction.