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INVITED REVIEW

HIGHLIGHTED TOPIC
A Physiological Systems Approach to Human and Mammalian Thermoregulation

Respiratory responses to cold water immersion: neural pathways, interactions, and clinical consequences awake and asleep

¹Institute of Biomedical and Biomolecular Sciences, Department of Sport and Exercise Science, University of Portsmouth, and ²Portsmouth Hospitals National Health Service Trust, Portsmouth, United Kingdom

The ventilatory responses to immersion and changes in temperature are reviewed. A fall in skin temperature elicits a powerful cardiorespiratory response, termed "cold shock," comprising an initial gasp, hypertension, and hyperventilation despite a profound hypocapnia. The physiology and neural pathways of this are examined with data from original studies. The respiratory responses to skin cooling override both conscious and other autonomic respiratory controls and may act as a precursor to drowning. There is emerging evidence that the combination of the reestablishment of respiratory rhythm following apnea, hypoxemia, and coincident sympathetic nervous and cyclic vagal stimulation appears to be an arrhythmogenic trigger. The potential clinical implications of this during wakefulness and sleep are discussed in relation to sudden death during immersion, underwater birth, and sleep apnea. A drop in deep body temperature leads to a slowing of respiration, which is more profound than the reduced metabolic demand seen with hypothermia, leading to hypercapnia and hypoxia. The control of respiration is abnormal during hypothermia, and correction of the hypoxia by inhalation of oxygen may lead to a further depression of ventilation and even respiratory arrest. The immediate care of patients with hypothermia needs to take these factors into account to maximize the chances of a favorable outcome for the rescued casualty.

cold shock; drowning; underwater birth; sleep apnea

This article has been cited by other articles:

				M. Buchheit and P. B. Laursen Treatment of hyperthermia: is assessment of cooling efficiency enough? Exp Physiol, June 1, 2009; 94(6): 627 - 629. [Full Text] [PDF]

				M. Buchheit, J. J. Peiffer, C. R. Abbiss, and P. B. Laursen Effect of cold water immersion on postexercise parasympathetic reactivation Am J Physiol Heart Circ Physiol, February 1, 2009; 296(2): H421 - H427. [Abstract] [Full Text] [PDF]