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  4. Effects of local hypothermia–rewarming on physiology, metabolism and inflammation of acutely injured human spinal cord

Effects of local hypothermia–rewarming on physiology, metabolism and inflammation of acutely injured human spinal cord

Scientific Reports, 2020 · DOI: 10.1038/s41598-020-64944-y · Published: May 22, 2020

Spinal Cord InjuryGenetics

Simple Explanation

This study investigated the effects of local cooling (hypothermia) and rewarming on the injured spinal cord in five patients with acute spinal cord injuries. The researchers monitored pressure, metabolism, and inflammation at the injury site. The study found that while cooling reduced inflammation, rewarming led to increased swelling, reduced blood flow, and increased inflammation in the spinal cord. The study was stopped early due to wound infections. The authors concluded that hypothermia might be beneficial for reducing inflammation after spinal cord injury, but rewarming reverses these benefits. They caution against using hypothermia-rewarming without careful monitoring.

Study Duration
6-29 months follow-ups
Participants
Five patients with acute, severe thoracic traumatic spinal cord injuries
Evidence Level
Not specified

Key Findings

  • 1
    Cooling did not affect cord physiology (ISP, SCPP), but markedly altered cord metabolism and markedly reduced cord inflammation.
  • 2
    Rewarming was associated with significantly worse cord physiology (increased ICP, decreased SCPP), cord metabolism and cord inflammation.
  • 3
    Three of the five (60%) patients had culture positive delayed wound infections

Research Summary

In five patients with acute, severe thoracic traumatic spinal cord injuries (TSCIs), American spinal injuries association Impairment Scale (AIS) grades A–C, we induced cord hypothermia (33 °C) then rewarming (37 °C). Cooling did not affect cord physiology (ISP, SCPP), but markedly altered cord metabolism (increased glucose, lactate, lactate/pyruvate ratio (LPR), glutamate; decreased glycerol) and markedly reduced cord inflammation (reduced IL1β, IL8, MCP, MIP1α, MIP1β). We conclude that, after TSCI, hypothermia is potentially beneficial by reducing cord inflammation, though after rewarming these benefits are lost due to increases in cord swelling, ischemia and inflammation.

Practical Implications

Caution in Hypothermia Trials

The study urges caution when performing trials of hypothermia for TSCI without simultaneous monitoring from the injury site.

Wound Infection Risk

The study highlights the increased risk of wound infections associated with hypothermia-rewarming in TSCI patients, suggesting the need for preventative measures.

Personalized Treatment Strategies

The findings suggest the need for personalized treatment strategies based on real-time monitoring of the spinal cord's physiological and metabolic responses to hypothermia and rewarming.

Study Limitations

  • 1
    Small sample size
  • 2
    Lack of a control group
  • 3
    Study was terminated early because of delayed wound infections

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