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Daanen HAM, Kohlen V, Teunissen LPJ. Heat flux systems for body core temperature assessment during exercise. J Therm Biol 2023; 112:103480. [PMID: 36796923 DOI: 10.1016/j.jtherbio.2023.103480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
Heat flux systems are increasingly used to assess core body temperature. However, validation of multiple systems is scarce. Therefore, an experiment was performed in which three commercially available heat flux systems (3 M, Medisim and Core) were compared to rectal temperature (Tre). Five females and four males performed exercise in a climate chamber set at 18 °C/50% relative humidity until exhaustion. Exercise duration was 36.3 ± 5.6 min (mean ± standard deviation). Tre in rest was 37.2 ± 0.3 °C. Medisim's-values were lower than Tre (36.9 ± 0.4 °C, p < 0.05); 3 M (37.2 ± 0.1 °C) and Core's (37.4 ± 0.3 °C) did not differ from Tre. Maximal temperatures after exercise were 38.4 ± 0.2 °C (Tre), 38.0 ± 0.4 °C (3 M), 38.8 ± 0.3 °C (Medisim) and 38.6 ± 0.3 °C (Core); Medisim was significantly higher than Tre (p < 0.05). The temperature profiles of the heat flux systems during exercise differed to varying degree from the rectal profiles; the Medisim system showed a faster increase during exercise than Tre (0.48 ± 0.25 °C in 20 min, p < 0.05), the Core system tended to show a systematic overestimation during the entire exercise period and the 3 M system showed large errors at the end of exercise, likely due to sweat entering the sensor. Therefore, the interpretation of heat flux sensor values as core body temperature estimates should be done with care; more research is required to elucidate the physiological significance of the generated temperature values.
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Affiliation(s)
- Hein A M Daanen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Veerle Kohlen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Yang SM, Cho HY, Kim HS. Comparison of tracheal temperature and core temperature measurement in living donor liver transplant recipients: a clinical comparative study. BMC Anesthesiol 2022; 22:315. [PMID: 36217113 PMCID: PMC9549662 DOI: 10.1186/s12871-022-01853-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Body temperature is a vital sign, and temperature monitoring during liver transplantation is important. Tracheal temperature can be measured via an endotracheal tube with a temperature sensor on the cuff of the tube. This study aimed to investigate the accuracy and trending ability of tracheal temperature measurement compared to those of the core temperature measured at the esophagus and pulmonary artery (PA) in living donor liver transplant recipients. METHODS Twenty-two patients who underwent living donor liver transplantation (LDLT) were enrolled. Patients were intubated using an endotracheal tube with a temperature sensor placed on the inner surface of the tube cuff. Tracheal, esophageal, and PA temperatures were recorded at five time points corresponding to the different phases of liver transplantation. The tracheal and esophageal, tracheal and PA, and esophageal and PA temperatures were compared using Bland-Altman analysis, four-quadrant plot/concordance analysis, and polar plot analysis. RESULTS Bland-Altman analysis showed an overall mean bias (95% limits of agreement) between tracheal and esophageal temperatures of -0.10 °C (-0.37 °C to 0.18 °C), with a percentage error of 0.27%; between tracheal and PA temperatures, -0.05 °C (-0.91 °C to 0.20 °C), with a percentage error of -0.15%; and between esophageal and PA temperatures, 0.04 °C (-0.27 °C to 0.35 °C), with a percentage error of 0.12%. The concordance rates between tracheal and esophageal temperatures, tracheal and PA temperatures, and esophageal and PA temperatures were 96.2%, 96.2%, and 94.94%, respectively. The polar plot analysis showed a mean angular bias (radial limits of agreement) of 4° (26°), -3° (13°), and 2° (21°). CONCLUSIONS Monitoring core temperature at the inner surface of the endotracheal tube cuff is accurate in all phases of LDLT with good trending ability; thus, it can be an excellent alternative for monitoring during LDLTs.
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Affiliation(s)
- Seong-Mi Yang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye-Yeon Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Chen HY, Chen A, Chen C. Investigation of the Impact of Infrared Sensors on Core Body Temperature Monitoring by Comparing Measurement Sites. SENSORS 2020; 20:s20102885. [PMID: 32438729 PMCID: PMC7284737 DOI: 10.3390/s20102885] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 01/24/2023]
Abstract
Many types of thermometers have been developed to measure body temperature. Infrared thermometers (IRT) are fast, convenient and ease to use. Two types of infrared thermometers are uses to measure body temperature: tympanic and forehead. With the spread of COVID-19 coronavirus, forehead temperature measurement is used widely to screen people for the illness. The performance of this type of device and the criteria for screening are worth studying. This study evaluated the performance of two types of tympanic infrared thermometers and an industrial infrared thermometer. The results showed that these infrared thermometers provide good precision. A fixed offset between tympanic and forehead temperature were found. The measurement values for wrist temperature show significant offsets with the tympanic temperature and cannot be used to screen fevers. The standard operating procedure (SOP) for the measurement of body temperature using an infrared thermometer was proposed. The suggestion threshold for the forehead temperature is 36 °C for screening of fever. The body temperature of a person who is possibly ill is then measured using a tympanic infrared thermometer for the purpose of a double check.
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Affiliation(s)
- Hsuan-Yu Chen
- Department of Materials Science and Engineering, University of California, San Diego, CA 92093, USA;
| | - Andrew Chen
- Africa Research Center, National Chung Hsing University, Taichung 40227, Taiwan;
| | - Chiachung Chen
- Department of Bio-industrial Mechatronics Engineering, National ChungHsing University, Taichung 40227, Taiwan
- Correspondence: ; Tel.: +886-4-22857562
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Morettini E, Turchini F, Tofani L, Villa G, Ricci Z, Romagnoli S. Intraoperative core temperature monitoring: accuracy and precision of zero-heat flux heated controlled servo sensor compared with esophageal temperature during major surgery; the ESOSPOT study. J Clin Monit Comput 2019; 34:1111-1119. [PMID: 31673946 DOI: 10.1007/s10877-019-00410-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022]
Abstract
Monitoring of intraoperative core temperature is strongly recommended to reduce the risk of perioperative thermic imbalance and related complications. The zero-heat-flux sensor (3M Bair Hugger Temperature monitoring system, ZHF), measures core temperature in a non-invasive manner. This study was aimed at comparing accuracy and precision of the ZHF sensor compared to the esophageal thermometer. Patients scheduled for major elective abdominal or urologic surgery were considered eligible for enrollment. Core body temperature was measured using both an esophageal probe (TESO) and a ZHF sensor (TZHF) every 15 min from induction until the end of general anaesthesia. A Bland-Altman plot for repeated measures was performed. The proportion of measurements within ± 0.5 °C was estimated; from a clinical point of view, a proportion greater than 90% was considered sufficiently accurate. Lin's concordance correlation coefficient (CCC) for repeated measures were calculated. To evaluate association between the two methods, a generalized estimating equation (GEE) simple linear regression model, was elaborated. A GEE multiple regression model was also performed in order to adjust the estimate of the association between measurements from surgical and patient's features. Ninety-nine patients were enrolled. Bland-Altman plot bias was 0.005 °C with upper and lower limits of agreement for repeated measures of 0.50 °C and - 0.49 °C. The percentage of measurements within 0.5 °C of the reference value was 97.98% (95% confidence interval 92.89-99.75%), indicating a clinically sufficient agreement between the two methods. This was also confirmed by a CCC for repeated measures of 0.89 (95% CI 0.80 to 0.94). The GEE simple regression model (slope value of 0.77) was not significantly influenced by any patient or surgical variables. According to GEE multiple regression model results, the explored patient- and surgery-related variables did not influence the association between methods. ZHF sensor has shown a clinically acceptable accuracy and precision for body core temperature monitoring during elective major surgery. CLINICAL TRIALS: Clinical trial number: NCT03820232.
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Affiliation(s)
- Elena Morettini
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy.
| | - Francesca Turchini
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Lorenzo Tofani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Gianluca Villa
- Section of Anesthesia, Intensive Care and Pain Medicine, Department of Health Sciences, University of Florence, Florence, Italy
| | - Zaccaria Ricci
- Pediatric Cardiac Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, Rome, Italy
| | - Stefano Romagnoli
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy.,Section of Anesthesia, Intensive Care and Pain Medicine, Department of Health Sciences, University of Florence, Florence, Italy
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Pesonen E, Silvasti-Lundell M, Niemi TT, Kivisaari R, Hernesniemi J, Mäkinen MT. The focus of temperature monitoring with zero-heat-flux technology (3M Bair-Hugger): a clinical study with patients undergoing craniotomy. J Clin Monit Comput 2018; 33:917-923. [PMID: 30467673 PMCID: PMC6710334 DOI: 10.1007/s10877-018-0227-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/16/2018] [Indexed: 11/29/2022]
Abstract
In the noninvasive zero-heat-flux (ZHF) method, deep body temperature is brought to the skin surface when an insulated temperature probe with servo-controlled heating on the skin creates a region of ZHF from the core to the skin. The sensor of the commercial Bair-Hugger ZHF device is placed on the forehead. According to the manufacturer, the sensor reaches a depth of 1-2 cm below the skin. In this observational study, the anatomical focus of the Bair-Hugger ZHF sensor was assessed in pre- and postoperative CT or MRI images of 29 patients undergoing elective craniotomy. Assuming the 2-cm depth from the forehead skin surface, the temperature measurement point preoperatively reached the brain cortex in all except one patient. Assuming the 1-cm depth, the preoperative temperature measurement point did not reach the brain parenchyma in any of the patients and was at the cortical surface in two patients. Corresponding results were obtained postoperatively, although either sub-arachnoid fluid or air was observed in all CT/MRI images. Craniotomy did not have a detectable effect on the course of the ZHF temperatures. In Bland-Altman analysis, the agreement of ZHF temperature with the nasopharyngeal temperature was 0.11 (95% confidence interval - 0.54 to 0.75) °C and with the bladder temperature - 0.14 (- 0.81 to 0.52) °C. As conclusions, within the reported range of the Bair-Hugger ZHF measurement depth, the anatomical focus of the sensor cannot be determined. Craniotomy did not have a detectable effect on the course of the ZHF temperatures that showed good agreement with the nasopharyngeal and bladder temperatures.
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Affiliation(s)
- Eero Pesonen
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Marja Silvasti-Lundell
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tomi T Niemi
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marja-Tellervo Mäkinen
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Epstein RH, Dexter F, Hofer IS, Rodriguez LI, Schwenk ES, Maga JM, Hindman BJ. Perioperative Temperature Measurement Considerations Relevant to Reporting Requirements for National Quality Programs Using Data From Anesthesia Information Management Systems. Anesth Analg 2018; 126:478-486. [DOI: 10.1213/ane.0000000000002098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Mäkinen MT, Pesonen A, Jousela I, Päivärinta J, Poikajärvi S, Albäck A, Salminen US, Pesonen E. Novel Zero-Heat-Flux Deep Body Temperature Measurement in Lower Extremity Vascular and Cardiac Surgery. J Cardiothorac Vasc Anesth 2016; 30:973-8. [PMID: 27521967 DOI: 10.1053/j.jvca.2016.03.141] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to compare deep body temperature obtained using a novel noninvasive continuous zero-heat-flux temperature measurement system with core temperatures obtained using conventional methods. DESIGN A prospective, observational study. SETTING Operating room of a university hospital. PARTICIPANTS The study comprised 15 patients undergoing vascular surgery of the lower extremities and 15 patients undergoing cardiac surgery with cardiopulmonary bypass. INTERVENTIONS Zero-heat-flux thermometry on the forehead and standard core temperature measurements. MEASUREMENTS AND MAIN RESULTS Body temperature was measured using a new thermometry system (SpotOn; 3M, St. Paul, MN) on the forehead and with conventional methods in the esophagus during vascular surgery (n = 15), and in the nasopharynx and pulmonary artery during cardiac surgery (n = 15). The agreement between SpotOn and the conventional methods was assessed using the Bland-Altman random-effects approach for repeated measures. The mean difference between SpotOn and the esophageal temperature during vascular surgery was+0.08°C (95% limit of agreement -0.25 to+0.40°C). During cardiac surgery, during off CPB, the mean difference between SpotOn and the pulmonary arterial temperature was -0.05°C (95% limits of agreement -0.56 to+0.47°C). Throughout cardiac surgery (on and off CPB), the mean difference between SpotOn and the nasopharyngeal temperature was -0.12°C (95% limits of agreement -0.94 to+0.71°C). Poor agreement between the SpotOn and nasopharyngeal temperatures was detected in hypothermia below approximately 32°C. CONCLUSIONS According to this preliminary study, the deep body temperature measured using the zero-heat-flux system was in good agreement with standard core temperatures during lower extremity vascular and cardiac surgery. However, agreement was questionable during hypothermia below 32°C.
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Affiliation(s)
- Marja-Tellervo Mäkinen
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine.
| | - Anne Pesonen
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine
| | - Irma Jousela
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine
| | - Janne Päivärinta
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine
| | - Satu Poikajärvi
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine
| | - Anders Albäck
- Abdominal Center, Department of Vascular Surgery, Meilahti Hospital, Helsinki, Finland
| | - Ulla-Stina Salminen
- Heart and Lung Center, Department of Cardiac Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Pesonen
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine
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An Evaluation of a Zero-Heat-Flux Cutaneous Thermometer in Cardiac Surgical Patients. Anesth Analg 2014; 119:543-549. [DOI: 10.1213/ane.0000000000000319] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Haugk M, Stratil P, Sterz F, Krizanac D, Testori C, Uray T, Koller J, Behringer W, Holzer M, Herkner H. Temperature monitored on the cuff surface of an endotracheal tube reflects body temperature. Crit Care Med 2010; 38:1569-73. [PMID: 20495450 DOI: 10.1097/ccm.0b013e3181e47a20] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE When treating patients with cardiac arrest with mild therapeutic hypothermia, a reliable and easy-to-use temperature probe is desirable. This study was conducted to investigate the accuracy and safety of tracheal temperature as a measurement of body temperature. DESIGN Observational cohort study. SETTING Emergency department of a tertiary care university hospital. PATIENTS Patients successfully resuscitated from cardiac arrest intended for mild hypothermia therapy. INTERVENTIONS Intubation was performed with a newly developed endotracheal tube that contains a temperature sensor inside the cuff surface. During the cooling, mild hypothermia maintenance, and rewarming phases, the temperature was recorded minute by minute. These data were compared with the temperature assessed by esophageal and blood temperature probes. Thereafter, tracheoscopy was performed to evaluate the condition of the tracheal mucosa. MEASUREMENTS AND MAIN RESULTS Approximately 2000 measurements per temperature sensor per patient were recorded in 21 patients. The mean bias between the blood temperature and the tracheal temperature was -0.16 degrees C (limits of agreement: -0.36 degrees C to 0.04 degrees C). The mean bias between the esophageal and tracheal temperatures was -0.22 degrees C (limits of agreement: -0.49 degrees C to 0.07 degrees C). Agreement between temperature probes investigated by the Bland-Altman method showed a mean bias of less than -(1/4) degrees C, and time lags assessed graphically by hysteresis plots were negligible. No clinically relevant injury to the tracheal mucosa was detected. CONCLUSION Temperature monitoring at the cuff surface of an endotracheal tube is safe and provides accurate and reliable data in all phases of therapeutically induced mild hypothermia after cardiac arrest.
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Affiliation(s)
- Moritz Haugk
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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Zeiner A, Klewer J, Sterz F, Haugk M, Krizanac D, Testori C, Losert H, Ayati S, Holzer M. Non-invasive continuous cerebral temperature monitoring in patients treated with mild therapeutic hypothermia: an observational pilot study. Resuscitation 2010; 81:861-6. [PMID: 20398992 DOI: 10.1016/j.resuscitation.2010.03.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 02/25/2010] [Accepted: 03/11/2010] [Indexed: 11/30/2022]
Abstract
AIM OF THE STUDY To investigate if body temperature as measured with a prototype of a non-invasive continuous cerebral temperature sensor using the zero-heat-flow method to reflect the oesophageal temperature (core temperature) during mild therapeutic hypothermia after cardiac arrest. METHODS In patients over 18 years old with restoration of spontaneous circulation after cardiac arrest, a temperature sensor that uses the zero-heat-flow principle was placed on the forehead during the periods of cooling and re-warming. This temperature was compared to oesophageal temperature as the primary temperature-monitoring site. To assess agreement, we used the Bland-Altman approach and Lin's concordance correlation coefficient. RESULTS From September 2008 to April 2009, data from 19 patients were analysed. The median time from restoration of spontaneous circulation until temperature sensor application was 53min (interquartile range, 31; 96). All sensors were removed when a core temperature of 36 degrees C was reached. These measurements were in agreement with oesophageal temperature measurements. No allergic reaction, rash or other irritation occurred on the skin around or under the probes. Bland-Altman results showed a bias of -0.12 degrees C and 95% limits of agreement of -0.59 and +0.36 degrees C. Lin's concordance correlation coefficient was 0.98. CONCLUSIONS Body temperature measurements using a non-invasive continuous cerebral temperature sensor prototype that uses the zero-heat-flow method accurately reflected oesophageal temperature measurements during mild therapeutic hypothermia in patients with restoration of spontaneous circulation after cardiac arrest.
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Affiliation(s)
- Andrea Zeiner
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20/6D, Wien, Austria
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Krizanac D, Haugk M, Sterz F, Weihs W, Holzer M, Bayegan K, Janata A, Losert UM, Herkner H, Behringer W. Tracheal temperature for monitoring body temperature during mild hypothermia in pigs. Resuscitation 2010; 81:87-92. [DOI: 10.1016/j.resuscitation.2009.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 10/08/2009] [Accepted: 10/09/2009] [Indexed: 11/24/2022]
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Urinary bladder and oesophageal temperatures correlate better in patients with high rather than low urinary flow rates during non-cardiac surgery. Eur J Anaesthesiol 2008; 25:805-9. [DOI: 10.1017/s0265021508004602] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Most clinically available thermometers accurately report the temperature of whatever tissue is being measured. The difficulty is that no reliably core-temperature-measuring sites are completely noninvasive and easy to use-especially in patients not undergoing general anesthesia. Nonetheless, temperature can be reliably measured in most patients. Body temperature should be measured in patients undergoing general anesthesia exceeding 30 min in duration and in patients undergoing major operations during neuraxial anesthesia. Core body temperature is normally tightly regulated. All general anesthetics produce a profound dose-dependent reduction in the core temperature, triggering cold defenses, including arteriovenous shunt vasoconstriction and shivering. Anesthetic-induced impairment of normal thermoregulatory control, with the resulting core-to-peripheral redistribution of body heat, is the primary cause of hypothermia in most patients. Neuraxial anesthesia also impairs thermoregulatory control, although to a lesser extent than does general anesthesia. Prolonged epidural analgesia is associated with hyperthermia whose cause remains unknown.
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Affiliation(s)
- Daniel I Sessler
- Department of Outcomes Research, The Cleveland Clinic-P77, Cleveland, Ohio 44195, USA.
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Matsukawa T, Goto T, Ozaki M, Sessler DI, Takeuchi A, Nishiyama T, Kumazawa T. Core temperature monitoring with new ventilatory devices. Anesth Analg 2003; 96:1688-1691. [PMID: 12760997 DOI: 10.1213/01.ane.0000063823.92862.6b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Widespread use of new airway devices, such as the laryngeal mask airway (LMA) and the cuffed oropharyngeal airway (COPA), preclude measuring core temperature in the distal esophagus. Therefore, we tested the hypothesis that core temperature measured with a thermocouple positioned on a LMA or COPA is sufficiently accurate and precise for clinical use. Temperatures were recorded from thermocouples positioned on the cuffs of LMAs or COPAs in 36 patients scheduled for prolonged orthopedic surgery or therapeutic hyperthermia for cancer. These temperatures, recorded at 15-min intervals, were compared with simultaneously obtained nasopharynx and tympanic membrane temperatures. Data were compared by linear regression and the bias calculated. Temperatures measured on the LMA correlated well with both nasopharyngeal (r(2) = 0.94) and tympanic membrane (r(2) = 0.94) temperatures. Temperatures measured on the COPA also correlated well with those on the nasopharynx (r(2) = 0.97) and tympanic membrane (r(2) = 0.96). The fraction of temperatures that differed from nasopharynx temperature by more than +/-0.5 degrees C was 8% with LMA and 11% with COPA; the fraction of temperatures that differed from tympanic temperature by more than +/-0.5 degrees C was 7% with LMA and 10% with COPA. These results suggest that body temperature measured from the cuffs of COPA or LMAs is sufficiently accurate for routine clinical use. IMPLICATIONS Temperatures measured on airway devices correlated well with independent measurements of core body temperature. Thus, body temperature measured on the cuffs of airway devices is sufficiently accurate for routine use.
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Affiliation(s)
- Takashi Matsukawa
- *Department of Anesthesia, University of Yamanashi, Faculty of Medicine; †Department of Anesthesia, Teikyo University, Tokyo; ‡Department of Anesthesia, Tokyo Women's Medical University; §Department of Oncology, St. Luke Hospital, Tokyo; ∥Department of Anesthesia, Tokyo University School of Medicine, Japan; and ¶the Outcomes Research™ Institute and Departments of Anesthesiology and Pharmacology, University of Louisville, KY
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Harioka T, Matsukawa T, Ozaki M, Nomura K, Sone T, Kakuyama M, Toda H. "Deep-forehead" temperature correlates well with blood temperature. Can J Anaesth 2000; 47:980-3. [PMID: 11032273 DOI: 10.1007/bf03024869] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the accuracy and precision of "deep-forehead" temperature with rectal, esophageal, and tympanic membrane temperatures, compared with blood temperature. METHODS We studied 41 ASA physical status 1 or 2 patients undergoing abdominal and thoracic surgery scheduled to require at least three hours. "Deep-forehead" temperature was measured using a Coretemp thermometer (Terumo, Tokyo, Japan). Blood temperature was measured with a thermistor of a pulmonary artery. Rectal, tympanic membrane, and distal esophageal temperatures were measured with thermocouples. All temperatures were recorded at 20 min intervals after the induction of anesthesia. We considered blood temperature as the reference value. Temperatures at the other four sites were compared with blood temperature using correlation, regression, and Bland and Altman analyses. We determined accuracy (mean difference between reference and test temperatures) and precision (standard deviation of the difference) of 0.5 degrees C to be clinically acceptable. RESULTS "Deep-forehead" temperature correlated well with blood temperature as well as other temperatures, the determination coefficients (r2) being 0.85 in each case. The bias for the "deep-forehead" temperature was 0.0 degrees C, which was the same as tympanic membrane temperature and was smaller than rectal and esophageal temperatures. The standard deviation of the differences for the "deep-forehead" temperature was 0.3 degrees C, which was the same as rectal temperature. CONCLUSIONS We have demonstrated that the "deep-forehead" temperature has excellent accuracy and clinically sufficient precision as well as other three core temperatures, compared with blood temperature.
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Affiliation(s)
- T Harioka
- Department of Anesthesia, Shimada Municipal Hospital, Japan
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Smith CE, Desai R, Glorioso V, Cooper A, Pinchak AC, Hagen KF. Preventing hypothermia: convective and intravenous fluid warming versus convective warming alone. J Clin Anesth 1998; 10:380-5. [PMID: 9702617 DOI: 10.1016/s0952-8180(98)00049-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To test the hypothesis that warming intravenous (i.v.) fluids in conjunction with convective warming results in less intraoperative hypothermia (core temperature < 36.0 degrees C) than that seen with convective warming alone. DESIGN Prospective, randomized study. SETTING University affiliated tertiary care teaching hospital. PATIENTS 61 ASA physical status, I, II, and III adults undergoing major surgery and general anesthesia with isoflurane. INTERVENTIONS All patients received convective warming. Group 1 patients received warmed fluids (setpoint 42 degrees C). Group 2 patients received room temperature fluids (approximately 21 degrees C). MEASUREMENTS AND MAIN RESULTS Lowest and final intraoperative distal esophageal temperatures were higher (p < 0.05) in Group 1 (mean +/- SEM: 35.8 +/- 0.1 degrees C and 36.6 +/- 0.1 degrees C) versus Group 2 (35.4 +/- 0.1 degrees C and 36.1 +/- 0.1 degrees C, respectively). Compared with Group 1, more Group 2 patients were hypothermic at the end of anesthesia (10 of 26 patients, or 38.5% vs. 4 of 30 patients, or 13%; p < 0.05). After 30 minutes in the recovery room, there were no differences in temperature between groups (36.7 +/- 0.1 degrees C and 36.5 +/- 0.1 degrees C in Groups 1 and 2, respectively). Intraoperative cessation of convective warming because of core temperature greater than 37 degrees C was required in 33% of Group 1 patients (vs. 11.5% in Group 2; p = 0.052). CONCLUSIONS The combination of convective and fluid warming was associated with a decreased likelihood of patients leaving the operating room hypothermic. However, average final temperatures were greater than 36 degrees C in both groups, and intergroup differences were small. Care must be taken to avoid overheating the patient when both warming modalities are employed together.
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Affiliation(s)
- C E Smith
- Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA
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