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

• Published in: Stroke (1970) Vol. 42; no. 8; pp. 2164 - 2169
• Main Authors: ABOU-CHEBL, Alex, SUNG, Gene, BARBUT, Denise, TORBEY, Michel
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-08-2011
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Brain - physiopathology; Brain Injuries - physiopathology; Brain Injuries - therapy; Equipment Safety; Feasibility Studies; Female; Fever - physiopathology; Fever - therapy; Humans; Hypothermia, Induced - adverse effects; Hypothermia, Induced - instrumentation; Hypothermia, Induced - methods; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Nervous system; Neurology; Prospective Studies; Stroke - physiopathology; Stroke - therapy; Ultrasonic investigative techniques; Vascular diseases and vascular malformations of the nervous system; Human; Stroke; Nervous system diseases; administration; neuroprotectants; Cardiovascular disease; Encephalon; Cerebral disorder; Vascular disease; Central nervous system disease; induced; intranasal; Head trauma; Cerebrovascular disease; acute brain injury; Hypothermia
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.110.613000

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.
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.
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.
Intranasal cooling with the RhinoChill device appears safe and effectively lowers brain and core temperatures. Further study is warranted to assess the efficacy of hypothermia through intranasal cooling for brain-injured patients.