Our bodies depend on an exquisitely sensitive and refined temperature control system to maintain a state of health and homeostasis. The exceptionally broad range of physical activities that humans engage in and the diverse array of environmental conditions we face require remarkable strategies and mechanisms for regulating internal and external heat transfer processes. On the occasions for which the body suffers trauma, therapeutic temperature modulation is often the approach of choice for reversing injury and inflammation and launching a cascade of healing. The focus of human thermoregulation is maintenance of the body core temperature within a tight range of values, even as internal rates of energy generation may vary over an order of magnitude, environmental convection, and radiation heat loads may undergo large changes in the absence of any significant personal control, surface insulation may be added or removed, all occurring while the body's internal thermostat follows a diurnal circadian cycle that may be altered by illness and anesthetic agents. An advanced level of understanding of the complex physiological function and control of the human body may be combined with skill in heat transfer analysis and design to develop life-saving and injury-healing medical devices. This paper will describe some of the challenges and conquests the author has experienced related to the practice of heat transfer for maintenance of health and enhancement of healing processes.
Issue Section:
Max Jakob Award Paper
Keywords:
Bio-Heat and mass transfer
References
1.
Hensel
, H.
, 1973
, “Neural Processes in Thermoregulation
,” Physiol. Rev.
, 53
(4
), pp. 948
–1017
.2.
Hensel
, H.
, 1981
, Thermoreception and Temperature Regulation
, Academic Press
, London
.3.
Jessen
, C.
, 2001
, Temperature Regulation in Humans and Other Mammals
, Springer
, Berlin
.10.1007/978-3-642-59461-84.
Cisneros
, A. B.
, and Goins
, B. L.
, eds., 2009
, Body Temperature Regulation
, Nova Science Publ.
, New York
.5.
Romanovsky
, A. A.
, 2007
, “Functional Architecture of the Thermoregulatory System
,” Am. J. Physiol.
, 292
(1
), pp. R37
–R46
.10.1152/ajpregu.00668.20066.
Hammel
, H. T.
, Hardy
, J. D.
, and Fusco
, M. M.
, 1960
, “Thermoregulatory Responses to Hypothalamic Cooling in Unanesthetized Dogs
,” Am. J. Physiol.
, 198
, pp. 481
–486
.7.
Hammel
, H. T.
, 1968
, “Regulation of Internal Body Temperature
,” Ann. Rev. Physiol.
, 30
, pp. 641
–710
.10.1146/annurev.ph.30.030168.0032338.
Nagashima
, K.
, 2006
, “Central Mechanisms for Thermoregulation in a Hot Environment
,” Ind. Health
, 44
(3
), pp. 359
–367
.10.2486/indhealth.44.3599.
Charkoudian
, N.
, 2003
, “Skin Blood Flow in Adult Human Thermoregulation: How It Works, When It Does Not, and Why
,” Mayo Clin. Proc.
78
(5
), pp. 603
–612
.10.4065/78.5.60310.
Gonzalez-Alonso
, J.
, 2012
, “Human Thermoregulation and the Cardiovascular System
,” Exp. Physiol.
, 97
(3
), pp. 340
–346
.10.1113/expphysiol.2011.05870111.
Jessen
, C.
, and Mayer
, E. Th.
, 1971
, “Spinal Cord and Hypothalamus as Core Sensors of Temperature in the Conscious Dog. I. Equivalence of Responses
,” Pflugers Arch.
, 324
(3
), pp. 189
–204
.10.1007/BF0058641812.
Jessen
, C.
, and Ludwig
, O.
, 1971
, “Spinal Cord and Hypothalamus as Core Sensors of Temperature in the Conscious Dog. II. Addition of Signals
,” Pflugers Arch.
, 324
(3
), pp. 205
–216
.10.1007/BF0058641913.
Jessen
, C.
, and Simon
, E.
, 1971
, “Spinal Cord and Hypothalamus as Core Sensors of Temperature in the Conscious Dog. III. Identity of Functions
,” Pflugers Arch.
, 324
(3
), pp. 217
–226
.10.1007/BF0058642014.
Hales
, J. R. S.
, Fawcett
, A. A.
, Bennett
, J. W.
, and Needham
, A. D.
, 1978
, “Thermal Control of Blood Flow Through Capillaries and Arteriovenous Anastomoses in Skin of Sheep
,” Pflugers Arch.
, 378
(1
), pp. 55
–63
.10.1007/BF0058195815.
Hales
, J. R. S.
, and Iriki
, M.
, 1975
, “Integrated Changes in Regional Circulatory Activity Evoked by Spinal Cord and Peripheral Thermoreceptor Stimulation
,” Brain Res.
, 87
(2–3
), pp. 267
–275
.10.1016/0006-8993(75)90424-216.
Jessen
, C.
, Felde
, D.
, Volk
, P.
, and Kuhnen
, G.
, 1990
, “Effects of Spinal Cord Temperature on the Generation and Transmission of Temperature Signals in the Goat
,” Pflugers Arch.
, 416
(4
), pp. 428
–433
.10.1007/BF0037075017.
Jessen
, C.
, McLean
, J. A.
, Calvert
, D. T.
, and Findlay
, J. D.
, 1972
, “Balanced and Unbalanced Temperature Signals Generated in Spinal Cord of the Ox
,” Am. J. Physiol.
, 222
(6
), pp. 1343
–1347
.18.
Lewis
, T.
, and Pickering
, G. W.
, 1931
, “Vasodilation in the Limbs in Response to Warming the Body; With Evidence for Sympathetic Vasodilator Nerves in Man
,” Heart
, 15
, pp. 33
–51
.19.
Gibbon
, J. H.
, Jr., and Landis
, E. M.
, 1932
, “Vasodilation in the Lower Extremities in Response to Immersing the Forearms in Warm Water
,” J. Clin. Invest.
, 11
(5
), pp. 1019
–1036
.10.1172/JCI10045620.
Freeman
, N. E.
, 1935
, “The Effect of Temperature on the Rate of Blood Flow in the Normal and in the Sympathectomized Hand
,” Am. J. Physiol.
, 113
, pp. 384
–398
.21.
Bader
, M. E.
, and Macht
, M. B.
, 1948
, “Indirect Peripheral Vasodilation Produced by the Warming of Various Body Areas
,” J. Appl. Physiol.
, 1
(3
), pp. 215
–226
.22.
Mackowiak
, P.
, Wasserman
, S.
, and Levine
, M.
, 1992
, “A Critical Appraisal of 98.6°F, the Upper Limit of the Normal Body Temperature, and Other Legacies of Carl Reinhold August Wunderlich
,” J. Am. Med. Assoc.
, 268
(12
), pp. 1578
–1580
.10.1001/jama.1992.0349012009203423.
Krauchi
, K.
, Knoblauch
, V.
, Wirz-Justice
, A.
, and Cajochen
, D.
, 2006
, “Challenging the Sleep Homeostat Does Not Influence the Thermoregulatory System in Men: Evidence From a Nap vs. Sleep-Deprivation Study
,” Am. J. Physiol.
, 290
(4
), pp. R1052
–R1061
.10.1152/ajpregu/00381.200524.
Weinert
, D.
, and Waterhouse
, J.
, 2007
, “The Circadian Rhythm of Core Temperature: Effects of Physical Activity and Aging
,” Physiol. Behav.
, 90
(2–3
), pp. 246
–256
.10.1016/j.physbeh.2006.09.00325.
Reinberg
, A.
, and Smolensky
, M.
, 1990
, “Chronobiology and Thermoregulation
,” Thermoregulation: Physiology and Biochemistry
, E.
Schonbaum
, and P.
Lomax
, eds., Pergamon Press
, New York
, pp. 61
–100
.26.
Rowell
, L. B.
, 1986
, Human Circulation Regulation During Physical Stress
, Oxford
, New York
.27.
Werner
, J.
, Mekjavic
, I. B.
, and Taylor
, N. A. S.
, 2008
, “Concepts in Physiological Regulation: A Thermoregulatory Perspective
,” Physiological Bases of Human Performance During Work and Exercise
, N. A. S.
Taylor
, and H.
Groeller
, ed., Churchill Livingstone Elsevier
, Amsterdam
, pp. 359
–377
.28.
Grahn
, D.
, and Heller
, H. C.
, 2004
, “The Physiology of Mammalian Temperature Homeostasis
,” ITACCS Critical Care Monograph, pp. 1
–21
.29.
Wilson
, T. E.
, Zhange
, G.
, Levine
, B. D.
, and Crandall
, C. G.
, 2005
, “Dynamic Autoregulation of Cutaneous Circulation: Differential Control in Glabrous Versus Nonglabrous Skin
,” Am. J. Physiol. Heart Circ. Physiol.
, 289
(1
), pp. H385
–H391
.10.1152/ajpheart.00622.200430.
Caldwell
, J. N.
, Matsuda-Nakamura
, M.
, and Taylor
, N. A. S.
, 2014
, “Three-Dimensional Interaction of Mean Body and Local Skin Temperatures in the Control of Hand and Foot Blood Flows
,” Eur. J. Appl. Physiol.
, 114
(8
), pp. 1679
–1689
.10.1007/s00421-014-2894-x31.
Grahn
, D.
, Brock-Utne
, J. G.
, Watenpaugh
, D. E.
, and Heller
, H. C.
, 1998
, “Recovery From Mild Hypothermia Can Be Accelerated by Mechanically Distending Blood Vessels in the Hand
,” J. Appl. Physiol.
, 85
(5
), pp. 1643
–1648
.32.
Grahn
, D. A.
, Murray
, J. vLS.
, and Heller
, H. C.
, 2008
, “Cooling Via One Hand Improves Physical Performance in Heat-Sensitive Individuals With Multiple Slerosis: A Preliminary Study
,” BMC Neurol.
, 8
(14
), pp. 1
–8
.10.1186/1471-2377-8-1433.
Grahn
, D. A.
, Dillon
, J. L.
, and Heller
, H. C.
, 2009
, “Heat Loss Through the Glabrous Skin Surfaces of Heavily Insulated, Heat-Stressed Individuals
,” ASME J. Biomech. Eng.
, 131
(7
), p. 071005
.10.1115/1.315681234.
Heller
, H. C.
, and Grahn
, D. A.
, 2012
, “Enhancing Thermal Exchange in Humans and Practical Applications
,” Disruptive Sci. Technol.
, 1
(1
), pp. 11
–19
.10.1089/dst.2012.000435.
Clark
, E. R.
, 1938
, “Arterio-Venous Anastomoses
,” Physiol. Rev.
18
, pp. 229
–247
.36.
Hales
, J. R. S.
, and Molyneux
, G. S.
, 1988
, “Control of Cutaneous Arteriovenous Anastomoses
,” Vasodilatation: Vascular Smooth Muscle, Peptides, Autonomic Nerves, and Endothelium
, P. M.
Vahoutte
, ed., Raven Press
, New York
, pp. 321
–332
.37.
Nyberg
, K. L.
, Diller
, K. R.
, and Wissler
, E. H.
, 2000
, “Automatic Control of Thermal Neutrality for Space Suit Applications Using a Liquid Cooling Garment
,” Aviat. Space Environ. Med.
, 71
(9
), pp. 904
–915
.38.
Lugo-Amador
, N. M.
, Rothenhaus
, T.
, and Moyer
, P.
, 2004
, “Heat-Related Illness
,” Emerg. Med. Clin. North Am.
, 22
(2
), pp. 315
–327
.10.1016/j.emc.2004.01.00439.
Danzl
, D. F.
, and Pozos
, R. S.
, 1994
, “Accidental Hypothermia
,” N. Engl. J. Med.
, 331
(26
), pp. 1756
–1760
.10.1056/NEJM19941229331260740.
Casa
, D. J.
, McDermott
, B. M.
, Lee
, E. C.
, Yeargin
, S. W.
, Armstrong
, L. E.
, and Maresh
, D. M.
, 2007
, “Cold-Water Immersion: The Gold Standard for Exertional Heat Stroke Treatment
,” Exercise Sports Sci. Rev.
, 35
(3
), pp. 146
–150
.10.1097/jes.0b013e3180a02bec41.
Johnson
, J. M.
, and Kellogg
, D. L.
, 2010
, “Local Thermal Control of the Human Cutaneous Circulation
,” J. Appl. Physiol.
, 109
(40
), pp. 1229
–1238
.10.1152/japplphysiol.00407.201042.
Taylor
, N. A. S.
, Caldwell
, J. N.
, Van Den Heuvel
, A. M. J.
, and Patterson
, M. J.
, 2008
, “To Cool, but Not Too Cool: That Is the Question—Immersion Cooling for Hyperthermia
,” Med. Sci. Sports Exercise
, 40
(11
), pp. 1962
–1969
.10.1249/MSS.0b013e31817eee9d43.
Mayer
, S. A.
, and Sessler
, D. I.
, eds., 2005
, Therapeutic Hypothermia
, Taylor & Francis
, Boca Raton, FL
.44.
Tisherman
, S. A.
, and Sterz
, F.
, eds., 2005
, Therapeutic Hypothermia
, Springer
, New York
.10.1007/b10731645.
Lundbye
, J. B.
, 2012
, Therapeutic Hypothermia After Cardiac Arrest: Clinical Application and Management
, Springer
, New York
.10.1007/978-1-4471-2951-646.
Ly
, H. Q.
, Denault
, A.
, Dupuis
, J.
, Vadeboncoeur
, A.
, Harel
, F.
, Arsenault
, A.
, Gibson
, C. M.
, and Bonan
, R.
, 2005
, “A Pilot Study: The Noninvasive Surface Cooling Thermoregulatory System for Mild Hypothermia Induction in Acute Myocardial Infarction (The NICAMI Study)
,” Am. Heart J.
, 150
(5
), pp. e9
–e13
.10.1016/j.ahj.2005.02.04947.
Sessler
, D. I.
, 2009
, “Defeating Normal Thermoregulatory Defenses: Induction of Therapeutic Hypothermia
,” Stroke
, 40
(11
), pp. e614
–e621
.10.1161/STROKEAHA.108.52085848.
Zweifler
, R. M.
, Voorhees
, M. E.
, Mahmood
, M. A.
, and Parnell
, M.
, 2004
, “Magnesium Sulfate Increases the Rate of Hypothermia Via Surface Cooling and Improves Comfort
,” Stroke
, 35
(10
), pp. 2331
–2334
.10.1161/01.STR.0000141161.63181.f149.
Bergersen
, T. K.
, Eriksen
, M.
, and Walloe
, L.
, 1997
, “Local Constriction of Arteriovenous Anastomoses in the Cooled Finger
,” Am. J. Physiol.
, 273
(3 Pt 2
), pp. R880
–R886
.50.
Hensley
, D. W.
, Hemmen
, L.
, Diller
, T. T.
, Mark
, A. E.
, Rodriguez
, J. C.
, Cowan
, K. R.
, Khoshnevis
, S.
, and Diller
, K. R.
, “Upregulation of Glabrous Skin Blood Flow by Thermal Stimulation Along the Cervical Spine
,” (in preparation).51.
Sessler
, D. I.
, Olofsson
, C. I.
, Rubinstein
, E. H.
, and Beebe
, J. J.
, 1988
, “The Thermoregulatory Threshold in Humans During Halothane Anesthesia
,” Anesthesiology
, 68
(6
), pp. 836
–842
.10.1097/00000542-198806000-0000252.
Sessler
, D. I.
, 2013
, “The Thermoregulation Story
,” Anesthesiology
, 118
(1
), pp. 181
–186
.10.1097/ALN.0b013e3182784df353.
Sun
, Z.
, Honar
, H.
, Sessler
, D. I.
, Dalton
, J. E.
, Yang
, D.
, Panjasawatwong
, K.
, Deroee
, A. F.
, Salmasi
, V.
, Saager
, L.
, and Kurz
, A.
, 2015
, “Intraoperative Core Temperature Patterns, Transfusion Requirement, and Hospital Duration in Patients Warmed With Forced Air
,” Anesthesiology
, 122
(2
), pp. 276
–285
.10.1097/ALN.000000000000055154.
Wissler
, E. H.
, 1961
, “Steady-State Temperature Distribution in Man
,” J. Appl. Physiol.
, 16
(4
), pp. 734
–740
.55.
Wissler
, E. H.
, 2012
, “Whole-Body Human Thermal Modeling, an Alternative to Immersion in Cold Water and Other Unpleasant Endeavors
,” ASME J. Heat Transfer
, 134
(3
), p. 031019
.10.1115/1.400515556.
Nyberg
, K. L.
, Diller
, K. R.
, and Wissler
, E. H.
, 2001
, “Model of Human/Liquid Cooling Garment Interaction for Space Suit Automatic Thermal Control
,” ASME J. Biomech. Eng.
, 123
(1
), pp. 114
–120
.10.1115/1.133614757.
Hensley
, D. W.
, Mark
, A. E.
, Abella
, J. R.
, Netscher
, G. M.
, Wissler
, E. H.
, and Diller
, K. R.
, 2013
, “50 Years of Computer Simulation of the Human Thermoregulatory System
,” ASME J. Biomech. Eng.
, 135
(2
), p. 021005
.10.1115/1.402338358.
Grahn
, D. A.
, Cao
, V. H.
, and Heller
, H. C.
, 2005
, “Heat Extraction Through the Palm of One Hand Improves Aerobic Exercise Endurance in a Hot Environment
,” J. Appl. Physiol.
, 99
(3
), pp. 972
–978
.10.1152/japplphysiol.00093.200559.
Taylor
, N. A. S.
, Machado-Moreira
, C.
, van den Heuvel
, A.
, Caldwell
, J.
, Taylor
, W. A.
, and Tipton
, M. J.
, 2009
, “The Roles of Hands and Feet in Temperature Regulation in Hot and Cold Environments
,” 13th International Conference on Environmental Ergonomics
, Boston, pp. 405
–409
.60.
Netscher
, G. M.
, Khoshnevis
, S.
, Hemmen
, L.
, Wissler
, E. H.
, and Diller
, K. R.
, “Computer Simulation of Thermoregulatory Alterations Caused by Anesthesia: Therapeutic Device Efficacy Analysis
,” (in preparation).61.
Andrzejowski
, J.
, Hoyle
, J.
, Eapen
, G.
, and Turnbull
, D.
, 2008
, “Effect of Prewarming on Post-Induction Core Temperature and the Incidence of Inadvertent Perioperative Hypothermia in Patients Undergoing General Anesthesia
,” Br. J. Anaesth.
, 101
(5
), pp. 627
–631
.10.1093/bja/aen27262.
Hart
, S. R.
, Bordes
, B.
, Hart
, J.
, Corsino
, D.
, and Harmon
, D.
, 2011
, “Unintended Perioperative Hypothermia
,” Ochsner J.
, 11
(3
), pp. 259
–270
.63.
Konrath
, G. A.
, Lock
, T.
, Goltz
, H. T.
, and Scheidler
, J.
, 1996
, “The Use of Cold Therapy After Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Study and Literature Review
,” Am. J. Sports Med.
, 24
(5
), pp. 629
–633
.10.1177/03635465960240051164.
Swenson
, C.
, Sward
, L.
, and Karlsson
, J.
, 1996
, “Cryotherapy in Sports Medicine
,” Scand. J. Med. Sci. Sports
, 6
(4
), pp. 193
–200
.65.
Cochrane
, D. J.
, 2004
, “Alternating Hot and Cold Water Immersion for Athlete Recovery: A Review
,” Phys. Ther. Sport
, 5
(1
), pp. 26
–32
.10.1016/j.ptsp.2003.10.00266.
Algafly
, A. A.
, and George
, K. P.
, 2007
, “The Effect of Cryotherapy on Nerve Conduction Velocity, Pain Threshold and Pain Tolerance
,” Br. J. Sports Med.
, 41
(6
), pp. 365
–369
.10.1136/bjsm.2006.03123767.
Moritz
, A. R.
, and Henriques
, F. C.
, 1947
, “Studies of Thermal Iinjury. II. The Relative Importance of Time and Surface Temperature in the Causation of Cutaneous Burns
,” Am. J. Pathol.
, 23
(5
), pp. 695
–720
.68.
Lawrence
, J. C.
, and Bull
, J. P.
, 1976
, “Thermal Conditions Which Cause Skin Burns
,” Eng. Med.
, 5
(3
), pp. 61
–63
.10.1243/EMED_JOUR_1976_005_023_0269.
Diller
, K. R.
, 2006
, “Kinetics of Stress Protein Expression
,” Ann. Rev. Biomed. Eng.
, 8
, pp. 403
–424
.10.1146/annurev.bioeng.7.060804.10044970.
Whayne
, T. F.
, and DeBakey
, M. E.
, 1958
, Cold Injury, Ground Type, in World War II
, Office of the Surgeon General
, Washington, DC
.71.
Francis
, T. J. R.
, 1984
, “Non Freezing Cold Injury: A Historical Review
,” J. R. Nav. Med. Serv.
, 70
(3
), pp. 134
–139
.72.
Irwin
, M. S.
, Sanders
, R.
, Green
, C. J.
, and Tereghi
, G.
, 1997
, “Neuropathy in Non-Freezing Cold Injury (Trench Foot)
,” J. R. Soc. Med.
, 90
(8
), pp. 433
–438
.73.
Anson
, J. A.
, McCormick
, J.
, and Zabramski
, J. M.
, 1992
, “Oxygen Dissociation Characteristics of Hemoglobin and Blood Substitute in Relation to Temperature
,” Barrow Neurol. Inst. Q.
, 8
(2
), pp. 35
–42
.74.
Waugh
, R.
, and Evans
, E. A.
, 1979
, “Thermoeleasticity of Red Blood Cell Membrane
,” Biophys. J.
, 26
(1
), pp. 115
–132
.10.1016/S0006-3495(79)85239-X75.
Khoshnevis
, S.
, Craik
, N. K.
, and Diller
, K. R.
, “Cold-Induced Vasoconstriction May Persist Long After Cooling Ends: An Evaluation of Multiple Cryotherapy Units
,” Knee Surg. Sports Traumatol. Arthroscopy
(in press).10.1007/s00167-014-2911-y76.
Khoshnevis
, S.
, Craik
, N. K.
, and Diller
, K. R.
, 2014
, “Experimental Characterization of the Domains of Coupling and Uncoupling Between Surface Temperature and Skin Blood Flow
,” Int. J. Transp. Phenom.
, 13
(4
), pp. 277
–301
.77.
Khoshnevis
, S.
, Craik
, N. K.
, Brothers
, R. M.
, and Diller
, K. R.
, “Cryotherapy-Induced Persistent Vasoconstriction After Cutaneous Cooling: Hysteresis Between Skin Temperature and Blood Perfusion
,” (in preparation).78.
Clough
, G.
, Chipperfield
, A.
, Syrne
, C.
, de Mul
, F.
, and Gush
, R.
, 2009
, “Evaluation of a New High Power, Wide Separation Laser Doppler Probe: Potential Measurement of Deeper Tissue Blood Flow
,” Microvasc. Res.
, 78
(2
), pp. 155
–161
.10.1016/j.mvr.2009.05.00379.
Higgins
, D.
, and Kaminski
, T. W.
, 1998
, “Contrast Therapy Does Not Cause Fluctuations Inhuman Gastrocnemius Intramuscular Temperature
,” J. Athletic Train.
, 33
(4
), pp. 336
–340
.80.
Myrer
, J. W.
, Measom
, G.
, Durrant
, E.
, and Fellingham
, G. W.
, 1997
, “Cold- and Hot-Pack Contrast Therapy: Subcutaneous and Intramuscular Temperature Change
,” J. Athletic Train.
, 32
(3
), pp. 238
–241
.81.
Mejia
, N.
, Dedlow
, K.
, Nguy
, L.
, Sullivan
, P.
, Khoshnevis
, S.
, and Diller
, K. R.
, “An On-Site Thermoelectric Cooling Device for Cryotherapy and Control of Skin Blood Flow
,” ASME J. Med. Devices
(in press).10.1115/1.402950882.
Khoshnevis
, S.
, Nordhauser
, J. E.
, Craik
, N. K.
, and Diller
, K. R.
, 2014
, “Quantitative Evaluation of the Thermal Heterogeneity on the Surface of Cryotherapy Cooling Pads
,” ASME J. Biomech. Eng.
, 136
(7
), p. 074503
.10.1115/1.4027270Copyright © 2015 by ASME
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