Conventional, conventional cooling with ice cold fluids and ice/coldpacks; BR, water-circulating cooling system; CC, air-circulating cooling system; AS, gel-coated cooling system; CG, intravascular cooling system.
Ice-cold fluid flows through your veins, chilling them.
As the infusion of ice-cold fluid was associated with increased mean arterial pressure (MAP) and lactate levels, the authors assumed that vasoconstriction with decreased tissue perfusion played a role in worsening the outcome [48].
The intermittent thermodilution technique, in which boluses of ice-cold fluid are injected into the right atrium via a PAC and the change in temperature detected in the blood of the pulmonary artery used to calculate cardiac output, is still widely considered as the standard method of reference.
In contrast, rapid cooling ice-cold fluids showed a decreased survival rate in the same model.
These innovative cooling techniques and devices, which comprise infusion of large volumes of ice-cold crystalloid fluid (4°C), cooling catheters using ice-cold fluids circulating in a closed circuit, cooling helmets designed to cool the brain, and cold-air or water pads and blankets controlled with sophisticated algorithms, should prove to be of some benefit to patients with heatstroke [ 51].
An even higher temperature decrease of 4°C in the first hour was found by Polderman and colleagues [ 19], who combined ice-cold fluids with a water-circulating cooling device.
Therapeutic hypothermia was started immediately after admission to the emergency department and was applied by using a cooling technique combining the administration of intravenous ice-cold fluids and the application of a surface cooling device (Arctic Sun System; Medivance, Louisville, CO, USA), according to the protocol in use in our institution [ 6, 12].
Because the protective effects of MIH appear to be greater when it is initiated early [ 20], investigators have recently proposed that ice cold intravenous fluid be administered to reduce the time needed to reach the target temperature [ 3, 6, 21].
PiCCO® and VolumeView™ use injections of ice cold intravenous fluid as the indicator, measuring change in temperature down-stream to calculate cardiac output, whereas LiDCO™ uses minute amounts of lithium chloride as the indicator and measures levels using a lithium-selective electrode.
The brain was removed in less than 1 min, and then immersed in ice cold artificial cerebrospinal fluid (aCSF; NaCl 140 mM, KCl 3 mM, MgSO4 1.3 mM, NaH2PO4 1.4 mM, CaCl2 2.4 mM, glucose 11 mM, HEPES 5 mM, pH 7.25 with NaOH) bubbled with O2.
