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Temperature response to severe head injury and the effect on body energy expenditure and cerebral oxygen consumption
D S Matthews1, R E Bullock, J N Matthews
1Department of Child Health, University of Newcastle upon Tyne.
Insights
In head-injured children, elevated core temperature correlates with increased whole body energy expenditure. However, core temperature does not significantly affect cerebral oxygen consumption, blood flow, or intracranial pressure.
Area of Science:
- Pediatric Neurocritical Care
- Physiology
- Metabolism
Background:
- Core body temperature management is critical in pediatric neurocritical care.
- The relationship between core temperature and cerebral physiology in head-injured children requires further elucidation.
- Understanding these relationships can inform therapeutic interventions.
Purpose of the Study:
- To investigate the association between core body temperature and whole body energy expenditure.
- To examine the impact of core temperature on cerebral oxygen consumption (CMRO2), cerebral blood flow (CBF), and intracranial pressure (ICP) in pediatric patients with severe head injuries.
Main Methods:
- Utilized indirect calorimetry to measure whole body energy expenditure.
- Employed the Kety-Schmidt technique to assess CMRO2 and CBF.
- Collected 107 serial measurements from 18 head-injured children undergoing neurointensive care.
Main Results:
- A positive correlation was observed between rectal temperature and energy expenditure (7.4% increase per degree Celsius).
- No significant relationships were found between rectal temperature and CMRO2, CBF, or ICP.
- Mild induced hypothermia did not demonstrably decrease CMRO2 or CBF in two patients.
Conclusions:
- Core body temperature significantly influences whole body energy expenditure in head-injured children.
- Core temperature does not appear to directly impact cerebral oxygen consumption, blood flow, or intracranial pressure in this population.
- Assessing the efficacy of core temperature modulation on cerebral metabolism solely through whole body responses may be limited.
Abstract:
This study examines the relationship between core temperature and whole body energy expenditure, cerebral oxygen consumption (CMRO2), cerebral blood flow (CBF), and intracranial pressure (ICP) in severely head injured children. A total of 107 serial measurements of temperature, energy expenditure, CMRO2, CBF, and ICP were made in 18 head injured children receiving neurointensive care. Energy expenditure was measured using indirect calorimetry, and CMRO2 and CBF using the Kety-Schmidt technique. The mean rectal temperature was 37.8 degrees C (34-39.1 degrees C) despite modification with paracetamol. Within each child there was a positive relationship between rectal temperature and energy expenditure, energy expenditure increasing by a mean of 7.4% per degree C. There was no evidence of significant relationships between rectal temperature and CMRO2, CBF, or ICP. Mild induced hypothermia in two children did not result in decreased CMRO2 or CBF measurements. The efficacy of interventions aiming to modify cerebral energy metabolism by changing core temperature cannot be readily assessed by the response of the whole body.