Head Injury and Neuroanesthesia

Local Brain Temperature Reduction Through Intranasal Cooling With the RhinoChill Device: Preliminary Safety Data in Brain-Injured Patients

Abou-Chebl A, Sung G, Barbut D, et al (Univ of Louisville School of Medicine, KY; Univ of Southern California, Los Angeles, CA; BeneChill Inc, San Diego, CA) Stroke 42:2164-2169, 2011^§

Abstract

Background and Purpose

Hypothermia is neuroprotectant but currently available cooling methods are laborious, invasive, and require whole-body cooling. There is a need for less invasive cooling of the brain. This study was conducted to assess the safety and efficacy of temperature reduction of the RhinoChill transnasal cooling device.

Methods

We conducted a prospective single-arm safety and feasibility study of intubated patients for whom temperature reduction was indicated. After rhinoscopy, the device was activated for 1 hour. Brain, tympanic, and core temperatures along with vital signs and laboratory studies were recorded. All general and device-related adverse events were collected for the entire hypothermia treatment.

Results

A total of 15 patients (mean age, 50.3±17.1 years) were enrolled. Brain injury was caused by intracerebral hemorrhage, trauma, and ischemic stroke in equal numbers. Hypothermia was induced for fever control in 9 patients and for neuroprotection/intracranial pressure control in 6. Core temperature, brain temperature, and tympanic temperature were reduced an average of 1.1±0.6°C (range, 0.3 to 2.1°C), 1.4±0.4°C (range, 0.8 to 5.1°C), and 2.2±2°C (range, 0.5 to 6.5°C), respectively. Only 2 patients did not achieve the goal of ≥1°C decrease in temperature. Brain temperature, tympanic temperature, and core temperature reductions were similar between the afebrile and febrile patients. There were no unanticipated adverse events and only 1 anticipated adverse event: hypertension in 1 subject that led to discontinuation of cooling after 30 minutes. There were no nasal complications.

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