Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Aug 3;15(1):170.
doi: 10.1186/s12967-017-1272-y.

Temperature variability in the day-night cycle is associated with further intracranial pressure during therapeutic hypothermia

Adriano Barreto Nogueira  1   2 , Eva Annen  3 , Oliver Boss  3 , Faraneh Farokhzad  3 , Christopher Sikorski  3 , Emanuela Keller  3
Affiliations

Temperature variability in the day-night cycle is associated with further intracranial pressure during therapeutic hypothermia

Adriano Barreto Nogueira et al. J Transl Med. .

Abstract

Background: To assess whether circadian patterns of temperature correlate with further values of intracranial pressure (ICP) in severe brain injury treated with hypothermia.

Methods: We retrospectively analyzed temperature values in subarachnoid hemorrhage patients treated with hypothermia by endovascular cooling. The circadian patterns of temperature were correlated with the mean ICP across the following day (ICP24).

Results: We analyzed data from 17 days of monitoring of three subarachnoid hemorrhage patients that underwent aneurysm coiling, sedation and hypothermia due to refractory intracranial hypertension and/or cerebral vasospasm. ICP24 ranged from 11.5 ± 3.1 to 24.2 ± 6.2 mmHg. The ratio between the coefficient of variation of temperature during the nocturnal period (18:00-6:00) and the preceding diurnal period (6:00-18:00) [temperature variability (TV)] ranged from 0.274 to 1.97. Regression analysis showed that TV correlated with ICP24 (Pearson correlation = -0.861, adjusted R square = 0.725, p < 0.001), and that ICP24 = 6 (4-TV) mmHg or, for 80% prediction interval, [Formula: see text] mmHg. The results indicate that the occurrence of ICP24 higher than 20 mmHg is unlikely after a day with TV ≥1.0.

Conclusions: TV correlates with further ICP during hypothermia regardless the strict range that temperature is maintained. Further studies with larger series could clarify whether intracranial hypertension in severe brain injury can be predicted by analysis of oscillation patterns of autonomic parameters across a period of 24 h or its harmonics.

Keywords: Circadian rhythm; Hypothermia; Intracranial pressure; Multimodality monitoring; Prediction; Temperature.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Temperature variability (TV) correlates inversely with mean intracranial pressure in the following day (ICP24) during hypothermia. Upper left-hand graph displays the distribution of the ICP24 in function of the TV from which derived the regression line and the formulas displayed above the graph. Upper right-hand graph displays daily TV and ICP24 of patients 1–3. Note that patient #2 underwent hypothermia during day 6 of monitoring. Broadly, the inverse of TV parallels ICP24. The remaining boxes display the daily temperature curves in degrees Celsius and the corresponding ICP curves in the following day. Temperature was recorded at 10 Hz and ICP at 1 Hz. Vertical line in the temperature curves corresponds to 18 h and divide the graph in day at left and night at right. Horizontal line in the ICP curves sets 20 mmHg. These graphs allow a qualitative analysis regarding temperature variability during day and night and ICP in the next 24 h. For example, compare the variability between day and night of days 6 and 8 of monitoring of patient #1 and the respective ICP values in the next day. CI confidence interval, D day of monitoring, PI prediction interval, arrows sudden ICP decrease due to cerebrospinal fluid drainage
See this image and copyright information in PMC

References

    1. Seule MA, Muroi C, Mink S, Yonekawa Y, Keller E. Therapeutic hypothermia in patients with aneurysmal subarachnoid hemorrhage, refractory intracranial hypertension, or cerebral vasospasm. Neurosurgery. 2009;64:86–92. doi: 10.1227/01.NEU.0000336312.32773.A0. - DOI - PubMed
    1. Muroi C, Seule M, Mishima K, Keller E. Novel treatments for vasospasm after subarachnoid hemorrhage. Curr Opin Crit Care. 2012;18:119–126. doi: 10.1097/MCC.0b013e32835075ae. - DOI - PubMed
    1. Nogueira AB, Nogueira AB, Esteves Veiga JC, Teixeira MJ. Multimodality monitoring, inflammation, and neuroregeneration in subarachnoid hemorrhage. Neurosurgery. 2014;75:678–689. doi: 10.1227/NEU.0000000000000512. - DOI - PMC - PubMed
    1. Nogueira AB, Sogayar MC, Colquhoun A, Siqueira SA, Nogueira AB, Marchiori PE, et al. Existence of a potential neurogenic system in the adult human brain. J Transl Med. 2014;12:75. doi: 10.1186/1479-5876-12-75. - DOI - PMC - PubMed
    1. Kim B, Nogueira AB, Thome-Souza S, Kapur K, Klehm J, Jackson M, et al. Diurnal and nocturnal patterns of autonomic neurophysiological measurements are related to timing of seizures. Ann Neurol. 2015;78(Suppl 19):S174–S175.

Publication types

LinkOut - more resources