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Eisenkraft A, Goldstein N, Fons M, Tabi M, Sherman AD, Ben Ishay A, Merin R, Nachman D. Comparing body temperature measurements using the double sensor method within a wearable device with oral and core body temperature measurements using medical grade thermometers-a short report. Front Physiol 2023; 14:1279314. [PMID: 38033330 PMCID: PMC10685445 DOI: 10.3389/fphys.2023.1279314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction: Body temperature is essential for diagnosing, managing, and following multiple medical conditions. There are several methods and devices to measure body temperature, but most do not allow continuous and prolonged measurement of body temperature. Noninvasive skin temperature sensor combined with a heat flux sensor, also known as the "double sensor" technique, is becoming a valuable and simple method for frequently monitoring body temperature. Methods: Body temperature measurements using the "double sensor" method in a wearable monitoring device were compared with oral and core body temperature measurements using medical grade thermometers, analyzing data from two prospective clinical trials of different clinical scenarios. One study included 45 hospitalized COVID-19 patients in which oral measurements were taken using a hand-held device, and the second included 18 post-cardiac surgery patients in which rectal measurements were taken using a rectal probe. Results: In study 1, Bland-Altman analysis showed a bias of -0.04°C [0.34-(-0.43)°C, 95% LOA] with a correlation of 99.4% (p < 0.001). In study 2, Bland-Altman analysis showed a bias of 0.0°C [0.27-(-0.28)°C, 95% LOA], and the correlation was 99.3% (p < 0.001). In both studies, stratifying patients based on BMI and skin tone showed high accordance in all sub-groups. Discussion: The wearable monitor showed high correlation with oral and core body temperature measurements in different clinical scenarios.
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Affiliation(s)
- Arik Eisenkraft
- Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem, Israel
- Biobeat Technologies Ltd., Petah Tikva, Israel
| | | | - Meir Fons
- Biobeat Technologies Ltd., Petah Tikva, Israel
| | | | | | | | - Roei Merin
- Biobeat Technologies Ltd., Petah Tikva, Israel
| | - Dean Nachman
- Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem, Israel
- Heart Institute, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
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Masè M, Werner A, Putzer G, Avancini G, Falla M, Brugger H, Micarelli A, Strapazzon G. Low Ambient Temperature Exposition Impairs the Accuracy of a Non-invasive Heat-Flux Thermometer. Front Physiol 2022; 13:830059. [PMID: 35309078 PMCID: PMC8931521 DOI: 10.3389/fphys.2022.830059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background Indirect core body temperature (CBT) monitoring from skin sensors is gaining attention for in-field applications thanks to non-invasivity, portability, and easy probe positioning. Among skin sensors, heat-flux devices, such as the so-called Double Sensor (DS), have demonstrated reliability under various experimental and clinical conditions. Still, their accuracy at low ambient temperatures is unknown. In this randomized cross-over trial, we tested the effects of cold temperature exposition on DS performance in tracking CBT. Methods Twenty-one participants were exposed to a warm (23.2 ± 0.4°C) and cold (−18.7 ± 1.0°C) room condition for 10 min, following a randomized cross-over design. The accuracy of the DS to estimate CBT in both settings was assessed by quantitative comparison with esophageal (reference) and tympanic (comparator) thermometers, using Bland–Altman and correlation analyses (Pearson’s correlation coefficient, r, and Lin’s concordance correlation coefficient, CCC). Results In the warm room setting, the DS showed a moderate agreement with the esophageal sensor [bias = 0.09 (−1.51; 1.69) °C, r = 0.40 (p = 0.069), CCC = 0.22 (−0.006; 0.43)] and tympanic sensor [bias = 2.74 (1.13; 4.35) °C, r = 0.54 (p < 0.05), CCC = 0.09 (0.008; 0.16)]. DS accuracy significantly deteriorated in the cold room setting, where DS temperature overestimated esophageal temperature [bias = 2.16 (−0.89; 5.22) °C, r = 0.02 (0.94), CCC = 0.002 (−0.05; 0.06)]. Previous exposition to the cold influenced temperature values measured by the DS in the warm room setting, where significant differences (p < 0.00001) in DS temperature were observed between randomization groups. Conclusion DS accuracy is influenced by environmental conditions and previous exposure to cold settings. These results suggest the present inadequacy of the DS device for in-field applications in low-temperature environments and advocate further technological advancements and proper sensor insulation to improve performance in these conditions.
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Affiliation(s)
- Michela Masè
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Andreas Werner
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- German Air Force – Centre of Aerospace Medicine, Aviation Physiology Training Centre, Aviation Physiology Diagnostic and Research, Königsbrück, Germany
| | - Gabriel Putzer
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Giovanni Avancini
- Department of Anaesthesia and Intensive Care, Santa Chiara Hospital, Trento, Italy
| | - Marika Falla
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Centre for Mind/Brain Sciences, CIMeC, University of Trento, Rovereto, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Alessandro Micarelli
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
- *Correspondence: Giacomo Strapazzon,
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Intra-operative cutaneous temperature monitoring with zero-heat-flux technique (3M SpotOn) in comparison with oesophageal and arterial temperature. Eur J Anaesthesiol 2018; 35:825-830. [DOI: 10.1097/eja.0000000000000822] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mendt S, Maggioni MA, Nordine M, Steinach M, Opatz O, Belavý D, Felsenberg D, Koch J, Shang P, Gunga HC, Stahn A. Circadian rhythms in bed rest: Monitoring core body temperature via heat-flux approach is superior to skin surface temperature. Chronobiol Int 2016; 34:666-676. [PMID: 27726448 DOI: 10.1080/07420528.2016.1224241] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Continuous recordings of core body temperature (CBT) are a well-established approach in describing circadian rhythms. Given the discomfort of invasive CBT measurement techniques, the use of skin temperature recordings has been proposed as a surrogate. More recently, we proposed a heat-flux approach (the so-called Double Sensor) for monitoring CBT. Studies investigating the reliability of the heat-flux approach over a 24-hour period, as well as comparisons with skin temperature recordings, are however lacking. The first aim of the study was therefore to compare rectal, skin, and heat-flux temperature recordings for monitoring circadian rhythm. In addition, to assess the optimal placement of sensor probes, we also investigated the effect of different anatomical measurement sites, i.e. sensor probes positioned at the forehead vs. the sternum. Data were collected as part of the Berlin BedRest study (BBR2-2) under controlled, standardized, and thermoneutral conditions. 24-hours temperature data of seven healthy males were collected after 50 days of -6° head-down tilt bed-rest. Mean Pearson correlation coefficients indicated a high association between rectal and forehead temperature recordings (r > 0.80 for skin and Double Sensor). In contrast, only a poor to moderate relationship was observed for sensors positioned at the sternum (r = -0.02 and r = 0.52 for skin and Double Sensor, respectively). Cross-correlation analyses further confirmed the feasibility of the forehead as a preferred monitoring site. The phase difference between forehead Double Sensor and rectal recordings was not statistically different from zero (p = 0.313), and was significantly smaller than the phase difference between forehead skin and rectal temperatures (p = 0.016). These findings were substantiated by cosinor analyses, revealing significant differences for mesor, amplitude, and acrophase between rectal and forehead skin temperature recordings, but not between forehead Double Sensor and rectal temperature measurements. Finally, Bland-Altman analysis indicated narrower limits of agreement for rhythm parameters between rectal and Double Sensor measurements compared to between rectal and skin recordings, irrespective of the measurement site (i.e. forehead, sternum). Based on these data we conclude that (1) Double Sensor recordings are significantly superior to skin temperature measurements for non-invasively assessing the circadian rhythm of rectal temperature, and (2) temperature rhythms from the sternum are less reliable than from the forehead. We suggest that forehead Double Sensor recordings may provide a surrogate for rectal temperature in circadian rhythm research, where constant routine protocols are applied. Future studies will be needed to assess the sensor's ecological validity outside the laboratory under changing environmental and physiological conditions.
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Affiliation(s)
- Stefan Mendt
- a Institute of Physiology, Center for Space Medicine and Extreme Environments , Charité Universitätsmedizin , Berlin , Germany
| | - Martina Anna Maggioni
- a Institute of Physiology, Center for Space Medicine and Extreme Environments , Charité Universitätsmedizin , Berlin , Germany.,b Department of Biomedical Sciences for Health , Universitá degli Studi di Milano , Milan , Italy
| | - Michael Nordine
- a Institute of Physiology, Center for Space Medicine and Extreme Environments , Charité Universitätsmedizin , Berlin , Germany
| | - Mathias Steinach
- a Institute of Physiology, Center for Space Medicine and Extreme Environments , Charité Universitätsmedizin , Berlin , Germany
| | - Oliver Opatz
- a Institute of Physiology, Center for Space Medicine and Extreme Environments , Charité Universitätsmedizin , Berlin , Germany
| | - Daniel Belavý
- c Centre for Muscle and Bone Research , Charité Universitätsmedizin , Berlin , Germany.,d Institute for Physical Activity and Nutrition, Deakin University , Burwood , Australia
| | - Dieter Felsenberg
- c Centre for Muscle and Bone Research , Charité Universitätsmedizin , Berlin , Germany
| | - Jochim Koch
- e Drägerwerk AG & Co. KGaA, Lübeck , Germany
| | - Peng Shang
- f Key Laboratory for Space Bioscience & Biotechnology , Northwestern Polytechnical University , Xi'an , China
| | - Hanns-Christian Gunga
- a Institute of Physiology, Center for Space Medicine and Extreme Environments , Charité Universitätsmedizin , Berlin , Germany
| | - Alexander Stahn
- a Institute of Physiology, Center for Space Medicine and Extreme Environments , Charité Universitätsmedizin , Berlin , Germany.,g Division of Sleep and Chronobiology , Unit of Experimental Psychiatry, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
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Snoek AP, Saffer E. Agreement between lower esophageal and nasopharyngeal temperatures in children ventilated with an endotracheal tube with leak. Paediatr Anaesth 2016; 26:213-20. [PMID: 26669266 DOI: 10.1111/pan.12830] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND A temperature probe placed in the lower third of the esophagus accurately reflects core temperature in anesthetized children. Temperature probes are commonly placed in the nasopharynx in children, but when utilizing an uncuffed endotracheal tube (ETT) with a softly audible leak, ventilated gases from the trachea can escape upwards toward the nasopharynx, thereby potentially causing a cooling effect in the nasopharynx. OBJECTIVES We sought to establish if nasopharyngeal and lower esophageal temperatures are in agreement in children undergoing general anesthesia, both in scenarios of ventilation with a cuffed ETT that has minimal or no leak (cuff up), as well as an ETT with leak (cuff down). METHODS A prospective, crossover agreement study was performed on anesthetized children. Children were intubated with a MicroCuff(®) ETT and had temperature probes inserted into both the nasopharynx and lower esophagus. Under standardized ventilator and gas flow settings, temperatures were recorded with the ETT cuff inflated, and with the cuff deflated. Bland-Altman plots were utilized to assess agreement of temperatures. RESULTS Fifty patients successfully completed this study. The mean difference between esophageal and nasopharyngeal temperature was found to be -0.03°C in the presence of minimal or no leak around the ETT (cuff up), with 95% limits of agreement (LOA) of -0.22 to 0.15°C. The mean difference between esophageal and nasopharyngeal temperature was found to be 0.1°C when a larger leak existed around the ETT (cuff down), with LOA of -0.31 to 0.51°C. CONCLUSIONS Nasopharyngeal temperature accurately reflects lower esophageal temperature when there is minimal or no ETT leak. When a larger ETT leak is present, nasopharyngeal temperature is on average 0.1°C cooler than lower esophageal temperature. As the nasopharyngeal temperature probe site confers the advantage of simplicity of accurate placement compared to its esophageal counterpart, our findings support the use of nasopharyngeal temperature probes in children ventilated with both cuffed and uncuffed ETTs.
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Affiliation(s)
- Aarjan P Snoek
- Department of Anesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Emily Saffer
- Department of Anesthesia, King's College Hospital NHS Foundation Trust, London, UK
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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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Akata T, Setoguchi H, Shirozu K, Yoshino J. Reliability of temperatures measured at standard monitoring sites as an index of brain temperature during deep hypothermic cardiopulmonary bypass conducted for thoracic aortic reconstruction. J Thorac Cardiovasc Surg 2007; 133:1559-65. [PMID: 17532957 DOI: 10.1016/j.jtcvs.2006.11.031] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Revised: 11/09/2006] [Accepted: 11/17/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE It is essential to estimate the brain temperature of patients during deliberate deep hypothermia. Using jugular bulb temperature as a standard for brain temperature, we evaluated the accuracy and precision of 5 standard temperature monitoring sites (ie, pulmonary artery, nasopharynx, forehead deep-tissue, urinary bladder, and fingertip skin-surface tissue) during deep hypothermic cardiopulmonary bypass conducted for thoracic aortic reconstruction. METHODS In 20 adult patients with thoracic aortic aneurysms, the 5 temperature monitoring sites were recorded every 1 minute during deep hypothermic (<20 degrees C) cardiopulmonary bypass. The accuracy was evaluated by the difference from jugular bulb temperature, and the precision was evaluated by its standard deviation, as well as by the correlation with jugular bulb temperature. RESULTS Pulmonary artery temperature and jugular bulb temperature began to change immediately after the start of cooling or rewarming, closely matching each other, and the other temperatures lagged behind these two temperatures. During either situation, the accuracy of pulmonary artery temperature measurement (0.3 degrees C-0.5 degrees C) was much superior to the other measurements, and its precision (standard deviation of the difference from jugular bulb temperature = 1.5 degrees C-1.8 degrees C; correlation coefficient = 0.94-0.95) was also best among the measurements, with its rank order being pulmonary artery > or = nasopharynx > forehead > bladder > fingertip. However, the accuracy and precision of pulmonary artery temperature measurement was significantly impaired during and for several minutes after infusion of cold cardioplegic solution. CONCLUSIONS Pulmonary artery temperature measurement is recommended to estimate brain temperature during deep hypothermic cardiopulmonary bypass, even if it is conducted with the sternum opened; however, caution needs to be exercised in interpreting its measurements during periods of the cardioplegic solution infusion.
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Affiliation(s)
- Takashi Akata
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Kyushu University Hospital, Fukuoka, Japan.
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Deakin CD, Clewlow F, Pierce JM. Thermal energy balance as a measure of adequate rewarming from hypothermic cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2000; 14:388-92. [PMID: 10972602 DOI: 10.1053/jcan.2000.7924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine whether the amount of heat (thermal energy) used actively to rewarm patients on cardiopulmonary bypass (CPB) was a better indicator of adequate rewarming from hypothermic CPB than core temperature. DESIGN Prospective study. SETTING Single hospital. PARTICIPANTS Fifty-four sequential patients undergoing hypothermic CPB. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Thermal energy balance (TEB) (net heat supplied to or removed from the body, from initiation to termination of CPB) was measured using previously validated apparatus. Adequacy of rewarming was assessed by measuring the coldest postoperative core (tympanic membrane) temperature and the time to rewarm postoperatively to a core temperature of 37.0 degrees C. Core temperature on termination of CPB did not correlate with the degree of postoperative hypothermia as judged by time to rewarm postoperatively to 37.0 degrees C (r = 0.14; p = 0.33), but did correlate with coldest postoperative core temperature (r = 0.47; p = 0.0003). TEB correlated better with time to rewarm to 37.0 degrees C (r = 0.43; p = 0.001) and coldest postoperative core temperature (r = 0.58, p = 0.0001). CONCLUSION TEB is a better predictor than corresponding values of core temperature on termination of CPB in predicting the coldest postoperative temperature and time to rewarm to 37 degrees C.
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Affiliation(s)
- C D Deakin
- Department of Anaesthetics, Southampton General Hospital, England.
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Hayes JK, Collette DJ, Peters JL, Smith KW. Monitoring body-core temperature from the trachea: comparison between pulmonary artery, tympanic, esophageal, and rectal temperatures. J Clin Monit Comput 1996; 12:261-9. [PMID: 8823651 DOI: 10.1007/bf00857648] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We designed an endotracheal tube (ETT) for acquiring body-core temperature from the trachea. This ETT had two temperature sensors, one attached to the inside surface of the cuff, the other mounted on the ETT shaft underneath the cuff. The ETT was evaluated in vitro and in dogs to determine: 1) optimal position of temperature sensors and 2) the responsiveness, accuracy, and resistance to ventilatory artifacts. METHODS In vitro. An artificial trachea assessed the response-time and accuracy of ETT temperature sensors to abrupt temperature changes and ventilatory flow-rates. In vivo. Body temperature in 5 dogs was lowered to approximately 26 degrees C then elevated toward 39 degrees C using a heat exchanger during carotid-jugular bypass. ETT temperature measurements were compared simultaneously with those from the artificial trachea (in vitro) or from the pulmonary artery, tympanic cavity, esophagus, and rectum of dogs using dry and humidified gas. RESULTS Cuff temperature sensor responded quickly and accurately to temperature changes and was less prone than the tube sensor to ventilatory and humidity artifacts. During carotid-jugular bypass, in vivo tube and cuff mean temperatures averaged 1.4 degrees C and 0.36 degree C lower, respectively, than pulmonary artery temperatures. There were no statistical differences (P > 0.05) between cuff temperatures and those measured from the pulmonary artery, tympanic cavity, esophagus, and rectum. Heating and humidifying the inspiratory gas of dogs with a water-bath humidifer or heat moisture exchanger (HME) had minimal effects on the cuff temperature sensor. An in-line HME increased in vivo tube temperature from baseline values by 1.13 +/- 0.80 degree C, while cuff temperature increased by 0.21 +/- 0.24 degree C. CONCLUSION The cuff of the ETT is a reliable site for measuring body-core temperature in intubated patients.
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Affiliation(s)
- J K Hayes
- Department of Anesthesiology, University of Utah College of Medicine, Salt Lake City 84132, USA
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