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Brandes IF, Tirilomis T, Nemeth M, Wieditz J, Bräuer A. Intraoperative zero-heat-flux thermometry overestimates nasopharyngeal temperature by 0.39 °C: an observational study in patients undergoing congenital heart surgery. J Clin Monit Comput 2024:10.1007/s10877-024-01204-8. [PMID: 39127818 DOI: 10.1007/s10877-024-01204-8] [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: 04/03/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024]
Abstract
During surgery for congenital heart disease (CHD) temperature management is crucial. Vesical (Tves) and nasopharyngeal (TNPH) temperature are usually measured. Whereas Tves slowly responds to temperature changes, TNPH carries the risk of bleeding. The zero-heat-flux (ZHF) temperature monitoring systems SpotOn™ (TSpotOn), and Tcore™ (Tcore) measure temperature non-invasively. We evaluated accuracy and precision of the non-invasive devices, and of Tves compared to TNPH for estimating temperature. In this prospective observational study in pediatric and adult patients accuracy and precision of TSpotOn, Tcore, and Tves were analyzed using the Bland-Altman method. Proportion of differences (PoD) and Lin´s concordance correlation coefficient (LCC) were calculated. Data of 47 patients resulted in sets of matched measurements: 1073 for TSpotOn vs. TNPH, 874 for Tcore vs. TNPH, and 1102 for Tves vs. TNPH. Accuracy was - 0.39 °C for TSpotOn, -0.09 °C for Tcore, and 0.07 °C for Tves. Precisison was between - 1.12 and 0.35 °C for TSpotOn, -0.88 to 0.71 °C for Tcore, and - 1.90 to 2.05 °C for Tves. PoD ≤ 0.5 °C were 71% for TSpotOn, 71% for Tcore, and 60% for Tves. LCC was 0.9455 for TSpotOn, 0.9510 for Tcore, and 0.9322 for Tves. Temperatures below 25.2 °C (TSpotOn) or 27.1 (Tcore) could not be recorded non-invasively, but only with Tves. Trial registration German Clinical Trials Register, DRKS00010720.
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Affiliation(s)
- Ivo F Brandes
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Theodor Tirilomis
- Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Marcus Nemeth
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Johannes Wieditz
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Anselm Bräuer
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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Feyling AC, Kamalo PD, Hanche-Olsen T, Chikumbanje SS, Zsidek AS, Ponzi E, Raeder J. Preventing hypothermia in pediatric neurosurgery in Africa-A randomized controlled non-inferiority trial of insulation versus active warming. Acta Anaesthesiol Scand 2024; 68:167-177. [PMID: 37882145 DOI: 10.1111/aas.14341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE The objective of this study was to compare the efficacy of a low-cost heat-preserving method in preventing intraoperative hypothermia with that of forced-air warming in a resource-limited setting. METHODS In this randomized controlled non-inferiority trial, we recruited children younger than 12 years scheduled for cranial neurosurgery in a large East-African hospital. Patients were block-randomized by age to intraoperative warming measures using Hibler's method (intervention) or warm air (comparator). Hibler's group patients were circumferentially wrapped in transparent plastic sheeting (providing a vapor-trap) over a layer of cotton blankets, then laid on an insulating foam mattress. Warm air group patients were treated with forced-air convection via an underlying Snuggle Warm™ Pediatric Full Body mattress. Allocated warming measures were initiated in the operating theatre and discontinued upon anesthesia emergence. Perioperative temperatures were measured using noninvasive forehead probes (SpotOn™). The primary outcome was incidence of hypothermia (core temperature < 36.0° for longer than 5 min). Our null hypothesis was that Hibler's method is inferior in efficacy to the warm air method by a margin exceeding 20%. Among secondary outcomes were duration of hypothermia as proportion of surgical duration, incidence of postoperative shivering and rescue measure requirements. RESULTS We analyzed data for 77 participants (Hibler's = 38; warm air = 39). There was no significant difference between the Hibler's and warm air arms of the study in the primary outcome of incidence of hypothermia (59.0% vs. 60.5% respectively; OR 1.07; 95% CI 0.43-2.65; p = .890). However, the risk difference (1.55%; 95% CI -0.20 to -0.24) exceeded the 0.2 margin and non-inferiority could not be declared. There was considerable need for rescue measures in both groups (71.1 0% vs. 69.2%; OR 1.09; 95% CI 0.41-2.90; p = .861). There was no statistically significant difference between groups for any prespecified secondary outcome. CONCLUSION Although perioperative core temperatures were not significantly different, we could not declare an inexpensive heat-preserving method non-inferior to warm air convection in preventing intraoperative hypothermia in children undergoing anesthesia for cranial neurosurgery in a resource-limited setting. The extensive need for rescue measures may have masked important differences. TRIAL REGISTRATION US National Institutes of Health Clinicaltrials.gov database (ID no. NCT02975817).
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Affiliation(s)
- Anders C Feyling
- Department of Anaesthesia and Intensive Care, Division of Emergencies & Critical Care, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research & Development, Division of Emergencies & Critical Care, Oslo University Hospital, Oslo, Norway
| | - Patrick D Kamalo
- Queen Elizabeth Central Hospital, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Terje Hanche-Olsen
- Department of Anaesthesia and Intensive Care, Division of Emergencies & Critical Care, Oslo University Hospital Ullevål, Oslo, Norway
| | | | - Aina S Zsidek
- Department of Anaesthesia and Intensive Care, Acute Care Division, Oslo University Hospital, Oslo, Norway
| | - Erica Ponzi
- Oslo Center for Biostatistics & Epidemiology, University of Oslo, Oslo, Norway
- Department for Research Support for Clinical Trials, Oslo University Hospital, Oslo, Norway
| | - Johan Raeder
- Department of Anaesthesia and Intensive Care, Division of Emergencies & Critical Care, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Oh KS, Park YH, Baek C, Woo YC. Application of the Bair Hugger™ core body temperature at wrist region with upper body warming blanket: a prospective observational study. Anesth Pain Med (Seoul) 2024; 19:35-43. [PMID: 38311353 PMCID: PMC10846997 DOI: 10.17085/apm.23107] [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: 09/02/2023] [Revised: 10/09/2023] [Accepted: 10/21/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Body temperature monitoring is essential during the perioperative period. However, core body temperature measurement requires invasive device that may cause complications. This study aimed to evaluate the accuracy of non-invasive Bair Hugger™ core body temperature monitoring system (BHTMS) at the wrist compared with esophageal temperature under general anesthesia. METHODS Twenty adult patients of the American Society of Anesthesiologists physical status I or II were enrolled. BHTMS sensor was applied at wrist region. After tracheal intubation, an esophageal probe was inserted. Bair Hugger™ upper body warming blankets were used. Esophageal temperature (Teso) and BHTMS at wrist (Twrist) were recorded every 10 min. RESULTS Total of 257 pairs of data sets were analyzed: Teso and Twrist had no statistically significant difference (P = 0.103). Median of Teso and Twrist were 36.5°C and 36.4°C. Bland-Altman analysis showed Teso - Twrist of 0.14°C ± 1.44. Subsequently, 99 pairs of 0-40 min data set were analyzed and showed significant difference at 0 and 10 min (P < 0.001) but no significant difference at 20, 30 and 40 min. Bland- Altman plot by times showed difference (Teso - Twrist) of 1.49°C ± 2.00, 0.82°C ± 1.30, 0.29°C ± 1.32, -0.03°C ± 0.84, and -0.12°C ± 0.82 at 0, 10, 20, 30 and 40 min respectively. CONCLUSIONS BHTMS at wrist area under the upper body warming blanket is a potential alternative other than esophageal temperature for monitoring body temperature after 30 min of anesthesia induction.
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Affiliation(s)
- Kyung Seo Oh
- Department of Anesthesiology and Pain Medicine, Chung-Ang University, Chung-Ang University Hospital, Seoul, Korea
| | - Yong-Hee Park
- Department of Anesthesiology and Pain Medicine, Chung-Ang University, Chung-Ang University Hospital, Seoul, Korea
| | - Chongwha Baek
- Department of Anesthesiology and Pain Medicine, Chung-Ang University, Chung-Ang University Hospital, Seoul, Korea
| | - Young-Cheol Woo
- Department of Anesthesiology and Pain Medicine, Chung-Ang University, Chung-Ang University Hospital, Seoul, Korea
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4
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Park C, Kim T, Oh S, Bang YS. Prospective comparative analysis of zero-heat-flux thermometer (SpotOn®) compared with tympanic thermometer and bladder thermometer in extremely aged patients undergoing lower extremity orthopedic surgery. Medicine (Baltimore) 2023; 102:e35593. [PMID: 37861486 PMCID: PMC10589526 DOI: 10.1097/md.0000000000035593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023] Open
Abstract
Thermoregulation is important for maintaining homeostasis in the body. It can be easily broken under anesthesia. An appropriate method for measuring core body temperature is needed, especially for elderly patients, because the efficiency of thermoregulation gradually decreases with age. Zero-heat-flux (ZHF) thermometry (SpotOn) is an alternative, noninvasive method for continuous temperature monitoring at the skin surface. The aim of this study was to examine the accuracy and feasibility of using the SpotOn sensor in lower extremity orthopedic surgery in elderly patients aged over 80 years by comparing a SpotOn sensor with 2 other reliable minimally invasive methods: a tympanic membrane thermometer and a bladder thermometer. This study enrolled 45 patients aged over 80 years who were scheduled to undergo lower extremity surgery. Body temperature was measured using a SpotOn sensor, a tympanic membrane thermometer and a bladder thermometer. Agreements between the SpotOn sensor and the other 2 methods were assessed using Bland and Altman plots for repeated measures adjusted for unequal numbers of measurements per patient. Compared with bladder temperature, bias and limits of agreement for SpotOn temperature were 0.07°C ± 0.58°C. Compared with tympanic membrane temperature, bias and limits of agreement for SpotOn temperature were -0.28°C ± 0.61°C. The 3M SpotOn sensor using the ZHF method for patients aged over 80 years undergoing lower extremity surgery showed feasible measurement value and sensitivity.
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Affiliation(s)
- Chunghyun Park
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Taeyeon Kim
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Soojeong Oh
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Yun-Sic Bang
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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Silvasti-Lundell M, Makkonen O, Kivisaari R, Luostarinen T, Pesonen E, Mäkinen MT. Zero-heat-flux thermometry over the carotid artery in assessment of core temperature in craniotomy patients. J Clin Monit Comput 2023; 37:1153-1159. [PMID: 36879085 PMCID: PMC10520089 DOI: 10.1007/s10877-023-00984-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/08/2023] [Indexed: 03/08/2023]
Abstract
Zero-heat-flux core temperature measurements on the forehead (ZHF-forehead) show acceptable agreement with invasive core temperature measurements but are not always possible in general anesthesia. However, ZHF measurements over the carotid artery (ZHF-neck) have been shown reliable in cardiac surgery. We investigated these in non-cardiac surgery. In 99 craniotomy patients, we assessed agreement of ZHF-forehead and ZHF-neck (3M™ Bair Hugger™) with esophageal temperatures. We applied Bland-Altman analysis and calculated mean absolute differences (difference index) and proportion of differences within ± 0.5 °C (percentage index) during entire anesthesia and before and after esophageal temperature nadir. In Bland-Altman analysis [mean (limits of agreement)], agreement with esophageal temperature during entire anesthesia was 0.1 (-0.7 to +0.8) °C (ZHF-neck) and 0.0 (-0.8 to +0.8) °C (ZHF-forehead), and, after core temperature nadir, 0.1 (-0.5 to +0.7) °C and 0.1 (-0.6 to +0.8) °C, respectively. In difference index [median (interquartile range)], ZHF-neck and ZHF-forehead performed equally during entire anesthesia [ZHF-neck: 0.2 (0.1-0.3) °C vs ZHF-forehead: 0.2 (0.2-0.4) °C], and after core temperature nadir [0.2 (0.1-0.3) °C vs 0.2 (0.1-0.3) °C, respectively; all p > 0.017 after Bonferroni correction]. In percentage index [median (interquartile range)], both ZHF-neck [100 (92-100) %] and ZHF-forehead [100 (92-100) %] scored almost 100% after esophageal nadir. ZHF-neck measures core temperature as reliably as ZHF-forehead in non-cardiac surgery. ZHF-neck is an alternative to ZHF-forehead if the latter cannot be applied.
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Affiliation(s)
- Marja Silvasti-Lundell
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
| | - Otto Makkonen
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teemu Luostarinen
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Eero Pesonen
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Marja-Tellervo Mäkinen
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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Fukushima A, Manabe Y, Kosaka Y, Akagi S. Sustained exercise load by young adult females while wearing surgical mask raises core body temperature measured with zero-heat-flux thermometer. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023:10.1007/s00484-023-02501-8. [PMID: 37365382 DOI: 10.1007/s00484-023-02501-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023]
Abstract
When a pandemic such as that caused by the novel coronavirus disease termed COVID-19 emerges, it is recommended to wear a mask when in public situations, with information regarding the impact on thermoregulation essential, especially during exercise or hard physical labor. The present study investigated changes in core body temperature (CBT) while wearing a surgical mask (SM) during exercise (TCBT) using a non-invasive zero-heat-flux (ZHF) thermometer. Nine young adult females performed ergometer exercise for 30 min at 60 W with (mask group) and without (control) a SM under a non-hot condition, shown by wet bulb globe temperature (WBGT) findings. TCBT, mean skin temperature (TMST), heart rate (HR), and humidity in the perioral region of the face (%RH) were determined. Each of those markers showed increased values during exercise, with the increases in TCBT, HR, and %RH, but not TMST, during exercise found to be significantly greater in the mask group. HR reserve (%HRR), derived as load intensity during exercise, was also significantly higher in the mask group. Each subject completed all of the experimental protocols without noting pain or discomfort. These results suggest that wearing a SM while performing mild exercise contributes to increased TCBT associated with increased exercise intensity, expressed as %HRR in a non-heated condition. Furthermore, the ZHF thermometer was shown to be safe and is considered useful for conducting such studies. Additional examinations will be necessary to examine gender and age group differences, as well as the use of different exercise methods and intensity and ambient conditions.
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Affiliation(s)
- Ayako Fukushima
- Graduate School of Contemporary Science, Chugoku Gakuen University, 83 Niwase Kita-Ku, Okayama, 701-0197, Japan
| | - Yoshie Manabe
- Graduate School of Contemporary Science, Chugoku Gakuen University, 83 Niwase Kita-Ku, Okayama, 701-0197, Japan
- Department of Human Nutrition, Faculty of Contemporary Science, Chugoku Gakuen University, Okayama, Japan
| | - Yuri Kosaka
- Department of Human Nutrition, Faculty of Contemporary Science, Chugoku Gakuen University, Okayama, Japan
| | - Shuji Akagi
- Graduate School of Contemporary Science, Chugoku Gakuen University, 83 Niwase Kita-Ku, Okayama, 701-0197, Japan.
- Department of Human Nutrition, Faculty of Contemporary Science, Chugoku Gakuen University, Okayama, Japan.
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Coiffard B, Merdji H, Boucekine M, Helms J, Clere-Jehl R, Mege JL, Meziani F. Changes in Body Temperature Patterns Are Predictive of Mortality in Septic Shock: An Observational Study. BIOLOGY 2023; 12:biology12050638. [PMID: 37237452 DOI: 10.3390/biology12050638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023]
Abstract
Biological rhythms are important regulators of immune functions. In intensive care unit (ICU), sepsis is known to be associated with rhythm disruption. Our objectives were to determine factors associated with rhythm disruption of the body temperature and to assess the relationship between temperature and mortality in septic shock patients; In a cohort of septic shock, we recorded body temperature over a 24-h period on day 2 after ICU admission. For each patient, the temperature rhythmicity was assessed by defining period and amplitude, and the adjusted average (mesor) of the temperature by sinusoidal regression and cosinor analysis. Analyses were performed to assess factors associated with the three temperature parameters (period, amplitude, and mesor) and mortality. 162 septic shocks were enrolled. The multivariate analysis demonstrates that the period of temperature was associated with gender (women, coefficient -2.2 h, p = 0.031) and acetaminophen use (coefficient -4.3 h, p = 0.002). The mesor was associated with SOFA score (coefficient -0.05 °C per SOFA point, p = 0.046), procalcitonin (coefficient 0.001 °C per ng/mL, p = 0.005), and hydrocortisone use (coefficient -0.5 °C, p = 0.002). The amplitude was associated with the dialysis (coefficient -0.5 °C, p = 0.002). Mortality at day 28 was associated with lower mesor (adjusted hazard ratio 0.50, 95% CI 0.28 to 0.90; p = 0.02), and higher amplitude (adjusted hazard ratio 5.48, 95% CI 1.66 to 18.12; p = 0.005) of temperature. Many factors, such as therapeutics, influence the body temperature during septic shock. Lower mesor and higher amplitude were associated with mortality and could be considered prognostic markers in ICU. In the age of artificial intelligence, the incorporation of such data in an automated scoring alert could compete with physicians to identify high-risk patients during septic shock.
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Affiliation(s)
- Benjamin Coiffard
- IHU-Méditerranée Infection, IRD, AP-HM, MEPHI, Aix Marseille Université, 13005 Marseille, France
- Médecine Intensive-Réanimation, APHM, Hôpital Nord, Aix Marseille Université, 13015 Marseille, France
| | - Hamid Merdji
- Service de Réanimation, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
- UMR 1260, Regenerative Nano Medecine, INSERM, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
| | - Mohamed Boucekine
- Health Service Research and Quality of Life Center, APHM, EA 3279 CEReSS, School of Medicine-La Timone Medical Campus, Aix Marseille Université, 13005 Marseille, France
| | - Julie Helms
- Service de Réanimation, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Raphaël Clere-Jehl
- Service de Réanimation, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Jean-Louis Mege
- IHU-Méditerranée Infection, IRD, AP-HM, MEPHI, Aix Marseille Université, 13005 Marseille, France
| | - Ferhat Meziani
- Service de Réanimation, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
- UMR 1260, Regenerative Nano Medecine, INSERM, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
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A photoacoustic patch for three-dimensional imaging of hemoglobin and core temperature. Nat Commun 2022; 13:7757. [PMID: 36522334 PMCID: PMC9755152 DOI: 10.1038/s41467-022-35455-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Electronic patches, based on various mechanisms, allow continuous and noninvasive monitoring of biomolecules on the skin surface. However, to date, such devices are unable to sense biomolecules in deep tissues, which have a stronger and faster correlation with the human physiological status than those on the skin surface. Here, we demonstrate a photoacoustic patch for three-dimensional (3D) mapping of hemoglobin in deep tissues. This photoacoustic patch integrates an array of ultrasonic transducers and vertical-cavity surface-emitting laser (VCSEL) diodes on a common soft substrate. The high-power VCSEL diodes can generate laser pulses that penetrate >2 cm into biological tissues and activate hemoglobin molecules to generate acoustic waves, which can be collected by the transducers for 3D imaging of the hemoglobin with a high spatial resolution. Additionally, the photoacoustic signal amplitude and temperature have a linear relationship, which allows 3D mapping of core temperatures with high accuracy and fast response. With access to biomolecules in deep tissues, this technology adds unprecedented capabilities to wearable electronics and thus holds significant implications for various applications in both basic research and clinical practice.
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Munday J, Sturgess D, Oishi S, Bendeich J, Kearney A, Douglas C. Implementation of continuous temperature monitoring during perioperative care: a feasibility study. Patient Saf Surg 2022; 16:32. [PMID: 36153550 PMCID: PMC9509652 DOI: 10.1186/s13037-022-00341-w] [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: 08/04/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Continuous body temperature monitoring during perioperative care is enabled by using a non-invasive “zero-heat-flux” (ZHF) device. However, rigorous evaluation of whether continuous monitoring capability improves process of care and patient outcomes is lacking. This study assessed the feasibility of a large-scale trial on the impact of continuous ZHF monitoring on perioperative temperature management practices and hypothermia prevention. Methods A feasibility study was conducted at a tertiary hospital. Participants included patients undergoing elective surgery under neuraxial or general anesthesia, and perioperative nurses and anesthetists caring for patient participants. Eighty-two patients pre and post introduction of the ZHF device were enrolled. Feasibility outcomes included recruitment and retention, protocol adherence, missing data or device failure, and staff evaluation of intervention feasibility and acceptability. Process of care outcomes included temperature monitoring practices, warming interventions and perioperative hypothermia. Results There were no adverse events related to the device and feasibility of recruitment was high (60%). Treatment adherence varied across the perioperative pathway (43 to 93%) and missing data due to electronic transfer issues were identified. Provision of ZHF monitoring had most impact on monitoring practices in the Post Anesthetic Care Unit; the impact on intraoperative monitoring practices was minimal. Conclusions Enhancements to the design of the ZHF device, particularly for improved data retention and transfer, would be beneficial prior to a large-scale evaluation of whether continuous temperature monitoring will improve patient outcomes. Implementation research designs are needed for future work to improve the complex area of temperature monitoring during surgery. Trial registration Prospective registration prior to patient enrolment was obtained from the Australian and New Zealand Clinical Trials Registry (ANZCTR) on 16th April 2021 (Registration number: ACTRN12621000438853).
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Study of Brain Circadian Rhythms in Patients with Chronic Disorders of Consciousness and Healthy Individuals Using Microwave Radiometry. Diagnostics (Basel) 2022; 12:diagnostics12081777. [PMID: 35892486 PMCID: PMC9331034 DOI: 10.3390/diagnostics12081777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/06/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022] Open
Abstract
The study of circadian rhythms in the human body using temperature measurements is the most informative way to assess the viability of the body’s rhythm-organizing systems. Pathological processes can affect circadian rhythm dynamics in damaged organs. Severe brain damage that caused the development of disorders of consciousness (DOC) (strokes, traumatic brain injury) disrupts the activity of central oscillators, by directly damaging or destroying the periphery links, and the level of preservation of circadian rhythms and the dynamics of their recovery can be informative diagnostic criteria for patient’s condition assessment. This study examined 23 patients with DOC by using a non-invasive method for obtaining body and cerebral cortex temperature to compare with healthy controls. Measurements were made with a 4 h interval for 52 h beginning at 08:00 on day 1 and ending at 08:00 on day 3. The profile of patients with DOC showed complete disruption compared to healthy controls with rhythmic patterns. The results indicate that the mechanisms for maintaining brain circadian rhythms are different from general homeostasis regulation of the body. Use of microwave radio thermometry for the identification of rehabilitation potential in patients with DOC is a promising area of investigation.
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A Method of Microwave Radiothermometry in Studies of Circadian Rhythms of Brain Temperature. Bull Exp Biol Med 2022; 173:380-383. [DOI: 10.1007/s10517-022-05553-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 10/17/2022]
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Lauronen SL, Kalliomäki ML, Kalliovalkama J, Aho A, Huhtala H, Yli-Hankala AM, Mäkinen MT. Comparison of zero heat flux and double sensor thermometers during spinal anaesthesia: a prospective observational study. J Clin Monit Comput 2022; 36:1547-1555. [PMID: 34978656 PMCID: PMC9508040 DOI: 10.1007/s10877-021-00799-6] [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: 10/29/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022]
Abstract
Because of the difficulties involved in the invasive monitoring of conscious patients, core temperature monitoring is frequently neglected during neuraxial anaesthesia. Zero heat flux (ZHF) and double sensor (DS) are non-invasive methods that measure core temperature from the forehead skin. Here, we compare these methods in patients under spinal anaesthesia. Sixty patients scheduled for elective unilateral knee arthroplasty were recruited and divided into two groups. Of these, thirty patients were fitted with bilateral ZHF sensors (ZHF group), and thirty patients were fitted with both a ZHF sensor and a DS sensor (DS group). Temperatures were saved at 5-min intervals from the beginning of prewarming up to one hour postoperatively. Bland–Altman analysis for repeated measurements was performed and a proportion of differences within 0.5 °C was calculated as well as Lin`s concordance correlation coefficient (LCCC). A total of 1261 and 1129 measurement pairs were obtained. The mean difference between ZHF sensors was 0.05 °C with 95% limits of agreement − 0.36 to 0.47 °C, 99% of the readings were within 0.5 °C and LCCC was 0.88. The mean difference between ZHF and DS sensors was 0.33 °C with 95% limits of agreement − 0.55 to 1.21 °C, 66% of readings were within 0.5 °C and LCCC was 0.59. Bilaterally measured ZHF temperatures were almost identical. DS temperatures were mostly lower than ZHF temperatures. The mean difference between ZHF and DS temperatures increased when the core temperature decreased. Trial registration: The study was registered in ClinicalTrials.gov on 13th May 2019, Code NCT03408197.
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Affiliation(s)
- Sirkka-Liisa Lauronen
- Department of Anaesthesia, Tampere University Hospital, Elämänaukio 2, POB 2000, 33521, Tampere, Finland.
| | - Maija-Liisa Kalliomäki
- Department of Anaesthesia, Tampere University Hospital, Elämänaukio 2, POB 2000, 33521, Tampere, Finland
| | | | - Antti Aho
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Arvi M Yli-Hankala
- Department of Anaesthesia, Tampere University Hospital, Elämänaukio 2, POB 2000, 33521, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Marja-Tellervo Mäkinen
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
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13
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Verheyden C, Neyrinck A, Laenen A, Rex S, Van Gerven E. Clinical evaluation of a cutaneous zero-heat-flux thermometer during cardiac surgery. J Clin Monit Comput 2021; 36:1279-1287. [PMID: 34559326 DOI: 10.1007/s10877-021-00758-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
We evaluated the disposable non-invasive SpotOn™ thermometer relying on the zero-heat-flux technology. We tested the hypothesis that this technology may accurately estimate the core temperature. The primary objective was to compare cutaneous temperature measurements from this device with blood temperatures measured with the pulmonary artery catheter. Secondary objective was to compare measurements from the zero-heat-flux thermometer indirectly with other routinely used thermometers (nasopharyngeal, bladder, rectal). We included 40 patients electively scheduled for either off-pump coronary artery bypass surgery or pulmonary thromboendarterectomy. Temperatures were measured using zero-heat-flux (SpotOn™), pulmonary artery catheter, nasopharyngeal, rectal, and bladder thermometers. Agreement was assessed using the Bland and Altman random effects method for repeated measures data, and Lin's concordance correlation coefficient. Accuracy was estimated (defined as <0.5° difference with the gold standard), with a 95% confidence interval considering the multiple pairs of measurements per patient. 17 850 sets of temperature measurements were analyzed from 40 patients. The mean overall difference between zero-heat-flux and pulmonary artery catheter thermometer was -0.06 °C (95% limits of agreement of ± 0.89 °C). In addition, 14 968 sets of temperature measurements were analyzed from 34 patients with all thermometers in situ. Results from the zero-heat-flux thermometer showed better agreement with the pulmonary artery catheter than the other secondary core thermometers assessed. In conclusion, the SpotOn™ thermometer reliably assessed core temperature during cardiac surgery. It could be considered an alternative for other secondary thermometers in the assessment of core temperature during general anesthesia.
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Affiliation(s)
| | - Arne Neyrinck
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Elke Van Gerven
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
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14
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Munday J, Higgins N, Jones L, Vagenas D, Van Zundert A, Keogh S. Zero-Heat-Flux and Esophageal Temperature Monitoring in Orthopedic Surgery: An Observational Study. J Multidiscip Healthc 2021; 14:1819-1827. [PMID: 34285500 PMCID: PMC8286425 DOI: 10.2147/jmdh.s313310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/14/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Perioperative hypothermia prevention requires regular, accurate, and consistent temperature monitoring. Zero-heat-flux (ZHF) thermometry offers a non-invasive, measurement method that can be applied across all surgical phases. The purpose of this study was to measure agreement between the zero-heat-flux device and esophageal monitoring, sensitivity, and specificity to detect hypothermia and patient acceptability amongst patients undergoing upper and lower limb orthopedic surgery. Patients and Methods This prospective, observational study utilized Bland–Altman analysis and Lin’s concordance coefficient to measure agreement between devices, sensitivity and specificity to detect hypothermia and assessed patient acceptability amongst 30 patients between December 2018 and June 2019. Results Bias was observed between devices via Bland Altman, with bias dependent on actual temperature. The mean difference ranged from −0.16°C at 34.9°C (where the mean of ZHF was lower than the esophageal device) to 0.46°C at 37.25°C (where the mean of ZHF was higher than esophageal device), with 95% limits of agreement (max) upper LOA = 0.80 to 1.41, lower LOA = −1.12 to −0.50. Seventy-five percentage of zero-heat-flux measurements were within 0.5°C of esophageal readings. Patient acceptability was high; 96% (n=27) stated that the device was comfortable. Conclusion ZHF device achieved lesser measurement accuracy with core (esophageal) temperature compared to earlier findings. Nonetheless, due to continuous capability, non-invasiveness and patient reported acceptability, the device warrants further evaluation. Title Registration The study was registered at www.ANZCTR.org.au (reference: ACTRN12619000842167).
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Affiliation(s)
- Judy Munday
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Department of Health and Nursing Science, Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway
| | - Niall Higgins
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Lee Jones
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Research Methods Group, Institute of Health and Biomedical Innovation (IHBI), Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Dimitrios Vagenas
- Research Methods Group, Institute of Health and Biomedical Innovation (IHBI), Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - André Van Zundert
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia & Queensland University of Technology, Brisbane, QLD, Australia
| | - Samantha Keogh
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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15
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Kim H, Kim S, Lee M, Rhee Y, Lee S, Jeong YR, Kang S, Naqi M, Hong S. Smart Patch for Skin Temperature: Preliminary Study to Evaluate Psychometrics and Feasibility. SENSORS 2021; 21:s21051855. [PMID: 33800920 PMCID: PMC7961890 DOI: 10.3390/s21051855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
There is a need for continuous, non-invasive monitoring of biological data to assess health and wellbeing. Currently, many types of smart patches have been developed to continuously monitor body temperature, but few trials have been completed to evaluate psychometrics and feasibility for human subjects in real-life scenarios. The aim of this feasibility study was to evaluate the reliability, validity and usability of a smart patch measuring body temperature in healthy adults. The smart patch consisted of a fully integrated wearable wireless sensor with a multichannel temperature sensor, signal processing integrated circuit, wireless communication feature and a flexible battery. Thirty-five healthy adults were recruited for this test, carried out by wearing the patches on their upper chests for 24 h and checking their body temperature six times a day using infrared forehead thermometers as a gold standard for testing validity. Descriptive statistics, one-sampled and independent t-tests, Pearson’s correlation coefficients and Bland-Altman plot were examined for body temperatures between two measures. In addition, multiple linear regression, receiver operating characteristic (ROC) and qualitative content analysis were conducted. Among the 35 participants, 29 of them wore the patch for over 19 h (dropout rate: 17.14%). Mean body temperature measured by infrared forehead thermometers and smart patch ranged between 32.53 and 38.2 °C per person and were moderately correlated (r = 0.23–0.43) overall. Based on a Bland-Altman plot, approximately 94% of the measurements were located within one standard deviation (upper limit = 4.52, lower limit = −5.82). Most outliers were identified on the first measurement and were located below the lower limit. It is appropriate to use 37.5 °C in infrared forehead temperature as a cutoff to define febrile conditions. Users’ position while checking and ambient temperature and humidity are not affected to the smart patch body temperature. Overall, the participants showed high usability and satisfaction on the survey. Few participants reported discomfort due to limited daily activity, itchy skin or detaching concerns. In conclusion, epidermal electronic sensor technologies provide a promising method for continuously monitoring individuals’ body temperatures, even in real-life situations. Our study findings show the potential for smart patches to monitoring non-febrile condition in the community.
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Affiliation(s)
- Heejung Kim
- College of Nursing, Yonsei University, Seoul 03722, Korea;
- Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul 03722, Korea
| | - Sunkook Kim
- Multifunctional Nano Bio Electronics Lab, Department of Advanced Materials and Science Engineering, Sungkyunkwan University, Suwon 16419, Korea; (S.K.); (S.K.); (M.N.)
| | - Mingoo Lee
- Korea Electronics Technology Institute, Seongnam 13509, Korea; (M.L.); (S.L.)
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, College of Medicine, Yonsei University, Seoul 03722, Korea;
| | - Sungho Lee
- Korea Electronics Technology Institute, Seongnam 13509, Korea; (M.L.); (S.L.)
| | - Yi-Rang Jeong
- Department of Nursing, Samsung Medical Center, Seoul 06351, Korea;
| | - Sunju Kang
- Multifunctional Nano Bio Electronics Lab, Department of Advanced Materials and Science Engineering, Sungkyunkwan University, Suwon 16419, Korea; (S.K.); (S.K.); (M.N.)
| | - Muhammad Naqi
- Multifunctional Nano Bio Electronics Lab, Department of Advanced Materials and Science Engineering, Sungkyunkwan University, Suwon 16419, Korea; (S.K.); (S.K.); (M.N.)
| | - Soyun Hong
- College of Nursing, Yonsei University, Seoul 03722, Korea;
- Correspondence:
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16
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Bräuer A, Fazliu A, Perl T, Heise D, Meissner K, Brandes IF. Accuracy of zero-heat-flux thermometry and bladder temperature measurement in critically ill patients. Sci Rep 2020; 10:21746. [PMID: 33303884 PMCID: PMC7730188 DOI: 10.1038/s41598-020-78753-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022] Open
Abstract
Core temperature (TCore) monitoring is essential in intensive care medicine. Bladder temperature is the standard of care in many institutions, but not possible in all patients. We therefore compared core temperature measured with a zero-heat flux thermometer (TZHF) and with a bladder catheter (TBladder) against blood temperature (TBlood) as a gold standard in 50 critically ill patients in a prospective, observational study. Every 30 min TBlood, TBladder and TZHF were documented simultaneously. Bland–Altman statistics were used for interpretation. 7018 pairs of measurements for the comparison of TBlood with TZHF and 7265 pairs of measurements for the comparison of TBlood with TBladder could be used. TBladder represented TBlood more accurate than TZHF. In the Bland Altman analyses the bias was smaller (0.05 °C vs. − 0.12 °C) and limits of agreement were narrower (0.64 °C to − 0.54 °C vs. 0.51 °C to – 0.76 °C), but not in clinically meaningful amounts. In conclusion the results for zero-heat-flux and bladder temperatures were virtually identical within about a tenth of a degree, although TZHF tended to underestimate TBlood. Therefore, either is suitable for clinical use. German Clinical Trials Register, DRKS00015482, Registered on 20th September 2018, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00015482.
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Affiliation(s)
- Anselm Bräuer
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch Strasse 40, 37099, Göttingen, Germany.
| | - Albulena Fazliu
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch Strasse 40, 37099, Göttingen, Germany
| | - Thorsten Perl
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Daniel Heise
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch Strasse 40, 37099, Göttingen, Germany
| | - Konrad Meissner
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch Strasse 40, 37099, Göttingen, Germany
| | - Ivo Florian Brandes
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch Strasse 40, 37099, Göttingen, Germany
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17
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Jitsuiki K, Omori K, Muramatsu KI, Ikegami S, Kushida Y, Nagawasa H, Takeuchi I, Ohsaka H, Oode Y, Yanagawa Y. Experience Using a Forehead Continuous Deep Temperature Monitoring System During Air Evacuation. Air Med J 2020; 40:79-80. [PMID: 33455634 DOI: 10.1016/j.amj.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The present study describes the utility of a forehead continuous deep temperature monitoring system by the staff members of a doctor helicopter (DH). METHODS A questionnaire survey was performed for all flight doctors who had used this system during transportation by the DH to assess its merits and demerits. RESULTS The major benefits of this system were its easy usability, disposable nature, low labor cost, continuous demonstration of the deep temperature in a prehospital setting, and low invasiveness. However, drawbacks of this system include its cost; need for a power supply; need for a few minutes for calibration to obtain stable results of temperature, making it impossible to verify the effects of intervention for body temperature during a short flight; and lack of a detachable measuring pad for the forehead when a patient has an injury on the face or head and hyperhidrosis. In addition, the system's attached cables may hamper medical interventions. CONCLUSION We reported the experience of DH staff using a forehead continuous deep temperature monitoring system in the prehospital setting. Further studies will be required to determine the indications for using such a system in the prehospital setting.
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Affiliation(s)
- Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Saya Ikegami
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Hiroki Nagawasa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan.
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18
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Non-invasive zero-heat-flux technology compared with traditional core temperature measurements in the emergency department. Am J Emerg Med 2020; 38:2383-2386. [DOI: 10.1016/j.ajem.2020.08.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/14/2020] [Accepted: 08/21/2020] [Indexed: 01/18/2023] Open
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19
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Intraoperative zero-heat-flux thermometry overestimates esophageal temperature by 0.26 °C: an observational study in 100 infants and young children. J Clin Monit Comput 2020; 35:1445-1451. [PMID: 33131009 PMCID: PMC8542556 DOI: 10.1007/s10877-020-00609-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/20/2020] [Indexed: 11/05/2022]
Abstract
In pediatric anesthesia, deviations from normothermia can lead to many complications, with infants and young children at the highest risk. A measurement method for core temperature must be clinically accurate, precise and should be minimally invasive. Zero-heat-flux (ZHF) temperature measurements have been evaluated in several studies in adults. We assessed the agreement between the 3M Bair Hugger™ temperature measurement sensor (TZHF) and esophageal temperature (TEso) in children up to and including 6 years undergoing surgery with general anesthesia. Data were recorded in 5 min-intervals. We investigated the accuracy of the ZHF sensor overall and in subgroups of different age, ASA classification, and temperature ranges by Bland–Altman comparisons of differences with multiple measurements. Change over time was assessed by a linear mixed model regression. Data were collected in 100 children with a median (1st–3rd quartile) age of 1.7 (1–3.9) years resulting in 1254 data pairs. Compared to TEso (range from 35.3 to 39.3 °C; median 37.2 °C), TZHF resulted in a mean bias of +0.26 °C (95% confidence interval +0.22 to +0.29 °C; 95% limits of agreement −0.11 to +0.62 °C). Lin’s concordance correlation coefficient was 0.89. There was no significant or relevant change of temperature over time (0.006 °C per hour measurement interval, p = 0.199) and no relevant differences in the subgroups. Due to the mean bias of +0.26 °C in TZHF, the risk of hypothermia may be underestimated, while the risk of hyperthermia may be overestimated. Nevertheless, because of its high precision, we consider ZHF valuable for intraoperative temperature monitoring in children and infants.
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20
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Araiza A, Duran M, Varon J. Non-invasive core temperature measurements in the emergency department: Where is the data? Am J Emerg Med 2020; 38:2381-2382. [PMID: 33041120 DOI: 10.1016/j.ajem.2020.08.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Alan Araiza
- United Memorial Medical Center, Houston, TX, USA; Universidad Autónoma de Baja California, Tijuana, México
| | - Melanie Duran
- United Memorial Medical Center, Houston, TX, USA; Universidad Xochicalco, Ensenada, México
| | - Joseph Varon
- Chief of Staff and Chief of Critical Care Services, United Memorial Medical Center, Professor of Acute and Continuing Care, University of Texas Health Science Center at Houston, Houston, Texas, USA.
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21
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Accuracy and precision of zero-heat-flux temperature measurements with the 3M™ Bair Hugger™ Temperature Monitoring System: a systematic review and meta-analysis. J Clin Monit Comput 2020; 35:39-49. [PMID: 32488679 DOI: 10.1007/s10877-020-00543-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
Zero-heat-flux thermometers provide clinicians with the ability to continuously and non-invasively monitor body temperature. These devices are increasingly being used to substitute for more invasive core temperature measurements during surgery and in critical care. The aim of this review was to determine the accuracy and precision of zero-heat-flux temperature measurements from the 3M™ Bair Hugger™ Temperature Monitoring System. Medline and EMBASE were searched for studies that reported on a measurement of core or peripheral temperature that coincided with a measurement from the zero-heat-flux device. Study selection and quality assessment was performed independently using the Revised Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to summarize the strength of the evidence. Pooled estimates of the mean bias and limits of agreement with outer 95% confidence intervals (population limits of agreement) were calculated. Sixteen studies were included. The primary meta-analysis of zero-heat-flux versus core temperature consisted of 22 comparisons from 16 individual studies. Data from 952 participants with 314,137 paired measurements were included. The pooled estimate for the mean bias was 0.03 °C. Population limits of agreement, which take into consideration the between-study heterogeneity and sampling error, were wide, spanning from - 0.93 to 0.98 °C. The GRADE evidence quality rating was downgraded to moderate due to concerns about study limitations. Population limits of agreement for the sensitivity analysis restricted to studies rated as having low risk of bias across all the domains of the QUADAS-2 were similar to the primary analysis. The range of uncertainty in the accuracy of a thermometer should be taken into account when using this device to inform clinical decision-making. Clinicians should therefore consider the potential that a temperature measurement from a 3M™ Bair Hugger™ Temperature Monitoring System could be as much as 1 °C higher or lower than core temperature. Use of this device may not be appropriate in situations where a difference in temperature of less than 1 °C is important to detect.
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22
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Perioperative measurement of core body temperature using an unobtrusive passive heat flow sensor. J Clin Monit Comput 2020; 34:1351-1359. [PMID: 31902094 DOI: 10.1007/s10877-019-00446-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/13/2019] [Indexed: 01/15/2023]
Abstract
Clinicians strive to maintain normothermia, which requires measurement of core-body temperature and may necessitate active warming of patients. Monitoring temperature currently requires invasive probes. This work investigates a novel foam-based flexible sensor worn behind the ear for the measurement of core body temperature. This observational study uses the device prototype and clinical data to compare three methods for calculating the temperature from this sensor: a basic heat-flow model, a new dynamic model that addresses changing surrounding temperatures and one that combines the dynamic model with a correction for adhesive quality. Clinical validation was performed with 21 surgical patients (average length of surgery 4.4 h) using an esophageal temperature probe as reference. The operative period was divided into four segments: normal periods (with stable surrounding temperatures), surrounding temperatures increasing due to the use of the Bair Hugger™, stable periods during Bair Hugger™ use and surrounding temperatures decreasing due to its removal. The error bias and limits of agreement over these segments were on average of - 0.05 ± 0.28 °C (95% limits of agreement) overall. The dynamic model outperformed the simple heat-flow model for periods of surrounding temperature changes (12.7% of total time) while it had a similar, high, performance for the temperature-stable periods. The results suggest that our proposed topical sensor can replace invasive core temp sensors and provide a means of consistently measuring core body temperature despite surrounding temperature shifts.
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23
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West N, Cooke E, Morse D, Merchant RN, Görges M. Zero-heat-flux core temperature monitoring system: an observational secondary analysis to evaluate agreement with naso-/oropharyngeal probe during anesthesia. J Clin Monit Comput 2019; 34:1121-1129. [PMID: 31696391 DOI: 10.1007/s10877-019-00411-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/23/2019] [Indexed: 11/24/2022]
Abstract
General anesthesia impairs thermoregulation and contributes to perioperative hypothermia; core body temperature monitoring is recommended during surgical procedures lasting > 30 min. Zero-heat-flux core body temperature measurement systems enable continuous non-invasive perioperative monitoring. During a previous trial evaluating the benefits of preoperative forced-air warming, intraoperative temperatures were measured with both a zero-heat-flux sensor and a standard naso-/oropharyngeal temperature probe. The aim of this secondary analysis is to evaluate their agreement. ASA I-III patients, scheduled for elective, non-cardiac surgery under general anesthesia, were enrolled. A zero-heat-flux sensor was placed on the participant's forehead preoperatively. Following induction of anesthesia, a "clinical" temperature probe was placed in the nasopharynx or oropharynx at the anesthesiologist's discretion. Temperature measurements from both sensors were recorded every 10 s. Agreement was analyzed using the Bland-Altman method, corrected for repeated measurements, and Lin's concordance correlation coefficient, and compared with existing studies. Data were collected in 194 patients with a median (interquartile range) age of 60 (49-69) years, during surgical procedures lasting 120 (89-185) min. The zero-heat-flux measurements had a mean bias of - 0.05 °C (zero-heat-flux lower) with 95% limits of agreement within - 0.68 to + 0.58 °C. Lin's concordance correlation coefficient was 0.823. The zero-heat-flux sensor demonstrated moderate agreement with the naso-/oropharyngeal temperature probe, which was not fully within the generally accepted ± 0.5 °C limit. This is consistent with previous studies. The zero-heat-flux system offers clinical utility for non-invasive and continuous core body temperature monitoring throughout the perioperative period using a single sensor.
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Affiliation(s)
- Nicholas West
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Erin Cooke
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.,Research Institute, BC Children's Hospital, 950 West 28th Avenue, Rm V3-324, Vancouver, BC, V5Z 4H4, Canada
| | - Dan Morse
- 3M Infection Prevention Division, 3M Corporation, St Paul, MN, USA
| | - Richard N Merchant
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesia, Royal Columbian & Eagle Ridge Hospitals, Fraser Health, Vancouver, BC, Canada
| | - Matthias Görges
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada. .,Research Institute, BC Children's Hospital, 950 West 28th Avenue, Rm V3-324, Vancouver, BC, V5Z 4H4, Canada.
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Pesonen E, Silvasti-Lundell M, Niemi TT, Kivisaari R, Hernesniemi J, Mäkinen MT. In response to: "Temperature monitoring with zero-heat-flux technology in neurosurgical patients". J Clin Monit Comput 2019; 33:931-932. [PMID: 30771199 DOI: 10.1007/s10877-019-00275-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Eero Pesonen
- Division of Anesthesiology, Department of Anesthesiology and Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Marja Silvasti-Lundell
- Division of Anesthesiology, Department of Anesthesiology and Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tomi T Niemi
- Division of Anesthesiology, Department of Anesthesiology and 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 and Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Menzel M, Bräuer A. Temperature monitoring with zero-heat-flux technology in neurosurgical patients. J Clin Monit Comput 2019; 33:927-929. [PMID: 30739233 DOI: 10.1007/s10877-019-00274-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 02/05/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Matthias Menzel
- Department of Anesthesiology and Critical Care, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Anselm Bräuer
- Department of Anesthesiology, University Hospital Göttingen, Göttingen, Germany.
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