MXPA97006559A - Support device with cooling located in areas of the surface of the body with high contact - Google Patents

Abstract

The present invention relates to an apparatus for supporting a body while at the same time selectively cooling areas of the body that are in contact with the apparatus, which consists of: a cooling layer, a layer of thermally insulating compressible material disposed on the cooling layer, a surface on the layer of thermally insulating, compressible material, a thermally conductive material disposed in the layer of thermally insulating, compressible material and acting between the cooling layer and the insulating thermally insulating material layer; layer of compressible material, thermally insulating at the pressure exerted against the surface, in order to provide a thermal resistance between the surface and the cooling layer, which varies in inverse proportion to the pressure, and means to maintain the cooling layer at a temperature predetermined that is below the normal temperature of the human body

Description

SUPPORT DEVICE WITH COOLING LOCATED IN SURFACE AREAS OF THE BODY WITH HIGH PRESSURE CONTACT BACKGROUND OF THE INVENTION 1. Field of the Invention The invention relates to an apparatus for supporting at least a portion of the body of a human being or an animal, with localized or concentrated cooling in the areas of the weight bearing portion. Localized or concentrated cooling reduces the risk of damage to body areas that support weight of patients who must be in bed, operating room tables or wheelchairs for long periods of time.

It is known that the application of pressure to a patient's skin over a prolonged period causes ulcerations due to pressure. Weight-bearing areas of the body surface are exposed to pressures that can easily exceed 100 m Hg (torr.). It has been shown that blood flow ceases in capillaries that are exposed to compressive pressures exceeding 25 torrs. Consequently, it can be expected that the areas of the body surface and the subcutaneous tissues that support weight have an inadequate blood flow or even a total lack of blood flow during the time that the weight is being supported.

The normal cellular metabolism depends on the blood circulating properly, so that it provides oxygen and nutrients to eliminate waste products. Prolonged interference of the local circulation results in a sequence of events divided into two parts, beginning with ischemia (a severe reduction in the supply of blood and oxygen to the tissues) and ending with a necrosis (irreversible cell and tissue death, which results in a slough).

Normally people change positions when they are in a chair or get up and walk to relieve the pressure on their buttocks. Usually people turn from side to side in bed, while they sleep, to periodically redistribute their weight to a different area of the surface of their body. In general, this movement is a reaction to pain or discomfort caused by the ischemia of the skin tissue, or deep subcutaneous tissue, which is supporting weight. Patients bedridden or in wheelchairs, or patients who are in operating room tables, may not be aware of ischemic pain if they have a brain or spinal cord injury, paralysis, dementia, prolonged surgery with anesthesia, or prolonged sedation or mechanical breathing. Alternatively, also serious diseases, neuromuscular disorders or nervous system injuries can prevent the patient from moving even if they are realizing that they have ischemic pain.

In the operated patients, the incidence of ulcerations due to pressure fluctuated between 12% and 66% in different studies performed. Surveys performed on patients in general hospitals indicate that between 3-4.5% of all patients develop ulcerations due to pressure during their hospitalization. Pressure ulcers usually develop near regions of the body that have a bony prominence near the skin. More than 80% of all pressure ulcerations occur in the following five places: 1. Sacrococcygeal region (upper part of the gluteus), supine position. 2. Great trochanter (lower part of the hip), lateral recumbent position. 3. Ischial tuberosity (lower part of the gluteus), sitting position. 4. Tuberosity of the calcaneus (heel), supine position. 5. Male lateral (external ankle), lateral recumbent position. Patients with surgical or bed-ridden operations are not the only patients susceptible to developing ulcerations. For example, paralyzed patients spend much of their lives in wheelchairs. There is a study that indicates that the incidence of pressure ulcers is 21.6% in paraplegics and 23.1% in quadriplegics.

The equipment for the prevention of pressure ulcers has been concentrated in three areas: 1. Flip or periodically move the patient to minimize the time pressure is applied to any surface area. The fabric is given time to be perfused again during the period of time when pressure is not being applied. 2. Passive support surfaces (cushions, mattresses and mattresses of all kinds), which can use special materials or unique forms to minimize the pressure exerted on any given point of the body surface. Many types of materials have been tried, including: different types of polymeric foams, polymeric gels, and chambers filled with water and air.

Active support surfaces, such as a series of air-filled chambers that inflate and deflate alternately to automatically distribute the pressure.

Taking into account the high incidence of pressure ulcerations, despite the availability of many of these passive support surfaces (various materials and shapes), it is clear that the simple fact of distributing pressure to a larger surface area, and on itself It will not effectively prevent pressure ulcerations. Although active support surfaces have been used to prevent pressure ulcerations, it is clear that they are very expensive, uncomfortable and noisy. Consequently, it is not possible to use active support surfaces in many situations to prevent pressure ulcerations.

Finally, apart from the obvious pain and risk to the patient's health (with chronic infections in chronically open wounds), pressure ulcerations are extremely expensive and very slow to heal. The healing of an ulceration by normal pressure costs between $ 30,000 and $ 40,000, and takes between 3 and 6 months approximately. The high incidence of pressure ulcerations, the lack of a proven method to avoid pressure ulcerations, and the extremely high cost of curing them once they develop, indicate that there is a great need for new technology.

It is reasonable to assume that heat is an important factor in the formation of pressure ulcerations. All tissues increase between 7 and 10% metabolic rate each time the temperature increases 1 ° C. The increased metabolic rate increases the oxygen demand of cells by 7-10% similar for every 1 ° C increase in temperature. In a patient whose tissue perfusion is already compromised by external pressure or vascular insufficiency, this increased metabolic oxygen demand could increase the speed of tissue damage. We hypothesized that this increased metabolic demand was the cause of the frequent "burns" that were observed after a warm-water mattress therapy during surgery, despite the relatively low temperatures of the mattresses (39 ° -42). ° C). These low temperature injuries can result in damage to the entire thickness of the skin, which looks identical to third-degree burns that result from exposing the skin to high temperatures. Although the damage throughout the thickness of the skin is identical to that of a thermal injury caused by high temperature ("burn"), in fact the injury is caused by pressure necrosis, which is accelerated due to the higher metabolic rate of the skin. tissue. Although this interrelation between temperature, pressure and tissue ischemia is logical from the scientific point of view, it had never been proven before we carried out our recent experiments.

In addition, it is known that hypothermia decreases the cellular metabolic rate and increases the tolerance of the cells to periods of inadequate blood flow. This is the reason why patients are cooled when they have a cardiac vascularization. Consequently, we hypothesize that cooling the skin and subcutaneous tissue will make it more time, in fact, to appear a lesion when there is a risk of ischemia caused by inadequate local blood flow resulting from the pressure exerted against that tissue. .

To test these hypotheses, we created a porcine model to investigate the formation of pressure ulcers. Twelve metal discs were applied to the back of an anesthetized pig. The pressure in the skin under each disc was approximately 100 torres (totally occlusive to the blood flow), during a lapse of 10 hours. The temperature of the discs was carefully controlled at 25 ° C, 35 ° C, 40 ° C and 45 ° C. The normal body temperature of a pig is 38 ° C (the normal temperature of the human body is 37 ° C). The severity of the resulting tissue lesions was directly correlated with the increase in temperature. No tissue damage was found under the 25 ° C discs. Under the discs of 45 ° C severe damage was seen in the skin, in the subcutaneous tissues and in the deep ones. The discs of 35 ° C and 40 ° C also caused serious damage, but moderate in relation to those of extreme temperatures. The results of this experiment clearly indicate that our two hypotheses were correct. 1. Even moderate heat will accelerate the speed of tissue injury due to pressure induced ischemia. 2. Moderate cold will protect against tissue damage due to ischemia caused by pressure.

For decades, mattresses have been used in which fresh, or even cold, water circulates to cool patients with fever. However, experience has shown us that the application of cold in very large areas of the body surface is very annoying and causes hypothermia and tremor. 2. Description of Related Inventions In the prior invention of US Pat. No. 3,738,702, a seat structure is described which cools a portion of the human body resting on the seat, in reaction to body heat, at the part where the body contacts the body. seat. In order to maximize the sensitivity of the cooler in relation to body heat, the cooler is placed as close as possible to the surface of the seat with which the body contacts.

SUMMARY OF THE INVENTION The purpose of this invention is to offer a bed mattress, a cushion for an operating room table, or a chair cushion. or wheelchair that can automatically detect specific areas with "high" pressure contact (for example, greater than 20-25 torrs) and that selectively applies cooling to those specific areas (or, to be more precise, eliminates the heat of the same) .

In patients who are supine or seated, the metabolic heat generated by the ischemic tissue is trapped by padded cushions or mattresses and raises the temperature of the tissue. Metabolic heat can not be eliminated internally due to inadequate blood flow, nor can it be eliminated externally due to the thermal insulation characteristics of cushions or cushioned mattresses. Metabolism continues (anaerobically) despite inadequate blood flow, and the heat generated by this metabolism continues to accumulate. Our studies with pigs show that any heating of the tissue is obviously harmful, and that cooling the tissue below body temperature is beneficial to avoid tissue injury caused by pressure. A cooling below the normal body temperature will be beneficial. Accordingly, this invention alleviates or prevents the formation of metabolic body heat naturally generated in the ischemic tissue in areas of the body that support weight, supported on cushions or padded mattresses. The adjacent surface areas of the body that are not experiencing high pressure will not be cooled. Due to the minimal blood flow in the high pressure areas, the cooling effect will be considerably isolated in these tissues and will not cause total body hypothermia or discomfort.

Our invention is based on the essential observation that the application of cold (or heat removal) to areas of the body that are subject to an increased risk of ischemia by supporting the body's weight, they can be cold applied selectively by an apparatus having a heat transport path (or heat transmitter) that has a lower thermal resistance in inverse proportion to the pressure. In this respect, if a surface of the apparatus is equal to the one that supports the body, the force exerted against the surface by an area of the body that is supporting weight would compress the heat transport path that is below the area of the body that is supporting weight , causing the path to shorten, and making it less conductive (less resistant) to the flow of heat than that which exists under a portion of the surface that is supporting, relatively, less than the weight of the body.

To be more specific, our invention is a device that locates or concentrates cold applied to a human body supported, concentrating the cold in the areas of the body that are supporting the weight of it.

More specifically, the focal cooling apparatus of our invention includes a cooler, or heat sink, a layer on which is disposed another layer of thermally insulating compressible material. The layer of thermally insulating compressible material has a surface that supports a portion of a human body (or the body of an animal). The layer of thermally insulating compressible material reacts to the weight that makes contact with its surface, providing a thermal resistance between the surface and the cooling layer, which varies in inverse proportion to the pressure. Means are provided for controlling the chiller layer, so as to maintain a predetermined temperature that is below the normal temperature of the human body.

Accordingly, one of the objects of this invention is to provide an apparatus that concentrates the cooling in surface areas of the body with high pressure contact, which support the weight of the body.

Yet another object is to provide an apparatus that supports a human body while selectively cooling those portions of the body which, when in contact with the apparatus, support a relatively greater amount of body weight than other areas in contact with the apparatus.

Another advantage of the apparatus is that it inherently finds the specific areas of the human body that are subject to relatively high pressure contact, and that selectively apply cooling to those specific areas.

Another aspect of this advantage is that the apparatus inherently finds the specific areas of high pressure contact and removes the heat from them.

These and other objects and advantages of the invention will become clearer upon reading the following detailed description with reference to the drawings illustrated below.

BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 illustrates a person in a supine position and a graphic tracing showing the pressure exerted on the body parts of a person carrying weight, by a surface that supports the body.

Figures 2 and 3 illustrate a preferred embodiment of the invention in a partially longitudinal schematic section.

Figure 4 illustrates an option of the preferred embodiment in a partially longitudinal schematic section.

Figures 5 and 6 illustrate a support mat or mattress assembled according to the preferred embodiment, Figure 5 being a top plan view, with layers bent back for better visualization, and Figure 6 is a view in perspective with the layers bent backwards for better visualization.

Figures 7 and 8 illustrate a first alternative embodiment of the invention in a partially longitudinal schematic cross section.

Figure 9 illustrates an option of the first alternative embodiment in a partially longitudinal schematic section.

Figures 10 and 11 illustrate a second alternative embodiment of the invention in a partially longitudinal schematic cross section.

Figure 12 illustrates an option of the second alternative embodiment in a partially longitudinal schematic section.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Referring now to the figures illustrating this invention, and in which like parts are designated with similar reference numbers in all the drawings, Figure 1 shows a person in supine position 12 resting on a surface 14; that is, that it is supported by it. Directly below the surface 14 there is a graphic trace 15 representing the pressure measured at the surface 14. The pressure is exerted by the portions of the body that bear weight and has its maximum magnitude in those areas where the body 12 contacts the the surface 14. It should be noted in particular that the different pressure distributions of the back of the head are shown in the number 16, the upper part of the back in the 18, the buttocks in the 20, the calves in the 21, and the heels in the 22. (The contribution of the elbows is not shown). These are the areas of the body that support much of the person's weight, and are referred to as "weight-bearing areas." Of course, if the person in supine position 12 is raised in a bed, the areas that support weight in the buttocks and heels are those that are more at risk of pressure injuries.

In its structure and operation, the invention takes into account and takes advantage of the distribution of the pressure exerted by a support surface on the areas of the human or animal body that are supporting weight. In this regard, advantage is taken of the elevation of the local pressure, reducing the thermal resistance of a thermally insulating layer between a cooling layer and one or more portions of the support surface on which the areas of the human or animal body rest. They are supporting weight. This principle preferably takes the form of an apparatus such as that illustrated in the partially longitudinal sectional schematic drawings of Figures 2-4.

In Figures 2-4, an apparatus for supporting at least a portion of a human or animal body includes a cooling layer 30 on which is disposed a layer 32 of thermally insulating compressible material that is in thermal contact with the layer Cooling. Such thermal contact may include direct physical contact between layers 30 and 32 or through a thermally conductive intermediate, as described below. The layer 32 includes an upper surface 33 and a lower surface 34.

The basic operation of the invention is shown in Figure 3, wherein an area bearing weight in a portion of the human body, the buttocks, for example, represented by the shaded area 36, exerts a relatively greater pressure, represented by the arrow 37 , on a portion of the surface 33 below and around the weight bearing area, which below the area of the body that produces the magnitude of pressure represented by the arrow 38. In fact, as indicated by the arrows 37a, the area that Supports weight exerts a variable pressure or a pressure distribution on the surface 33 which presses it to the surface 34. In reaction to that higher pressure exemplified by the arrow 37, the pressure of the thermally insulating compressible layer 32 below the portion of the surface 33 supporting a higher pressure 37 (and the pressure distribution 37a) has been compressed and shows a transverse height smaller than that of the portion that is below the portion of the surface 33 on which the pressure is being exerted 38. In fact, as clearly seen in Figure 3, the compression of the layer 32 under the pressure distribution 37a shows a profile corresponding to the pressure 37a. The lower transverse height of the portion of the layer 32 that is being compressed, reduces the magnitude of the thermal resistance compared to the magnitude of the thermal resistance of the portion of the layer 32 bearing the pressure 38. In fact, the portion Compressed has a distribution of thermal resistance that varies approximately in inverse proportion to the pressure distribution. This lower magnitude of thermal resistance is a result of the reduction of the length of the thermally conductive path between the surfaces 33 and 34 going to the layer 30, as well as the alteration of other thermal characteristics caused by the compression of the layer 32. The reduced thermal resistance is equal to an increased thermal conductivity through the layer 32, between the weight-bearing body area, represented by the shaded area 36, and the cooling layer 30, on a portion of the surface 33 adjacent to the Body area that supports weight. The fact of providing the cooling layer 30 with the ability to locally cool the body to a lower than normal body temperature, represented by the shaded area 36, will result in a location or concentration of cooling in the area of the body that supports weight which is supported against the surface 33. In contrast, the relatively higher level of thermal resistance of the layer 32 below the areas of the body represented by the shaded area exerting little or no pressure, will prevent those areas of the body from cooling. body at levels similar to the cooling levels of the weight-bearing areas. This achieves the objective of locating or concentrating the cooling in the areas of a supported body that is supporting weight, without inducing a total hypothermia of the body or tremor.

Preferably, as shown in the Figures. 2 and 3, the layer 32 made of insulating and compressible thermal material, is formed of a material that is compressed as a reaction to pressure but that "remembers" its original shape, to which it returns when the pressure is released. Similarly, the cooling layer 30 has the ability to deform to adapt to the shape of the body portion that is supporting weight, but also "remembers" the shape it had before deforming, to which it returns when it is removed the pressure.

In the preferred embodiment, the layer 32 of thermally insulating and compressible material includes an insulating foam mat, which may be made, for example, of low density polymer foam plastic, or foam rubber, with a thickness, not compressed, 0.5"-1.0". In its normal uncompressed state this thickness provides considerable thermal insulation between the surfaces 33 and 34 towards the cooling layer 30. Because it is compressible, under the weight-bearing portions, thickness, thermal resistance and capacity and thermal insulation of the foam mat. The intrinsic compressibility and resilience of the foam material selected to form the layer 32 of thermally insulating and compressible material will determine how much pressure should be applied to any portion of the surface 33 in order to be able to compress the material to the minimum possible thickness.

To increase the thermal conductivity of layer 32, where it is compressed, a small amount of water or other liquid, such as glycol for example, can be spread internally in the material of layer 32. Preferably, the amount should not saturate the layer when it is not compressed, but when it is compressed. When not compressed, the liquid will have little effect on the thermal resistance of layer 32.

Basically, the cooling layer 30 acts as a heat sink which increases the magnitude of the temperature difference between the surface 33 and the layer itself, through the layer 32 of the thermally insulating compressible material. The cooling layer 30 may include, for example, a flexible water mattress in which cold water is circulating below the normal body temperature (i.e., below 37 ° C). Although the term "water mattress" is being used, those who are familiar with the technique will realize that different fluids can be circulated through this layer with a similar cooling effect. Such fluids may include, for example, glycol-water mixtures, alcohol-water mixtures, air, and other fluids. The water mattress can be a normal water mattress obtainable, for example, from the Cincinnati Sub Zero Products Company, Cincinnati, OH or at Gaymar Industries, Orchard Park, NJ. Generally these mattresses are made with two sheets of flexible polyethylene or polyvinyl film, thermoformed in a parallel set or in a labyrinth of fluid channels, and then heat sealed together. With an external pump with cooling capacity the water is circulated through the mattresses. Circulating cooling water causes the water mattress to function as a heat sink. The heat absorbed in the fluid that circulates through the mattress eventually dissipates to a secondary heat sink, which is usually room air. Generally, such an arrangement may require a pipe to circulate the water to and from the water mattress plus a pump, receiver and cooling means (which are not shown in Figs 2-4). The cooling means may be compression, thermoelectricity, air radiators, heat exchangers operating with ice, or any other type suitable for cooling the circulating fluid.

Alternatively, the cooling layer 30 may be a mattress or mat made of heat-absorbing material with phase variation. It is known that many saline and paraffin solutions have such a characteristic. The desired temperature of the phase variation can be obtained by selecting the appropriate combination of salts and solvents.

An optional additional element of the apparatus illustrated in FIGS. 2-4 is a support layer 39 which may include a mattress or mat of some compressible and resilient material or which is constructed in that manner. If chosen, the support layer 39 is placed below the cooling layer 30, and supports it, and the layer 32, of thermally insulating compressible material, such as that of the layer 30, is introduced in the middle of the layer 32. and of the support layer 39.

Another optional element added is illustrated in Figure 4. Figure 4 is a partially schematic longitudinal sectional drawing illustrating the structure of the cooling layer 30 incorporated into a multi-channel water mattress, which includes several adjacent channels typified by the channel 41. Because the water mattress of the Cooling layer 30 has an irregular top surface, a "softening" layer 43 is added between layer 32, of thermally insulating compressible material, and cooling layer 30. The softening layer 43 may include a thin mat that matches the uneven surface of the water mattress of the cooling layer 30. The softening layer 43 may include a thin mat containing a thermally conductive material such as a polymeric gel, water or other fluid. Preferably, the layer 43 is flexible and deforms in reaction to the pressure and returns back to its original configuration when the pressure is released.

Referring now to Figures 5 and 6, which show a manufactured article such as a mat or a support mattress embodying the invention, as expressed in the first embodiment shown in Figures 2-4 or in the embodiments shown in FIGS. will comment below. In the figures, the manufactured article 44 includes a cooling layer 30 in the form of a water mattress with serpentine channels inserted between the layer 32 of compressible thermally insulating material and the support layer 39. The elements 30, 32 and 39 can be join with means known in the art, gumming, stitching, enclosing them in a thin-walled bedspread cavity, or others. The tubes 45 and the cooling apparatus 46 provide the means for maintaining the temperature of the cooling layer 30 at a predetermined temperature, for example, below the normal temperature of the human body. The tubes 45 are in fluid communication with the coil tubes of the water mattress having the cooling layer 30. The tubes 45 are connected to the cooling apparatus 46, which operates in accordance with any of the cooling techniques described above with reference to Figures 2-4. The cooling apparatus 46 may include, for example, a compressor cooler, a thermoelectric cooler, a Stirling cycle cooler, a radiator or a heat exchanger.

Figures 7 and 8 show a first alternative embodiment of the invention in longitudinal sections. Figure 9 shows an option to the first alternative embodiment in longitudinal section. In the first alternative embodiment, the layer 32 of insulating material, which was discussed above with respect to Figures 2-6, is specifically incorporated into an insulating mat 52 having a gas filled chamber, which is disposed on the cooling layer 30. , which preferably has the form of a flexible water mattress in which cold water circulates at a temperature below the normal temperature of the human body (below 37 ° C). Preferably, but not necessarily, the chamber 52 and the cooling chamber 30 are disposed on the support structure 39.

Preferably the chamber 52 is made of a polymeric film or a woven synthetic material, or is a laminate of these two materials and, when filled with a gas such as air, achieves a thickness sufficient to provide considerable thermal insulation between the cooling layer 30 and the surface 53 of the chamber 52 supporting one or more of the portions of a human body or of an animal. For example, the thickness of the chamber 52, when it is filled with air, can range between 1.0"and 2.0". The gas that is in the chamber 52 should preferably be under slight pressure, and may or may not be circulating in the chamber. Of course, the chamber 52 should be compressible (i.e. compressed or compressible air in an extensible material) so that, under the areas of the human or animal body that bear weight, its surface 53 will be pressed towards its surface. , which reduces its thermal resistance. Figure 8 shows how the buttocks of a patient represented by the shaded area 36 compress the chamber 52. It is clear that the thermal resistance of the gas that is in the chamber 52 is reduced below the portion of the surface 53 on which the buttocks. Here the heat is effectively removed from the weight bearing area and transferred to the cooling layer 30. Figure 9 shows the layer of the optional thermal conductive mat 43 interposed between the chamber 52 and the cooling chamber 30 to match the uneven surface caused by the channels of a water mattress that incorporates the cooling layer 30.

A second alternative embodiment of the invention is illustrated in Figures 10-12. The second alternative embodiment is equivalent, in all its aspects, to the preferred embodiment, except that the layer 32 of compressible thermally insulating material is specifically incorporated into a metallic wool insulating mat 62 having an upper surface 63 and a lower surface 64. The metallic wool mat is preferably a chamber made of a polymeric film or a woven material, or of a laminate composed of the two materials containing metallic wool fibers.

The metal wool material is preferably made of finely stretched aluminum, steel, brass or other similar materials. The fibers intertwine to form a compressible mat. In its normal non-compressed state, the thickness of the metal wool mat 62 is sufficient to provide good thermal insulation between the surface 63 and the cooling layer 30. For example, the metal wool mat 62 may have a thickness that oscillates between 0.5"and 2.0". As with the previously described embodiments, the metal wool mat 62 is compressible and has a lower thermal resistance in the portions that are between the areas of the human body that support weight and the cooling layer 30. In its compressed state, the Heat conduction through the compressed metal fibers is high.

All the specific embodiments of our invention have been described and set forth in drawings for purposes of illustration, and it should be understood that many alternative variants and constructions may be made without departing from the spirit and scope of the invention, which is limited only by the following claims.

Claims (30)

1. An apparatus for supporting a body at the same time that selectively cools areas of the body that are in contact with the apparatus, which consists of: a cooling layer; a layer of thermally insulating compressible material disposed on the cooling layer; a surface on the layer of thermally insulating compressible material; reacting the layer of thermally insulating and compressible material to the pressure exerted against the surface, so as to provide a thermal resistance between the surface and the cooling layer, which varies in inverse proportion to the pressure; Y means for maintaining the cooling layer at a predetermined temperature that is below the normal temperature of the human body.

2. The apparatus of Claim 1, wherein the thermally insulating compressible material includes a foam material.

3. The apparatus of Claim 2, wherein the foam material includes a honeycomb plastic.

4. The apparatus of Claim 2, wherein the foam material includes a foam rubber.

5. The apparatus of Claim 2, wherein the thermally insulating compressible material has a thickness, between the surface and the cooling layer, that ranges from 1/2 inch to 1 inch.

6. The apparatus of Claim 1, which further includes a thermally conductive material in the layer of thermally insulating compressible material.

7. The apparatus of Claim 1, wherein the cooling layer is a mattress containing fluid flowing therethrough.

8. The apparatus of Claim 1, further including a layer of thermally conductive material between the layer of thermally insulating compressible material and the cooling layer.

9. The apparatus of Claim 1, wherein the cooling layer is contiguous with the layer of thermally insulating compressible material.

10. The apparatus of Claim 1, further including a support mat that is in contact with the cooling layer, such that the cooling layer lies between the support mat and the layer of thermally insulating compressible material.

11. The apparatus of Claim 1, wherein the thermally insulating compressible layer is a mat filled with gas.

12. The apparatus of Claim 1, wherein the thermally insulating compressible layer includes a metal wool mat.

13. The apparatus of Claim 1, wherein the means for maintaining the temperature includes a phase-absorbing heat-absorbing material.

14. The apparatus of Claim 1, wherein the means for maintaining the temperature includes a refrigerator.

15. The apparatus of Claim 1, wherein the means for maintaining the temperature includes a cooler.

16. The apparatus of Claim 1, wherein the means for maintaining the temperature includes a radiator.

17. The apparatus of Claim 1, wherein the means for maintaining the temperature includes a heat exchanger.

18. The apparatus of Claim 1, further including a thermally conductive liquid in the layer of thermally insulating compressible material.

19. A support mat to support a human body sitting or in a supine position, consisting of: a cooling layer; a layer of thermally insulating compressible material disposed on the cooling layer; a surface on the layer of thermally insulating compressible material; a layer of thermally insulating compressible material that reacts to the pressure exerted against the surface in order to provide a thermal resistance between the surface and the cooling layer, which varies in inverse proportion to the pressure; Y a support mat that supports the cooling layer, such that the cooling layer lies between the support mat and the layer of thermally insulating compressible material.

20. The apparatus of Claim 19, wherein the layer of thermally insulating compressible material includes a foam material.

21. The apparatus of Claim 20, wherein the foam material includes a honeycomb plastic.

22. The apparatus of Claim 20, wherein the foam material includes an alveolar rubber.

23. The apparatus of Claim 20, wherein the layer of thermally insulating compressible material has a thickness, between the surface and the cooling layer, that ranges from 1/2 inch to 1 inch.

24. The apparatus of Claim 19, further including a thermally conductive material suspended in the layer of thermally insulating compressible material.

25. The apparatus of Claim 19, wherein the cooling layer is a mattress containing a fluid circulating therethrough.

26. The apparatus of Claim 19, further including a layer of thermally conductive material between the layer of thermally insulating compressible material and the cooling layer.

27. The apparatus of Claim 19, wherein the cooling layer is contiguous with the layer of thermally insulating compressible material.

28. The apparatus of Claim 19, wherein the thermally insulating compressible layer is comprised of one or more gas-filled mats.

29. The apparatus of Claim 19, wherein the thermally insulating compressible layer includes a metal wool mat.

30. A method for supporting a body on an apparatus that includes a layer of thermally insulating compressible material, while selectively cooling areas of the body that are in contact with the apparatus, including the steps of: placing a cooling layer in contact thermal with the layer of thermally insulating compressible material; Y applying pressure against the layer of thermally insulating compressible material by placing at least a portion of the body on the apparatus; With which, a portion of the thermally insulating compressible material layer is compressed under the body portion, the thermal resistance of the layer portion is reduced, and cold with the cooling layer is applied to the portion of the layer of thermally insulating compressible material . SUPPORT DEVICE WITH COOLING LOCATED IN SURFACE AREAS OF THE BODY WITH HIGH PRESSURE CONTACT SUMMARY OF THE INVENTION A concentrated cooling apparatus consisting of a cooler, or thermal disperser, a layer on which a layer of thermally insulating compressible material is disposed. The layer of thermally insulating compressible material has a surface so that a portion of a human (or animal) body rests on it. The layer of thermally insulating compressible material reacts to the pressure exerted against the surface by opposing a thermal resistance between the surface and the cooling layer, which varies in inverse proportion to the pressure exerted. Means are provided for maintaining the cooling layer at a predetermined temperature below the normal temperature of the human body.