Cooling athletes with a spinal cord injury

Cooling strategies that help prevent a reduction in exercise capacity whilst exercising in the heat have received considerable research interest over the past 3 decades, especially in the lead up to a relatively hot Olympic and Paralympic Games. Progressing into the next Olympic/Paralympic cycle, the host, Rio de Janeiro, could again present an environmental challenge for competing athletes. Despite the interest and vast array of research into cooling strategies for the able-bodied athlete, less is known regarding the application of these cooling strategies in the thermoregulatory impaired spinal cord injured (SCI) athletic population. Individuals with a spinal cord injury (SCI) have a reduced afferent input to the thermoregulatory centre and a loss of both sweating capacity and vasomotor control below the level of the spinal cord lesion. The magnitude of this thermoregulatory impairment is proportional to the level of the lesion. For instance, individuals with high-level lesions (tetraplegia) are at a greater risk of heat illness than individuals with lower-level lesions (paraplegia) at a given exercise intensity. Therefore, cooling strategies may be highly beneficial in this population group, even in moderate ambient conditions (~21 °C). This review was undertaken to examine the scientific literature that addresses the application of cooling strategies in individuals with an SCI. Each method is discussed in regards to the practical issues associated with the method and the potential underlying mechanism. For instance, site-specific cooling would be more suitable for an athlete with an SCI than whole body water immersion, due to the practical difficulties of administering this method in this population group. From the studies reviewed, wearing an ice vest during intermittent sprint exercise has been shown to decrease thermal strain and improve performance. These garments have also been shown to be effective during exercise in the able-bodied. Drawing on additional findings from the able-bodied literature, the combination of methods used prior to and during exercise and/or during rest periods/half-time may increase the effectiveness of a strategy. However, due to the paucity of research involving athletes with an SCI, it is difficult to establish an optimal cooling strategy. Future studies are needed to ensure that research outcomes can be translated into meaningful performance enhancements by investigating cooling strategies under the constraints of actual competition. Cooling strategies that meet the demands of intermittent wheelchair sports need to be identified, with particular attention to the logistics of the sport

Effect of facial cooling on tympanic temperature

BACKGROUND: In clinical practice, tympanic temperature is used as an estimate of body temperature. Theoretically, temperature recorded directly from the tympanum reflects the temperature of arterial blood circulating to the brain. However, some studies do not support this connection. Ear-based thermometers in clinical use, commonly called tympanic thermometers, detect heat emission from the aural canal and tympanum. Dissociation of core body temperature and tympanic temperature would suggest that factors other than arterial blood perfusion affect tympanic temperature. METHODS: In a controlled laboratory experiment with four adult volunteers, esophageal and tympanic temperatures were recorded repeatedly at 2-minute intervals during whole-body heating and cooling. Facial cooling, produced by a small electrical fan, was used in three subjects. RESULTS: The gradient between tympanic and esophageal temperature was inconsistent across subjects, with tympanic temperature both higher and lower than esophageal temperature. Correlations between esophageal and tympanic temperature varied widely across subjects. Fanning the face produced a decrease in tympanic temperature without an accompanying decline in esophageal temperature. CONCLUSIONS: Facial cooling in the form of fanning altered the relationship between tympanic and esophageal temperature. This result suggests the possible lowering of tympanic temperature by cooled facial venous blood flow. Use of tympanic temperature in circumstances in which facial temperature may be different from that of other regions of the body deserves further study.</jats:p

Shivering following cardiac surgery: predictive factors, consequences, and characteristics

BACKGROUND: Shivering is common after cardiac surgery and may evoke harmful hemodynamic changes. Neither those changes nor factors increasing probability of shivering are well defined. OBJECTIVES: (1) To identify factors linked with risk of shivering by comparing age, weight, body surface area, gender, intraoperative details, anesthetics, postoperative temperatures, hemodynamics, and therapeutics in shivering vs nonshivering patients. (2) To describe temperatures, hemodynamics, therapeutics, myocardial oxygen consumption correlates (rate-pressure product, heart rate, systemic vascular resistance) in shivering and nonshivering groups, and shivering and nonshivering periods. (3) To characterize the electromyogram to determine whether the tremor is cold-induced. METHODS: A descriptive design with a time series component was used to study a convenience sample of 10 shivering and 10 nonshivering adults for 4 hours during early recovery from cardiac surgery. Pulmonary artery and skin (facial, calf, trunk) temperature were measured every 60 seconds; heart rate and arterial pressure, every 15 minutes; cardiac output, 3 times. Electromyogram was recorded intermittently. Medications and treatments were noted. RESULTS: Lower skin temperature was significantly related to shivering risk. Heart rate was significantly higher initially in shiverers and remained higher by 13.6 beats per minute. Significantly more nitroprusside was used to control arterial pressure before than after shivering. No significant differences were noted between groups in core temperature, age, weight, body surface area, anesthesia type, intraoperative temperature; or surgery, circulatory bypass, or cardiac cross-clamp duration. The electromyogram pattern during shivering was typical of that produced by cold. CONCLUSIONS: These results suggest that true shivering occurs after cardiac surgery. Skin, but not core, temperature and elevated heart rate predict shivering. Shivering may be more likely in hemodynamically unstable patients.</jats:p

Stimulation of skin sympathetic nerve discharge by central command. Differential control of sympathetic outflow to skin and skeletal muscle during static exercise.

Microneurographic measurements of muscle sympathetic nerve activity (SNA) have suggested that, during static exercise, central command is much less important than skeletal muscle afferents in causing sympathetic neural activation. The possibility remains, however, that the sympathetic discharge produced by central command is targeted mainly to tissues other than skeletal muscle. To examine this possibility, we recorded SNA with microelectrodes placed selectively in skin, as well as in muscle, nerve fascicles of the peroneal nerve during static handgrip maneuvers designed to separate the effects of central command from those of muscle afferents. To study the relative effects of cutaneous sympathetic activation on sudomotor versus vasomotor function, we simultaneously estimated changes in skin blood flow (laser Doppler velocimetry) and in sudomotor (electrodermal) activation in the region of skin innervated by the impaled nerve fascicle. Two minutes of static handgrip at 10%, 20%, and 30% of maximal voluntary contraction caused large and intensity-dependent increases in skin SNA. These increases in SNA immediately preceded the onset of muscle tension, accelerated progressively during sustained handgrip, and resolved promptly with the cessation of motor effort. The handgrip-induced increases in skin SNA were not maintained when handgrip was followed by arrest of the forearm circulation, a maneuver that maintains the stimulation of chemically sensitive muscle afferents while eliminating the influences of central command and mechanically sensitive muscle afferents. During normothermia, static handgrip at 30% maximal voluntary contraction caused sustained increases in skin SNA (+400 +/- 83%, mean +/- SEM, p less than 0.05) and in electrodermal activity (+276 +/- 56%, p less than 0.05) but only transient increases in estimated skin vascular resistance (+11 +/- 2%, p less than 0.05). When skin temperature was increased or decreased to a new stable baseline level, subsequent increases in skin SNA during handgrip were accompanied by sustained but directionally opposite changes in estimated skin vascular resistance, with exercise-induced vasodilation during hyperthermia but exercise-induced vasoconstriction during hypothermia. From these observations, we conclude the following: 1) static exercise markedly increases sympathetic outflow to skin as well as to skeletal muscle; 2) the increases in skin SNA, unlike muscle SNA, appear to be caused mainly by central command rather than by muscle afferent reflexes; and 3) this cutaneous sympathetic activation appears to be targeted both to sweat glands and to vascular smooth muscle, with the relative targeting being temperature dependent.(ABSTRACT TRUNCATED AT 400 WORDS

Effect of the 30 degree lateral recumbent position on pulmonary artery and pulmonary artery wedge pressures in critically ill adult cardiac surgery patients

BACKGROUND: Despite demonstrated benefits of lateral positioning, critically ill patients may require prolonged supine positioning to obtain reproducible hemodynamic measurements. OBJECTIVES: TO determine the effect of 30 degree right and left lateral positions on pulmonary artery and pulmonary artery wedge pressures after cardiac surgery in critically ill adult patients. METHODS: An experimental repeated-measures design was used to study 35 patients with stable hemodynamics after cardiac surgery. Subjects were randomly assigned to 1 of 2 position sequences. Pulmonary artery and pulmonary artery wedge pressures were measured in each position. RESULTS: Measurements obtained from patients in the 30 degree left lateral position differed significantly (all Ps &amp;lt; .05) from measurements obtained from patients in the supine position for pulmonary artery systolic, end-diastolic, and mean pressures. Pulmonary artery wedge pressures did not differ significantly; however, data were available from only 17 subjects. The largest mean difference in pressures between the 2 positions was 2.0 +/- 2.1 mm Hg for pulmonary artery systolic pressures, whereas maximum differences for end-diastolic and pulmonary artery wedge pressures were 1.4 +/- 2.7 mm Hg and 1.6 +/- 2.4 mm Hg, respectively. Clinically significant position-related changes in pressure occurred in 12 (2.1%) of 581 pressure pairs. Clinically significant changes occurred in end-diastolic pressure in 2 subjects and in pulmonary artery wedge pressure in 1 subject. CONCLUSiONS: In patients with stable hemodynamics during the first 12 to 24 hours after cardiac surgery, measurements of pulmonary artery and pulmonary artery wedge pressures obtained in the 30 degree lateral and supine positions are clinically interchangeable.</jats:p