Methods and devices for non-invasive cerebral and systemic cooling alternating liquid mist/gas for induction and gas for maintenance
Methods for cerebral and systemic cooling via a patient's nasopharyngeal cavity are described. In one method, a cooling assembly is inserted into a nasal cavity through a patient's nostril. A substantially dry gas is delivered through a lumen of the catheter onto the surface of the patient's nasal cavity. Evaporative heat loss cools the patient's nasal cavity. If additional cooling is needed, a liquid coolant is delivered through a separated lumen of the catheter. The liquid coolant is nebulized at a plurality of delivery ports on the distal end of the catheter and is delivered onto the surface of the patient's nasal cavity in combination with the dry gas. The dry gas enhances evaporation of the nebulized coolant and additional cooling is provided from the evaporative heat loss of the liquid coolant.
1. A method for cerebral cooling, comprising the steps of:
inserting an elongate member into a nasal cavity of a patient through a patient's nostril, the elongate member comprising a proximal end, a distal end, a first lumen extending therebetween, and a plurality of ports in fluid communication with the first lumen;
delivering a nebulized liquid coolant and a substantially dry gas in combination onto a surface of the patient's nasal cavity through the plurality of ports in the elongate member for a period of between about 10 minutes to 9 hours; and
delivering the substantially dry gas without the nebulized liquid coolant onto a surface of the patient's nasal cavity through the plurality of ports in the elongate member for a period of between about 10 minutes to 240 hours,
wherein the liquid coolant is nebulized at the plurality of ports within the nasal cavity and wherein the substantially dry gas enhances evaporation of the liquid coolant from the nasal cavity to reduce the cerebral temperature of the patient.
2. The method of claim 1 , wherein the cerebral temperature of the patient is reduced by between about 0.1 to 5.0° C./hour by evaporation of the liquid coolant in the nasal cavity.
3. The method of claim 1 , further comprising repeating the step of delivering the substantially dry gas without the nebulized liquid coolant on the surface of the patient's nasal cavity through the plurality of ports in the elongate member for the period of between about 10 min to 40-days 240 hours to prevent rewarming of cerebral temperature of the patient.
4. The method of claim 3 , wherein the step of repeating delivery of the substantially dry gas without the nebulized liquid coolant is initiated when the brain has been cooled to a temperature of between about 18 to 36° C.
5. The method of claim 4 , wherein the step of repeating delivery of the substantially dry gas without the nebulized liquid coolant is initiated when the brain has been cooled to a temperature of between about 30 to 36° C.
6. The method of claim 4 , further comprising repeating the step of delivering the nebulized liquid coolant and the substantially dry gas in combination onto the surface of the patient's nasal cavity through the plurality of ports in the elongate member for a period of between about 10 minutes to 9 hours to maintain a cerebral temperature of between about 18 to 36° C.
7. The method of claim 6 , further comprising repeating the step of delivering the nebulized liquid coolant and the substantially dry gas in combination onto the surface of the patient's nasal cavity through the plurality of ports in the elongate member for a period of between about 10 minutes to 9 hours to maintain a cerebral temperature of between about 30 to 36° C.
8. The method of claim 1 , wherein the method occurs for about 6 hours when the patient is transitioning from nasal cooling to systemic cooling.
9. The method of claim 8 , wherein the systemic cooling comprises surface cooling or intravascular cooling.
10. The method of claim 1 , wherein the substantially dry gas is delivered a rate of between about 20 to 100 L/min.
11. The method of claim 10 , wherein the substantially dry gas is substantially dry air or one of its components.
12. The method of claim 10 , wherein the substantially dry gas is oxygen.
13. The method of claim 10 , wherein the substantially dry gas is a noble gas.
14. The method of claim 10 , wherein the substantially dry gas is an anesthetic agent.
15. The method of claim 1 , wherein the step of delivering the substantially dry gas without the nebulized liquid coolant is administered first to reduce the patient's cerebral temperature and the step of delivering the nebulized liquid coolant and the substantially dry gas in combination is initiated subsequently to further reduce the patient's cerebral temperature to between about 18 to 36° C.
16. The method of claim 15 , wherein the step of delivering the substantially dry gas without the nebulized liquid coolant is administered first to reduce the patient's cerebral temperature and the step of delivering the nebulized liquid coolant and the substantially dry gas in combination is initiated subsequently to further reduce the patient's cerebral temperature to between about 30 to 36° C.
17. The method of claim 15 , further comprising repeating the step of delivering the substantially dry gas without the nebulized liquid coolant on the surface of the patient's nasal cavity through the plurality of ports in the elongate member for the period of between about 10 minutes to 240 hours to maintain the reduced cerebral temperature or prevent rewarming during transition to a surface cooling method.
18. The method of claim 1 , wherein the nebulized liquid coolant is a perfluorocarbon.
19. A method for cerebral cooling, comprising the steps of:
inserting an elongate member into a nasal cavity of a patient through a patient's nostril, the elongate member comprising a proximal end, a distal end, a first lumen extending therebetween, and a plurality of ports in fluid communication with the first lumen; and
delivering a nebulized liquid coolant and a substantially dry gas in combination onto a surface of the patient's nasal cavity through the plurality of ports in the elongate member for a period of between about 10 minutes to 9 hours, wherein the liquid coolant is nebulized at the plurality of ports within the nasal cavity and wherein the substantially dry gas enhances evaporation of the liquid coolant from the nasal cavity to further reduce the cerebral temperature of the patient;
delivering the substantially dry gas without the nebulized liquid coolant onto a surface of the patient's nasal cavity through the plurality of ports in the elongate member for a period of between about 10 minutes to 10 days;
measuring the patient's temperature; and
adjusting delivery of the nebulized liquid coolant in response to the patient's temperature.
20. The method of claim 19 , wherein the step of adjusting the delivery of the nebulized liquid coolant comprises stopping delivery of the nebulized liquid coolant.
21. The method of claim 20 , further comprising repeating the step of delivering the nebulized liquid coolant and the substantially dry gas in combination onto the surface of the patient's nasal cavity through the plurality of ports in the elongate member for the period of between about 10 minutes to 9 hours to prevent rewarming of the cerebral temperature of the patient.
22. The method of claim 19 , wherein measuring the patient's temperature comprises measuring one of the patient's cerebral temperature, esophageal temperature, tympanic temperature, body temperature, bladder temperature, blood temperature, or rectal temperature.
23. The method of claim 19 , wherein the step of measuring the patient's temperature further comprises continuously monitoring the patient's core temperature.
24. The method of claim 19 , further comprising the step of setting a target temperature for the core temperature of no lower than 30° C., wherein the step of delivering the nebulized liquid coolant and the substantially dry gas in combination further comprises delivering the nebulized liquid coolant and the substantially dry gas in combination onto the surface of the patient's nasal cavity until the earlier of the core temperature reaching the target temperature or 9 hours.
25. The method of claim 24 , further comprising automatically repeating the step of delivering the substantially dry gas without the nebulized liquid coolant onto the surface of the patient's nasal cavity when the patient's core temperature reaches the target temperature.
26. The method of claim 24 , further comprising automatically repeating the step of delivering the nebulized liquid coolant and the substantially dry gas in combination onto the surface of the patient's nasal cavity when the patient's core temperature rises more than 0.1° C. above the target temperature.
27. The method of claim 24 , wherein the step of adjusting the delivery of the nebulized liquid coolant further comprises repeating the step of delivering the nebulized liquid coolant and the substantially dry gas in combination onto the surface of the patient's nasal cavity when the patient's core temperature reaches substantially greater than the target temperature.
28. The method of claim 24 , wherein the target core temperature is set by an operator within a range of about 30 to 37° C.
29. The method of claim 19 , further comprising setting a target temperature for the patient's cerebral temperature of within a range of about 18-36° C., wherein the step of delivering the nebulized liquid coolant and the substantially dry gas in combination further comprises intermittently delivering the nebulized liquid coolant and the substantially dry gas in combination onto the surface of the patient's nasal cavity to maintain the patient's cerebral temperature within ±0.5° C. of the target temperature.
30. The method of claim 19 , wherein the step of delivering the substantially dry gas without the nebulized liquid coolant is administered first to reduce the patient's cerebral temperature and the step of delivering the nebulized liquid coolant and the substantially dry gas in combination is initiated subsequently to further reduce the patient's cerebral temperature to a temperature of between about 30 to 36° C.
31. The method of claim 30 , further comprising repeating the step of delivering the substantially dry gas without the nebulized liquid coolant onto the surface of the patient's nasal cavity for the period of between about 10 minutes to 240 hours to maintain a cerebral temperature of between about 30 to 36° C.
32. The method of claim 19 , wherein the nebulized liquid coolant is a perfluorocarbon.