Device-based physical therapies in chronic pruritus: A narrative review.

Chronic pruritus is a highly prevalent disease associated with high psychosocial and economic burdens. In addition to pharmacological treatments, device-based physical therapies also offer antipruritic effects. Phototherapy, laser, electrical neurostimulation technologies, acupuncture, cryotherapy, and cold atmospheric plasma are, in part, still experimental but emerging treatment options that augment our repertoire to treat patients with chronic pruritus. In this narrative review, we provided an overview of these physical modalities and their role in itch management.

Evaluation of a Novel Dermal Cooling System for the Treatment of Benign Pigmented Lesions in Asians.

OBJECTIVE: Our study aimed to evaluate the efficacy of this novel dermal cooling system (DCS) in reducing pigmentation in benign pigmented lesions in Asian patients and its potential side effects. METHODS: It was a prospective open-label single-center study. Asian patients, with the presence of benign pigmented lesions mainly including lentigines, melasma, nevus spilus, ephelides, café au lait, and seborrheic keratosis were recruited for a novel DCS. The DCS provided localized cooling of the epidermal layer below freezing but was less intense than cryotherapy. Each patient received DCS at Week 0 and repeated at 4-week intervals up to 10 sessions. Global aesthetic improvement scores (GAIS) by blinded physicians and subjects were recorded at 2, 6, and 12 months posttreatment follow-up. RESULTS: Eighty-one patients were recruited with a total of 305 sessions performed and 1716 lesion sites treated. At 2-month posttreatment, 76.5% and 58.6% treatment sites showed obvious to marked improvement respectively and the improvement sustained at 6 and 12 months. Only minor adverse events were reported. Erythema and edema were the most commonly anticipated effects immediately after treatment. The pain was minimal. Postinflammatory hyperpigmentation was only reported in 2.2% (38/1716) treated sites. CONCLUSION: To our knowledge, this study was the first study to demonstrate that this novel DCS was an effective, safe, and well-tolerated treatment for benign pigmented lesions in Asians.

Effects of a forehead cooling device in veterans with chronic insomnia disorder and co-morbid medical and psychiatric conditions: a pilot study.

PURPOSE: While forehead cooling has been studied in patients with insomnia in the absence of comorbid medical/psychiatric disorders, it has never been evaluated in patients with insomnia in the presence of co-morbid medical/psychiatric disorders. METHODS: Veterans with chronic insomnia disorder and co-morbid medical and psychiatric conditions received 4-week open-label, in-home, nightly treatment with a forehead cooling device (14-16 °C) along with personalized sleep hygiene following baseline assessments. Pre- and post-treatment, participants completed the Insomnia Severity Index (ISI), the Generalized Anxiety Disorder 7-item scale (GAD-7), and the Patient Health Questionnaire 9-item scale (PHQ-9). Participants recorded daily sleep and anxiety/arousal symptoms. RESULTS: Of 24 veterans (20 men, 42.2 ± 9.5 years), 17 (71%) had marked insomnia severity improvement (a decrease of > 8 on the ISI) and 10 (42%) participants scored 7 or below on the ISI at post-treatment reflecting remission. Participants reported reductions in sleep onset latency (SOL) (F = 12.9, p < 0.001), and wakefulness after sleep onset (WASO) (F = 8.4, p < 0.001) across treatment. They also had significant reductions in insomnia severity (t = 10.04, p < 0.001), anxiety (t = 3.59, p = 0.002), and depression (t = 7.75, p < 0.001) from pre- to post-treatment. CONCLUSION: This pilot study shows that 4-week nightly use of a forehead cooling device produces improvements in insomnia, anxiety, and depressive symptoms in veterans with chronic insomnia disorder and co-morbid medical and psychiatric conditions. Controlled studies are warranted to determine the role of this therapy in the management of insomnia in veterans. TRIAL REGISTRATION: Not required as a small sample size feasibility study.

Cooling During Exercise May Induce Benefits Linked to Improved Brain Perfusion.

The aim of this study was to evaluate the impact of using a cooling vest during physical exercise (per-cooling) in humid and temperate conditions (≈22°C, ≈80% relative humidity) on perceptual and physiological responses (tissue oxygenation and heart rate). 20 physically active men performed twice a 30-min cycling exercise at 70% of their theoretical maximum heart rate while using an activated (experimental condition) and a deactivated (control condition) cooling system in a randomized crossover study. Heart rate and tissue (cerebral and muscular) oxygenation were continuously measured during exercise and recovery, and skin temperature was measured every 10 min. Perception of temperature, humidity and comfort were assessed at the end of the recovery period. Results showed a decrease in trunk skin temperature (p<0.05), a faster heart rate recovery and an increase in the concentration of total hemoglobin at the brain level (p<0.05) compared with control condition. Moreover, an improved subjective rating of thermal sensations, wetness and comfort compared to control values (p<0.05) was noted. In conclusion, wearing a cooling vest during submaximal exercise improves perceptual and physiological responses in humid temperate conditions, which may be due to a better blood perfusion at the brain level and a better parasympathetic reactivation.

Continuous forearm cooling attenuates gastrointestinal temperature increase during cycling.

Hot environmental conditions can challenge thermoregulation resulting in exacerbated heat strain. This study evaluated the influence of continuous inner forearm cooling on gastrointestinal temperature (TGI) and physiological responses to exercise in hot (30°C) and humid (relative humidity: 70%) conditions. Eleven trained cyclists (seven male age: 37±12 years; four female age: 41±15 years; mean±standard deviation) performed two experimental trials, cycling at 66% of their self-reported functional threshold power (average work rate over an hour of maximum effort cycling; 175±34W) for 45 minutes in an environmental chamber. One trial employed continuous inner forearm cooling (COOL) with 5°C water passing through aluminum heat exchangers, while the other had no cooling (CONTROL). Heat was removed from the body at an average rate of 30.3±6.6W during the COOL trial resulting in an attenuation of TGI rise (CONTROL: 2.46±0.70, COOL: 2.03±0.63°C·h-1; p=0.002). The change in heart rate from the 10th minute to the end of exercise, as an indicator of cardiovascular drift, was reduced (CONTROL: 20±7, COOL: 17±6beats·min-1; p=0.050) and end-exercise thermal comfort was improved in the COOL trial with a trend for reduced rating of perceived exertion (p=0.055). Findings suggest that continuous cooling of the inner forearms can attenuate the rise of TGI and help mitigate the risk of heat injury during exercise in hot and humid conditions.

Effectiveness and safety of a thermal insulating coverage on the top of the cryo-cabin during a partial-body cryostimulation.

Partial Body Cryostimulation (PBC) consists of exposing minimally dressed participants to very cold air, in a specially designed cabin (cryo-cabin), for a short period of time. In recent years, cryo-cabins have been launched with a coverage to limit thermo-dispersion, however a validation study is lacking. The aim of this study was to compare thermal responses after a PBC protocol in an open cryo-cabin or into a cryo-cabin closed at the top with a polyurethane-made lid. Eighteen young male adults completed the two 150 s PBC sessions in a cross-over fashion. Temperature of the inner cabin and thermal responses were measured prior and 1, 5, 10, 20 min after completing each PBC session. When covered, cryo-cabins maintained a lower temperature in the front with respect to the back. There was a significant interaction regarding coverage*time*position with a main effect of coverage. Body surfaces were significantly colder under covered condition compared to open PBC. Subjects perceived a greater thermal discomfort during a covered PBC rather than during an open condition. For the first time, the use of a coverage placed on the top of the cabin was demonstrated to maintain lower temperatures of the inner environment and the users' skin with respect to a standard PBC. This evidence indicates that practitioners and clinicians making use of PBC can successfully and safely cover cryo-cabins with an insulating lid so to improve the effectiveness of their treatments.

Effective intranasal cooling in an 80 year old patient with heatstroke.

Intranasal cooling by the evaporation of perflourcarbon is almost exclusively used for the induction of therapeutic hypothermia in post-resuscitation care. This method has proven to be effective and safe. This case presents a successful application to a patient with external heatstroke. The 80 year old male patient was found in deep coma (GCS 4) by emergency medical services (EMS) showing a core temperature around 42 °C. Despite of preclinical physical cooling, the patient showed a persistent temperature of 41.5 °C upon reaching the emergency department. After endotracheal intubation intranasal evaporation cooling was performed and the patient's core temperature was reduced efficiently. We recorded an excellent cooling rate of 2.8 °C per hour. 16 h later the patient was successfully extubated with a good neurological outcome. This case shows that although intranasal cooling is mostly known for post-resuscitation care, there is a sensible application in heatstroke with imminent cerebral oedema.

Effects of Cryolipolysis with Plates in Localized Adiposity with the CrioPlace Concept.

BACKGROUND: Plate cryolipolysis is a method of applying cooling without a vacuum system, which can be used in regions with less possibility of skin suction or fibrosis. OBJECTIVE: To investigate the effects of cryolipolysis with the use of plate-shaped applicators (CrioPlaceTM) for localized fat treatment. METHODS: The sample consisted of men aged 20 to 45 years with complaints of localized adiposity in the abdominal region and flanks. Two plates were positioned in the flank and abdomen regions, respectively. They received two 60-min applications in the temperature of -2°C. The anthropometric, thermographic and ultrasound assessments were performed, and a satisfaction questionnaire was applied after treatment. The re-evaluations occurred 30 and 60 days after the first intervention. RESULT: A reduction in adiposity was observed in flank region plicometry (p<0.05) and abdominal and flank ultrasound (p < 0.05). About 66.7% of the volunteers reported less water retention, about 41.7% reported that their clothes were looser, and 100% reported overall satisfaction. Fifty percent rated the treatment as excellent and 58.3% felt improvement in overall aesthetics. CONCLUSION: The CrioPlaceTM method was effective in reducing localized adiposity, with clinical satisfaction of measurement reduction, both in plicometry and ultrasound analyses, with highlights to the flank region results.

Cryotherapy after Total Knee Arthroplasty provides faster recovery and better ranges of motion in short term follow up. Results of a prospective comparative study.

Cryotherapy is applied in Total Knee Arthroplasty (TKA) to improve functional outcome. The aim of this study is to investigate whether an advanced cryotherapy device does not increase the risk of complications and improves knee function or decreases swelling. A prospective cohort of TKA patients was formed by a cryotherapy group and a control group. The primary outcome was complication ratio. Our secondary outcomes were functional results and swelling. No significant differences were found in complication ratio between 31 patients in the cryotherapy group and 31 patients in the control group. The cryotherapy group showed a significant better knee flexion and less swelling in the early rehabilitation phase. No differences were found at the other follow-up moments or in the other outcomes. This advanced cryotherapy device is safe in respect of postoperative complications, improves knee function and decreases swelling in the early rehabilitation phase. However, it is questionable if an advanced cryotherapy device with its additional costs is necessary to provide the desired effects of cryotherapy.

A prospective comparative study between a cooling device and manual cooling after total knee arthroplasty.

Studies have shown that the use of cryotherapy after a total knee arthroplasty can have beneficial effect on blood loss, pain and medication usage. In this study, the effect of the applied cryotherapy procedure is investigated. 52 patients underwent a total knee arthroplasty. The test group received continuous cooling, whereas the control group received manual conventional cooling with ice dressing. The knee circumference and range of motion, medication use, satisfaction and pain were investigated. There is no statistical significant difference in pain and medication usage. A significant difference is observed in the swelling of the knee on the first postoperative day, the range of motion on the 7 th , 10 th , 11 th and 12 th postoperative day, and the satisfaction rate. This study shows that continuous cooling has a positive effect on the swelling and range of motion of the knee, and on the satisfaction of the treatment. Clinical trial registration number : Clinical trial number : EudraCT2015-000259-26.

[Cryotherapy chambers and cold-water immersion : therapeutic use and risks]. / Chambres de cryothérapie et immersion en eau froide†: utilisation thérapeutique et risques.

Whole body cryotherapy is mainly performed either by immersion in cold water or in a cryotherapy chamber. Practiced since Antiquity and considered as a «â€…natural ¼ method, cryotherapy is attracting more and more followers. Beneficial health effects have been described in the literature. However, interpretation of its effects is difficult due to low quality of current studies. Cryotherapy could however be useful in addition to conventional therapies in various pathologies and situations, provided that the risks, contraindications and rules of good practice are known.

La cryothérapie du corps entier se pratique principalement soit par immersion en eau froide, soit en chambre de cryothérapie. Pratiquée depuis l'Antiquité et considérée comme une méthode «â€…naturelle ¼, la cryothérapie tend à attirer de plus en plus d'adeptes. Des effets bénéfiques pour la santé ont été décrits dans la littérature. Néanmoins, l'interprétation de ses effets est difficile en raison de la faible qualité des études actuelles. La cryothérapie pourrait toutefois être utile en complément des thérapies classiques dans diverses pathologies et situations, à condition de connaître les risques, les contre-indications et les règles de bonnes pratiques.

Cryolipolysis for Noninvasive Contouring of the Periumbilical Abdomen With a Nonvacuum Conformable-Surface Applicator.

BACKGROUND: Although most cryolipolysis treatments are performed with vacuum applicators, some patients may have areas of fibrous, nonpinchable fat or find vacuum suction to be uncomfortable. OBJECTIVE: This study evaluates a nonvacuum conformable-surface applicator for cryolipolysis of the periumbilical abdomen. METHODS/MATERIALS: Twenty subjects with periumbilical subcutaneous fat were treated with a nonvacuum cryolipolysis applicator in this prospective, single-center, open-label clinical trial. Each subject underwent a single treatment cycle with an optional second treatment 10 weeks later. Efficacy was evaluated by blinded review of digital photographs. Subject satisfaction was assessed at 10-week follow-up. RESULTS: Twenty subjects completed one treatment, of which 6 underwent the optional retreatment. Independent review demonstrated 77% correct identification of baseline photographs after one treatment, which improved to 100% after a second treatment. Patient questionnaires after one treatment revealed 50% satisfaction, with 60% willing to recommend the procedure and 60% reporting visible fat reduction. After second treatment, however, 100% were satisfied, 83% were willing to recommend, and 100% reported visible fat reduction. CONCLUSION: Cryolipolysis with a nonvacuum conformable-surface applicator is safe, effective, and well tolerated for noninvasive reduction of fibrous periumbilical abdominal fat. Efficacy and subject satisfaction is significantly greater with 2 treatments than with a single session.

Double stacking cryolipolysis treatment of the abdominal fat with use of a novel contoured applicator.

Background: Cryolipolysis is a noninvasive method for the selective reduction of subcutaneous fat. The abdomen and flank area are most commonly treated sites and now the treatment efficacy became the important issue. Objectives: To evaluate the effectiveness and safety of double stacking cryolipolysis treatment with the novel contoured applicator for abdominal fat reduction. Materials and methods: 12 healthy Korean were treated using cryolipolysis contact device. The device was applied on participant's left lower abdomen. Performance was held for 35 minutes and immediately repeated the second performance. The right abdomen was left untreated. Participants were examined with high resolution ultrasound and the depth of subcutaneous fat layer was measured initially and 8 weeks after the sessions. Any adverse events were assessed during the entire study period. Results: The subjective reduction of abdominal fat was noted in most participants. No serious adverse events was reported. Reduction of subcutaneous fat layer depth was confirmed in high resolution ultrasound after 8 weeks of treatment. Conclusion: The results of this study indicate that abdominal fat can be reduced effectively by the novel cryolipolysis applicator. With subjective satisfaction of participants our study shows that double stacking treatment appears safe and well tolerated with enhanced treatment outcomes.

Evaluation of the Clinical Efficacy of Using Thermal Camera for Cryotherapy in Patients with Total Knee Arthroplasty: A Prospective Study.

Background and objectives: Cryotherapy is a method of treatment using cold application. This study aimed to evaluate postoperative clinical and hematological parameters and pain associated with total knee arthroplasty in patients and compared cryotherapy to the conventional method of cold ice pack compressions. Materials and Methods: Between January 2015 and January 2016, 90 patients who underwent total knee arthroplasty for grade 4 gonarthrosis were prospectively evaluated. The patients were divided into three groups (n = 30, each): Group 1, cryotherapy was applied in the pre- and postoperative periods; Group 2, cryotherapy was applied only in the postoperative period; and Group 3 (control group), only a cold pack (gel ice) was applied postoperatively. In all groups, pre- and postoperative evaluations at 6, 24, and 48 h, hemorrhage follow-up, knee circumference measurement, visual analog scale pain score, knee circumference, and temperature measured by thermal camera were recorded. Results: Of the 90 patients, 10% were men and 90% were women. The mean age was 64.3 ± 8.1 (range: 46-83) years. The patella upper end diameter values were significantly lower in the postoperative period in Groups 1 and 2 than in Group 3 (p = 0.003). Hemoglobin levels at 24 and 48 h postoperatively were significantly lower in Group 3 than in Group 1 (p < 0.001, each) and Group 2 (p = 0.038, p < 0.001). At 6, 24, and 48 h follow-ups, pain values were significantly lower in Group 2 than in Group 3 (p < 0.001). Preoperative 6, 24, and 48 h temperature values were significantly lower in Group 1 than in Group 3 (p < 0.001 for each). It was found that the difference between preoperative and postoperative knee flexion measurements was significantly different in both groups or the difference between the groups was changed in each period (p < 0.001). Conclusions: Postoperative cryotherapy is a potentially simple, noninvasive option and beneficial for the reduction of reducing pain, bleeding, length of stay, analgesic requirement and swelling after total knee arthroplasty. Moreover, there was no early or late prosthesis infection in cryotherapy groups, which may be considered as an additional measure to prevent prosthesis infection.

The effect of cryotherapy on fibromyalgia: a randomised clinical trial carried out in a cryosauna cabin.

Evidence of symptomatic treatment for fibromyalgia (FM) is very low. Whole body cryotherapy (WBC) modulates different neurotransmitters, which might have a role in pain alleviation and could exert an effect on FM. Our aim was to evaluate the efficacy of WBC for the control of pain and impact of disease in FM. For this we run an open, randomized, crossover trial of Cryosense TCT™ cabin vs rest. Patients with FM according to ACR criteria were recruited consecutively from general practices. Trial endpoints were change (∆) in pain after 2 and 4 weeks, measured by a visual analogue scale (VAS), ∆ burden of disease, evaluated by the Fibromyalgia Impact Questionnaire (FIQ), and severity of FM, measured by the Combined Index of Severity of Fibromyalgia (ICAF). Within group differences, sequence and period effects were tested with Student's t or Mann-Whitney U tests. Multiple linear regression models were used to adjust effect by baseline differences between groups. Sixty patients were included in the trial. A period effect was noted, with residual effect of WBC; therefore, only results from the first sequence were analysed. ∆VAS pain, ∆FIQ and ∆ICAF scores were significantly larger in the WBC group after the first period (3.0 vs 0.3 in ∆VAS pain; 32.1 vs 0.4 in ∆FIQ; 13.7 vs 0.07 in ∆ICAF; all p < 0.001), and were confirmed after adjustment. In conclusion, WBC with a Cryosense TCT cabin may be a useful adjuvant therapy for FM; further studies on long-term effect and compared to other physical therapies are warranted.Trial registration NCT03425903.

Evaluation the Efficacy of Hilotherm Cooling System in Reducing Postoperative Pain and Edema in Maxillofacial Traumatized Patients and Orthognathic Surgeries.

Surgical treatment in patients with facial bone surgeries governs a meaningful extent of tissue trauma prompting prevalent postoperative portents of pain, facial swelling, and inconvenience. Beneficial effects of local cold therapy following surgery, facial swelling, pain, and inflammation have been discussed. The aim of study is to evaluate the efficacy of hilotherm cooling system in reducing postoperative pain and edema in patients following maxillofacial trauma and orthognathic surgeries.A clinical prospective study was done in the postoperative period for patients with facial trauma or those subjected to orthognathic surgery, 34 patients divided randomly into 2 groups; study group treated with the hilotherm cooling system and control group without. Facial swelling was quantified by 5 linear distances (A, B, C, D, and E). Pain was reported on day 1, 2, and 7 postoperatively. Satisfaction with cooling therapy at day 7 following surgery was recorded. The means of swelling variation in study group were less than in control group with highly significant difference (P < 0.01) except in (line D) which is from tragus to the chin most prominent point where it was significant. Pain scores in control group were higher than in study group with highly significant difference (P < 0.01) except at 7th day which was not significant (P > 0.05). All patients in the study group were very satisfied.

Effects of Maintenance on Quality of Performance of Cryotherapy Devices for Treatment of Precancerous Cervical Lesions.

OBJECTIVE: The aim of the study was to evaluate the impact of maintenance on performance of cryosurgical equipment used in El Salvador primary health clinics. MATERIALS AND METHODS: Nine gynecological cryotherapy devices used in El Salvador were bench tested against a new machine of the same make and model. The devices were run for five successive double-freeze cycles. The El Salvador machines then received maintenance by a specialized engineer and another double-freeze cycle was performed. Temperature at the device probe tip was recorded throughout each cycle and ballistic gelatin was used as the tissue analogue to measure freeze ball dimensions achieved by the devices. Outcome measures were mean lowest-sustained temperatures and freeze ball mean weight, depth, and diameter. Paired and unpaired t tests were used to compare results premaintenance versus postmaintenance and postmaintenance versus the reference, respectively. RESULTS: Premaintenance versus postmaintenance freeze ball dimensions were significantly different (mean differences in weight = 2.31 g, p = .01; depth = 2.29 mm, p = .03; diameter = 3.51 mm, p = .02). However, postmaintenance dimensions were not significantly different than those of the reference (weight = 7.44 g vs. 8.39 g, p = .07; depth = 10.71 vs. 11.24 mm, p = .1; diameter = 31.38 mm vs. 32.05 mm, p = .3). Postmaintenance, minimum, and lowest-sustained temperatures were within the recommended clinical range. CONCLUSIONS: Specialized maintenance was necessary for heavily used cryotherapy devices to perform adequately, highlighting the challenges of gas-based cryotherapy in low- and middle-income countries.

Impact of a new cryotherapy device on early rehabilitation after primary total knee arthroplasty (TKA): a prospective randomised controlled trial.

BACKGROUND: The aim of this prospective, randomised and single blinded study was to evaluate the efficiency and safety of a new cryotherapy device in patients undergoing unilateral, primary total knee arthroplasty (TKA). Our hypothesis was that patients administered to the new cryotherapy device would perform better than patients receiving a conventional standard cold therapy regimen. METHODS: Ninety-seven patients were randomised into two groups receiving either the cTreatment® (new cryotherapy device) or the standard cold therapy protocol (including cold pack application for six days after the surgical intervention). We evaluated the following endpoints consisting of range of motion (ROM), pain intensity, and knee girth on admission day and the second, fourth, and sixth post-operative day (POD). RESULTS: A statistically significant benefit of the new cryotherapy device was detected regarding the ROM on the sixth POD with an average gain of 7 degrees (p = 0.021). Pain in the numeric rating scale (NRS) score in motion was significantly lower in the cTreatment® group on the second POD (p = 0.034). There were no statistically significant differences between groups regarding the NRS in rest, patient controlled analgesia (PCA) consumption, and girth measurements. No adverse effects were observed in both study groups. CONCLUSION: The new computer-controlled cooling therapy device provides benefits in terms of early post-operative remobilisation with respect to ROM and pain, which might be attributed to a reduced inflammatory response, as well as reduced secretion and bleeding. The cTreatment® system appears to be a safe and efficient procedure.

Examination of Intramuscular and Skin Temperature Decreases Produced by the PowerPlay Intermittent Compression Cryotherapy.

CONTEXT: Previous research has found ice bags are more effective at lowering intramuscular temperature than gel packs. Recent studies have evaluated intramuscular temperature cooling decreases with ice bag versus Game Ready and with the PowerPlay system wetted ice bag inserts; however, intramuscular temperature decreases elicited by PowerPlay with the standard frozen gel pack inserts have not been examined. OBJECTIVE: Evaluate the rate and magnitude of cooling using PowerPlay with frozen gel pack (PP-gel) option, PowerPlay with wetted ice bag (PP-ice) option, and control (no treatment) on skin and intramuscular temperature (2 cm subadipose). DESIGN: Repeated-measures counterbalanced study. SETTING: University research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twelve healthy college-aged participants (4 men and 8 women; age = 23.08 (1.93) y, height = 171.66 (9.47) cm, mass = 73.67 (13.46) kg, and subcutaneous thickness = 0.90 (0.35) cm). INTERVENTION(S): PowerPlay (70 mm Hg) with either wetted ice bag or frozen gel pack was applied to posterior aspect of nondominant calf for 30 minutes; control lay prone for 30 minutes. Participants underwent each treatment in counterbalanced order (minimum 4 d, maximum 10 d between). MAIN OUTCOME MEASURE(S): Muscle temperature was measured via 21-gauge catheter thermocouple (IT-21; Physitemp Instruments, Inc). Skin temperature was measured via surface thermocouple (SST-1; Physitemp Instruments, Inc). RESULTS: Significant treatment-by-time interaction for muscle cooling (F10,80 = 11.262, P = .01, [Formula: see text], observed ß = 0.905) was observed. PP-ice cooled faster than both PP-gel and control from minutes 12 to 30 (all Ps < .05); PP-gel cooled faster than control from minutes 18 to 30 (all Ps < .05). Mean decreases from baseline: PP-ice = 4.8°C (2.8°C), PP-gel = 2.3°C (0.8°C), and control = 1.1°C (0.4°C). Significant treatment-by-time interaction for skin cooling (F10,80 = 23.920, P = .001, [Formula: see text], observed ß = 0.998) was observed. PP-ice cooled faster than both PP-gel and control from minutes 6 to 30 (all Ps < .05); PP-gel cooled faster than control from minutes 12 to 30 (all Ps < .05). Mean decreases from baseline: PP-ice = 14.6°C (4.8°C), PP-gel = 4.0°C (0.9°C), and control = 1.0°C (1.0°C). CONCLUSIONS: PP-ice produces clinically and statistically greater muscle and skin cooling compared with PP-gel and control.

Tarp-Assisted Cooling as a Method of Whole-Body Cooling in Hyperthermic Individuals.

STUDY OBJECTIVE: We investigated the efficacy of tarp-assisted cooling as a body cooling modality. METHODS: Participants exercised on a motorized treadmill in hot conditions (ambient temperature 39.5°C [103.1°F], SD 3.1°C [5.58°F]; relative humidity 38.1% [SD 6.7%]) until they reached exercise-induced hyperthermia. After exercise, participants were cooled with either partial immersion using a tarp-assisted cooling method (water temperature 9.20°C [48.56°F], SD 2.81°C [5.06°F]) or passive cooling in a climatic chamber. RESULTS: There were no differences in exercise duration (mean difference=0.10 minutes; 95% CI -5.98 to 6.17 minutes or end exercise rectal temperature (mean difference=0.10°C [0.18°F]; 95% CI -0.05°C to 0.25°C [-0.09°F to 0.45°F] between tarp-assisted cooling (48.47 minutes [SD 8.27 minutes]; rectal temperature 39.73°C [103.51°F], SD 0.27°C [0.49°F]) and passive cooling (48.37 minutes [SD 7.10 minutes]; 39.63°C [103.33°F], SD 0.40°C [0.72°F]). Cooling time to rectal temperature 38.25°C (100.85°F) was significantly faster in tarp-assisted cooling (10.30 minutes [SD 1.33 minutes]) than passive cooling (42.78 [SD 5.87 minutes]). Cooling rates for tarp-assisted cooling and passive cooling were 0.17°C/min (0.31°F/min), SD 0.07°C/min (0.13°F/min) and 0.04°C/min (0.07°F/min), SD 0.01°C/min (0.02°F/min), respectively (mean difference=0.13°C [0.23°F]; 95% CI 0.09°C to 0.17°C [0.16°F to 0.31°F]. No sex differences were observed in tarp-assisted cooling rates (men 0.17°C/min [0.31°F/min], SD 0.07°C/min [0.13°F/min]; women 0.16°C/min [0.29°F/min], SD 0.07°C/min [0.13°F/min]; mean difference=0.02°C/min [0.04°F/min]; 95% CI -0.06°C/min to 0.10°C/min [-0.11°F/min to 0.18°F/min]). Women (0.04°C/min [0.07°F/min], SD 0.01°C/min [0.02°F/min]) had greater cooling rates than men (0.03°C/min [0.05°F/min], SD 0.01°C/min [0.02°F/min]) in passive cooling, with negligible clinical effect (mean difference=0.01°C/min [0.02°F/min]; 95% CI 0.001°C/min to 0.024°C/min [0.002°F/min to 0.04°F/min]). Body mass was moderately negatively correlated with the cooling rate in passive cooling (r=-0.580) but not in tarp-assisted cooling (r=-0.206). CONCLUSION: In the absence of a stationary cooling method such as cold-water immersion, tarp-assisted cooling can serve as an alternative, field-expedient method to provide on-site cooling with a satisfactory cooling rate.