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Pornsirirat T, Kasemvilawan N, Pattanacharoenwong P, Arpibanwana S, Kondon H, Naorungroj T. Incidence of hypothermia in critically ill patients receiving continuous renal replacement therapy in Siriraj Hospital, Thailand. Acute Crit Care 2024; 39:379-389. [PMID: 39266273 PMCID: PMC11392699 DOI: 10.4266/acc.2024.00038] [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: 01/08/2024] [Accepted: 05/30/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Hypothermia is a relatively common complication in patients receiving continuous renal replacement therapy (CRRT). However, few studies have reported the factors associated with hypothermia. METHODS A retrospective cohort study was performed in five intensive care units (ICUs) to evaluate the incidence of hypothermia and the predictive factors for developing hypothermia during CRRT, with hypothermia defined as a time-weighted average temperature <36 °C. RESULTS From January 2020 to December 2021, 300 patients were enrolled. Hypothermia developed in 23.7% of them within the first 24 hours after CRRT initiation. Compared to non-hypothermic patients, hypothermic patients were older and had lower body weight, more frequent acidemia, and higher ICU and 30-day mortality rates. In the multivariate analysis, age >70 years (odds ratio [OR], 2.59; 95% CI, 1.38-4.98; P=0.004), higher positive fluid balance on the day before CRRT (OR, 1.11; 95% CI, 1.02-1.22; P=0.02), and CRRT dose (OR, 1.003; 95% CI, 1.00-1.01; P=0.04) were significantly associated with hypothermia. Conversely, a higher body weight was independently associated with mitigated risk of hypothermia (OR, 0.89; 95% CI, 0.81-0.97; P=0.01). Moreover, a higher coefficient of variance of temperature was associated with greater ICU mortality (OR, 1.41; 95% CI, 1.13-1.78; P=0.003). CONCLUSIONS Hypothermia during CRRT is a relatively common occurrence, and factors associated with hypothermia onset in the first 24 hours include older age, lower body weight, higher positive fluid balance on the day before CRRT, and higher CRRT dose. Greater temperature variability was associated with increased ICU mortality.
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Affiliation(s)
- Thonnarat Pornsirirat
- Division of Intensive Care, Department of Nursing, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nualnapa Kasemvilawan
- Division of Intensive Care, Department of Nursing, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Saisunee Arpibanwana
- Division of Intensive Care, Department of Nursing, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Hatairat Kondon
- Division of Intensive Care, Department of Nursing, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thummaporn Naorungroj
- Division of Intensive Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Nottelmann K, Menzen A, Röding T, Grünewald M, Kehl F. [Anesthesia in bariatric surgery-Results of a web-based survey]. DIE ANAESTHESIOLOGIE 2024; 73:348-351. [PMID: 38607385 DOI: 10.1007/s00101-024-01401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Klaus Nottelmann
- Anästhesiologie, Intensiv- und Schmerzmedizin, Schön Klinik Hamburg Eilbek, Hamburg, Deutschland.
| | - Angelika Menzen
- Anästhesiologie und Intensivmedizin, St. Marien-Hospital Friesoythe, Friesoythe, Deutschland
| | - Thomas Röding
- Adipositaszentrum der Klinik Ernst von Bergmann, Bad Belzig und Adipositaszentrum im Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - Matthias Grünewald
- Klinik für Anästhesiologie und Intensivmedizin, Ev. Amalie Sieveking Krankenhaus, Hamburg, Deutschland
| | - Franz Kehl
- Städtisches Klinikum Karlsruhe, Klinik für Anästhesie und Intensivmedizin, Karlsruhe, Deutschland
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Bozkurt Z, Şahin Akboğa Ö. The Relationship of Perioperative Inadvertent Hypothermia with Anxiety and Comfort. Ther Hypothermia Temp Manag 2024. [PMID: 38394137 DOI: 10.1089/ther.2023.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
The study aimed to investigate the relationship of perioperative inadvertent hypothermia with anxiety and thermal and general comfort in surgical patients. Inadvertent perioperative hypothermia occurs after surgery and affects many patient outcomes. However, the relationship between hypothermia and anxiety has been given little attention. The research is of descriptive type. A total of 117 surgical patients who met the inclusion criteria were sampled and divided into two groups: hypothermic (n = 54) and normothermic (n = 63). Patients undergoing surgery were monitored for body temperature, systolic and diastolic blood pressure, heart rate, pain intensity, anxiety (Numeric Rating Scale [NRS] and State Anxiety Scale [SAI]), and comfort (Perianesthesia Comfort Questionnaire) levels. The groups were similar in terms of descriptive characteristics (p > 0.05). Among the patients undergoing surgical intervention, 46.1% were hypothermic. Compared with the normothermic group, the hypothermic group had significantly lower body temperature until the second postoperative hour, lower thermal comfort score until the third postoperative hour, and higher heart rate and anxiety (NRS) score until the first postoperative day. Furthermore, there was a significant difference between the groups in terms of pain intensity up to the first 30 minutes after surgery (p < 0.05). Moreover, there was no significant difference between the groups in terms of pre and postoperative day one anxiety (SAI) and Periantesthesia Comfort Scale mean scores (p > 0.05). The study findings showed that hypothermia affected thermal comfort up to the first 3 hours after surgery, pain intensity up to the first 30 minutes, and heart rate and anxiety (NRS) levels up to the first day.
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Affiliation(s)
- Zehra Bozkurt
- Department of Nursing, Faculty of Health Sciences, University of Yozgat Bozok, Yozgat, Turkey
| | - Özlem Şahin Akboğa
- Department of Nursing, Faculty of Health Sciences, University of Yozgat Bozok, Yozgat, Turkey
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Tan DJ, Chen J, Zhou Y, Ong JSQ, Sin RJX, Bui TV, Mehta AA, Feng M, See KC. Association of body temperature and mortality in critically ill patients: an observational study using two large databases. Eur J Med Res 2024; 29:33. [PMID: 38184625 PMCID: PMC10770998 DOI: 10.1186/s40001-023-01616-3] [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: 09/10/2023] [Accepted: 12/23/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Body temperature (BT) is routinely measured and can be controlled in critical care settings. BT can impact patient outcome, but the relationship between BT and mortality has not been well-established. METHODS A retrospective cohort study was conducted based on the MIMIC-IV (N = 43,537) and eICU (N = 75,184) datasets. The primary outcome and exposure variables were hospital mortality and first 48-h median BT, respectively. Generalized additive models were used to model the associations between exposures and outcomes, while adjusting for patient age, sex, APS-III, SOFA, and Charlson comorbidity scores, temperature gap, as well as ventilation, vasopressor, steroids, and dialysis usage. We conducted subgroup analysis according to ICU setting, diagnoses, and demographics. RESULTS Optimal BT was 37 °C for the general ICU and subgroup populations. A 10% increase in the proportion of time that BT was within the 36-38 °C range was associated with reduced hospital mortality risk in both MIMIC-IV (OR 0.91; 95% CI 0.90-0.93) and eICU (OR 0.86; 95% CI 0.85-0.87). On the other hand, a 10% increase in the proportion of time when BT < 36 °C was associated with increased mortality risk in both MIMIC-IV (OR 1.08; 95% CI 1.06-1.10) and eICU (OR 1.18; 95% CI 1.16-1.19). Similarly, a 10% increase in the proportion of time when BT > 38 °C was associated with increased mortality risk in both MIMIC-IV (OR 1.09; 95% CI 1.07-1.12) and eICU (OR 1.09; 95% CI 1.08-1.11). All patient subgroups tested consistently showed an optimal temperature within the 36-38 °C range. CONCLUSIONS A BT of 37 °C is associated with the lowest mortality risk among ICU patients. Further studies to explore the causal relationship between the optimal BT and mortality should be conducted and may help with establishing guidelines for active BT management in critical care settings.
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Affiliation(s)
- Daniel J Tan
- Institute of Data Science, National University of Singapore, Singapore, Singapore
| | - Jiayang Chen
- National University Hospital, Singapore, Singapore
| | - Yirui Zhou
- School of Computing, National University of Singapore, Singapore, Singapore
| | | | | | - Thach V Bui
- Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | | | - Mengling Feng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Kay Choong See
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
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Stahl K, Schuette E, Schirmer P, Fuge J, Weber AL, Heidrich B, Schneider A, Pape T, Krauss T, Wedemeyer H, Lenzen H. Prevention of peri-interventional hypothermia during endoscopic retrograde cholangiopancreatography using a forced-air heating system. Endosc Int Open 2024; 12:E59-E67. [PMID: 38193008 PMCID: PMC10774017 DOI: 10.1055/a-2210-4799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/27/2023] [Indexed: 01/10/2024] Open
Abstract
Background and study aims Perioperative hypothermia is associated with significant complications and can be prevented with forced-air heating systems (FAHS). Whether hypothermia occurs during prolonged endoscopic sedation is unclear and prevention measures are not addressed in endoscopic sedation guidelines. We hypothesized that hypothermia also occurs in a significant proportion of patients undergoing endoscopic interventions associated with longer sedation times such as endoscopic retrograde cholangiopancreaticography (ERCP), and that FAHS may prevent it. Patients and methods In this observational study, each patient received two consecutive ERCPs, the first ERCP following current standard of care without FAHS (SOC group) and a consecutive ERCP with FAHS (FAHS group). The primary endpoint was maximum body temperature difference during sedation. Results Twenty-four patients were included. Median (interquartile range) maximum body temperature difference was -0.9°C (-1.2; -0.4) in the SOC and -0.1°C (-0.2; 0) in the FAHS group ( P < 0.001). Median body temperature was lower in the SOC compared with the FAHS group after 20, 30, 40, and 50 minutes of sedation. A reduction in body temperature of > 1°C ( P < 0.001) and a reduction below 36°C ( P = 0.01) occurred more often in the SOC than in the FAHS group. FAHS was independently associated with reduced risk of hypothermia ( P = 0.006). More patients experienced freezing in the SOC group ( P = 0.004). Hemodynmaic and respiratory stability were comparable in both groups. Conclusions Hypothermia occurred in the majority of patients undergoing prolonged endoscopic sedation without active temperature control. FAHS was associated with higher temperature stability during sedation and better patient comfort.
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Affiliation(s)
- Klaus Stahl
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Eloise Schuette
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Paul Schirmer
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Anna-Lena Weber
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Andrea Schneider
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Thorben Pape
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Terence Krauss
- Department of Anaesthesiology, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Henrike Lenzen
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
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Diaz M, Duclos A, Mifsud M, Wofford KA. Warming bundle for patients with microvascular free-flaps: A quality improvement project. Nursing 2023; 53:52-56. [PMID: 37973015 DOI: 10.1097/01.nurse.0000991572.95456.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Mayte Diaz
- Mayte Diaz is an instructor and Kenneth Wofford is an associate professor and the DNP program director at the University of South Florida (USF) College of Nursing. April Duclos is the lead CRNA for the Department of Otolaryngology at Tampa General Hospital. Matthew Mifsud is an assistant professor with the Department of Otolaryngology-Head and Neck Surgery at USF's College of Medicine
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Şahin Akboğa Ö, Gürkan A. Effects of Active Heating Methods on Body Temperature, Shivering, Thermal Comfort, Pain, Nausea and Vomiting During General Anesthesia: A Randomized Controlled Trial. Ther Hypothermia Temp Manag 2023. [PMID: 38011688 DOI: 10.1089/ther.2023.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
To investigate the effect of forced-air warming and heated intravenous (IV) and irrigation fluids alone and in combination on body temperature, shivering, thermal comfort, pain, nausea and vomiting in adult patients undergoing surgery under general anesthesia in a prospective, four-group, randomized controlled trial. After induction of anesthesia, 120 patients were divided into the following groups: patients warmed with forced-air warming (n = 30), patients receiving warmed IV and irrigation fluid (n = 30), patients receiving warmed IV and irrigation fluid with forced-air warming (n = 30), and the control group without any intervention (n = 30). Body temperature, shivering, thermal comfort, pain, nausea and vomiting were monitored in the first 24 hours after surgery. The general characteristics of the groups, mean body temperature, length of stay, ambient temperature, and duration of surgery in the preoperative waiting unit were similar (p > 0.05). Compared with the other groups, patients in the control group had a significant decrease in body temperature from the 30th minute during surgery (p < 0.001), lower body temperature in the first 2 hours and thermal comfort in the first three hours after surgery (p < 0.01), and higher shivering levels in the first hour after surgery (p < 0.01). There was no significant difference between the groups in terms of postoperative pain, nausea and vomiting (p > 0.05). The study findings showed that normothermia was maintained in all three intervention groups during the surgery and in the first 24 hours after surgery. Moreover, postoperative thermal comfort increased and shivering levels decreased compared with the control group, but pain, nausea and vomiting levels were not affected. The study was registered on ClinicalTrials.gov (NCT04907617).
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Affiliation(s)
| | - Aysel Gürkan
- Faculty of Health Sciences, University of Marmara, Istanbul, Turkey
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Xing Z, Xu Y, Wu Y, Fu X, Shen P, Che W, Wang J. Development and validation of a nomogram for predicting in-hospital mortality in patients with nonhip femoral fractures. Eur J Med Res 2023; 28:539. [PMID: 38001553 PMCID: PMC10668411 DOI: 10.1186/s40001-023-01515-7] [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: 08/31/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The incidence of nonhip femoral fractures is gradually increasing, but few studies have explored the risk factors for in-hospital death in patients with nonhip femoral fractures in the ICU or developed mortality prediction models. Therefore, we chose to study this specific patient group, hoping to help clinicians improve the prognosis of patients. METHODS This is a retrospective study based on the data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Least absolute shrinkage and selection operator (LASSO) regression was used to screen risk factors. The receiver operating characteristic (ROC) curve was drawn, and the areas under the curve (AUC), net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated to evaluate the discrimination of the model. The consistency between the actual probability and the predicted probability was assessed by the calibration curve and Hosmer-Lemeshow goodness of fit test (HL test). Decision curve analysis (DCA) was performed, and the nomogram was compared with the scoring system commonly used in clinical practice to evaluate the clinical net benefit. RESULTS The LASSO regression analysis showed that heart rate, temperature, red blood cell distribution width, blood urea nitrogen, Glasgow Coma Scale (GCS), Simplified Acute Physiology Score II (SAPSII), Charlson comorbidity index and cerebrovascular disease were independent risk factors for in-hospital death in patients with nonhip femoral fractures. The AUC, IDI and NRI of our model in the training set and validation set were better than those of the GCS and SAPSII scoring systems. The calibration curve and HL test results showed that our model prediction results were in good agreement with the actual results (P = 0.833 for the HL test of the training set and P = 0.767 for the HL test of the validation set). DCA showed that our model had a better clinical net benefit than the GCS and SAPSII scoring systems. CONCLUSION In this study, the independent risk factors for in-hospital death in patients with nonhip femoral fractures were determined, and a prediction model was constructed. The results of this study may help to improve the clinical prognosis of patients with nonhip femoral fractures.
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Affiliation(s)
- Zhibin Xing
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yiwen Xu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yuxuan Wu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaochen Fu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Pengfei Shen
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wenqiang Che
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jing Wang
- The First Affiliated Hospital of Jinan University, Guangzhou, China.
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Sahin Akboga O, Dikmen Aydin Y. Barriers and Solutions in Implementing Evidence-Based Recommendations to Prevent Intraoperative Inadvertent Hypothermia: A Qualitative Study. Ther Hypothermia Temp Manag 2023. [PMID: 37976212 DOI: 10.1089/ther.2023.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
In this study, it was aimed to understand the barriers and solutions for operating room (OR) nurses and anesthesiologists to implement evidence-based recommendations to prevent intraoperative inadvertent hypothermia (IIH). A qualitative, inductive, and descriptive study was conducted. This qualitative interview study was conducted face-to-face with 19 participants working in OR units between February and March 2023. The interviews were analyzed using qualitative content analysis. The COREQ checklist was followed. Two main themes and five sub-themes were identified as a result of content analysis. According to the participants, barriers to IIH prevention interventions are caused by individual and organizational inefficiencies and personal opinions, and the main solution is education. Participants reported many factors that hinder IIH prevention practices. The individual characteristics of OR staff and the opinions and behavior of the institution are very important for IIH prevention.
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Affiliation(s)
- Ozlem Sahin Akboga
- Department of Nursing, Faculty of Health Sciences, University of Yozgat Bozok, Yozgat, Turkey
| | - Yesım Dikmen Aydin
- Department of Nursing, Faculty of Health Sciences, University of Marmara, Istanbul, Turkey
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Kiekkas P, Kourtis G, Feizidou P, Igoumenidis M, Almpani E, Tzenalis A. Associations Between Core Temperature Disorders and Outcomes of Pediatric Intensive Care Unit Patients. Am J Crit Care 2023; 32:338-345. [PMID: 37652884 DOI: 10.4037/ajcc2023567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND The few studies of associations between fever and outcomes in pediatric intensive care unit (PICU) patients have conflicting findings. Associations between hypothermia and patient outcomes have not been studied. OBJECTIVE To investigate the incidence and characteristics of fever and hypothermia and their associations with adverse outcomes among PICU patients. METHODS Patients consecutively admitted to 2 PICUs in a 2-year period were prospectively studied. Core temperature was mainly measured by rectal or axillary thermometry. Fever and hypothermia were defined as core temperatures of greater than 38.0 °C and less than 36.0 °C, respectively. Prolonged mechanical ventilation, prolonged PICU stay, and PICU mortality were the adverse patient outcomes studied. Associations between patient outcomes and core temperature disorders were evaluated with univariate comparisons and multivariate analyses. RESULTS Of 545 patients enrolled, fever occurred in 299 (54.9%) and hypothermia occurred in 161 (29.5%). Both temperature disorders were independently associated with prolonged mechanical ventilation and prolonged PICU stay (P < .001) but not with PICU mortality. Late onset of fever (P < .001) and hypothermia (P = .009) were independently associated with prolonged mechanical ventilation, fever magnitude and duration (both P < .001) were independently associated with prolonged PICU stay, and fever magnitude (P < .001) and infectious cause of hypothermia (P= .01) were independently associated with higher PICU mortality. CONCLUSIONS These findings provide evidence that the manifestation and characteristics of fever and hypothermia are independent predictors of adverse outcomes in PICU patients.
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Affiliation(s)
- Panagiotis Kiekkas
- Panagiotis Kiekkas is a professor in the Nursing Department, University of Patras, Greece
| | - Grigorios Kourtis
- Grigorios Kourtis is a grade B registered nurse in the pediatric intensive care unit, General University Hospital of Patras
| | - Paraskevi Feizidou
- Paraskevi Feizidou is the head registered nurse in the pediatric intensive care unit, General Children's Hospital P. & A. Kyriakou, Athens, Greece
| | - Michael Igoumenidis
- Michael Igoumenidis is an assistant professor in the Nursing Department, University of Patras
| | - Eleni Almpani
- Eleni Almpani is an assistant professor in the Nursing Department, University of Patras
| | - Anastasios Tzenalis
- Anastasios Tzenalis is an assistant professor in the Nursing Department, University of Patras
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Singh P, Nagori A, Lodha R, Sethi T. Early prediction of hypothermia in pediatric intensive care units using machine learning. Front Physiol 2022; 13:921884. [PMID: 36171970 PMCID: PMC9511412 DOI: 10.3389/fphys.2022.921884] [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: 04/16/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Hypothermia is a life-threatening condition where the temperature of the body drops below 35°C and is a key source of concern in Intensive Care Units (ICUs). Early identification can help to nudge clinical management to initiate early interventions. Despite its importance, very few studies have focused on the early prediction of hypothermia. In this study, we aim to monitor and predict Hypothermia (30 min-4 h) ahead of its onset using machine learning (ML) models developed on physiological vitals and to prospectively validate the best performing model in the pediatric ICU. We developed and evaluated ML algorithms for the early prediction of hypothermia in a pediatric ICU. Sepsis advanced forecasting engine ICU Database (SafeICU) data resource is an in-house ICU source of data built in the Pediatric ICU at the All-India Institute of Medical Science (AIIMS), New Delhi. Each time-stamp at 1-min resolution was labeled for the presence of hypothermia to construct a retrospective cohort of pediatric patients in the SafeICU data resource. The training set consisted of windows of the length of 4.2 h with a lead time of 30 min-4 h from the onset of hypothermia. A set of 3,835 hand-engineered time-series features were calculated to capture physiological features from the time series. Features selection using the Boruta algorithm was performed to select the most important predictors of hypothermia. A battery of models such as gradient boosting machine, random forest, AdaBoost, and support vector machine (SVM) was evaluated utilizing five-fold test sets. The best-performing model was prospectively validated. A total of 148 patients with 193 ICU stays were eligible for the model development cohort. Of 3,939 features, 726 were statistically significant in the Boruta analysis for the prediction of Hypothermia. The gradient boosting model performed best with an Area Under the Receiver Operating Characteristic curve (AUROC) of 85% (SD = 1.6) and a precision of 59.2% (SD = 8.8) for a 30-min lead time before the onset of Hypothermia onset. As expected, the model showed a decline in model performance at higher lead times, such as AUROC of 77.2% (SD = 2.3) and precision of 41.34% (SD = 4.8) for 4 h ahead of Hypothermia onset. Our GBM(gradient boosting machine) model produced equal and superior results for the prospective validation, where an AUROC of 79.8% and a precision of 53% for a 30-min lead time before the onset of Hypothermia whereas an AUROC of 69.6% and a precision of 38.52% for a (30 min-4 h) lead time prospective validation of Hypothermia. Therefore, this work establishes a pipeline termed ThermoGnose for predicting hypothermia, a major complication in pediatric ICUs.
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Affiliation(s)
- Pradeep Singh
- Indraprastha Institute of Information Technology, Delhi, India
| | - Aditya Nagori
- Indraprastha Institute of Information Technology, Delhi, India
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Rakesh Lodha
- All India Institute of Medical Sciences, Department of Pediatrics, New Delhi, India
| | - Tavpritesh Sethi
- Indraprastha Institute of Information Technology, Delhi, India
- All India Institute of Medical Sciences, Department of Pediatrics, New Delhi, India
- *Correspondence: Tavpritesh Sethi,
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Mroczek TJ, Prodromidis AD, Pearce A, Malik RA, Charalambous CP. Perioperative Hypothermia Is Associated With Increased 30-Day Mortality in Hip Fracture Patients in the United Kingdom: Α Systematic Review and Meta-analysis. J Orthop Trauma 2022; 36:343-348. [PMID: 34941601 DOI: 10.1097/bot.0000000000002332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To undertake a systematic review and meta-analysis to determine the relationship between perioperative hypothermia and mortality after surgery for hip fracture. DATA SOURCES A systematic literature search of Medline, EMBASE, CINAHL, and Cochrane CENTRAL databases was performed using the Cochrane methodology for systematic reviews with no publication year limit. Only studies available in the English language were included. STUDY SELECTION Predetermined inclusion criteria were patients of any age with a hip fracture, exposure was their body temperature and outcome was mortality rate. Any comparative study design was eligible. DATA EXTRACTION The quality of selected studies was assessed according to each study design with the Methodological Index for Non-Randomised Studies (MINORS) used for all the retrospective comparative studies. The GRADE approach was used to assess the quality of evidence. DATA SYNTHESIS A meta-analysis was conducted using a random-effects model. RESULTS The literature search identified 1016 records. After removing duplicates and those not meeting inclusion criteria, 3 studies measuring 30-day mortality were included. All included studies were carried out in the United Kingdom. The mortality rate was higher in the hypothermic groups as compared with the normothermic group in all the studies, with the difference being significant in 2 of the studies (P < 0.0001). The meta-analysis showed that low body temperature was associated with an increased mortality risk (estimated odds ratio: 2.660; 95% confidence interval: 1.948-3.632; P < 0.001) in patients undergoing surgery for hip fracture. CONCLUSIONS This study shows that low body temperature in hip fracture patients is associated with an increased 30-day mortality risk in the United Kingdom. Randomized control trials are required to determine whether the association between perioperative hypothermia in hip fracture patients and mortality is causal. Nevertheless, based on this analysis, we urge the maintenance of normal body temperature in the perioperative period to be included in national hip fracture guidelines. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Thomas J Mroczek
- Blackpool Teaching Hospitals NHS Foundation Trust, Trauma & Orthopaedics, Blackpool, United Kingdom
| | | | - Adrian Pearce
- Salford Royal NHS Foundation Trust, Trauma & Orthopaedics, Salford, United Kingdom
| | - Rayaz A Malik
- Weill Cornell Medicine, Doha, Qatar
- University of Manchester, Manchester, United Kingdom; and
| | - Charalambos P Charalambous
- Blackpool Teaching Hospitals NHS Foundation Trust, Trauma & Orthopaedics, Blackpool, United Kingdom
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
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A Pilot Quality Improvement Project to Reduce Intraoperative MRI Hypothermia in Neurosurgical Patients. Pediatr Qual Saf 2022; 7:e531. [PMID: 35369418 PMCID: PMC8970077 DOI: 10.1097/pq9.0000000000000531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022] Open
Abstract
Intraoperative hypothermia increases patient morbidity, including bleeding and infection risk. Neurosurgical intraoperative magnetic resonance imaging (iMRI) can lead to hypothermia from patient exposure and low ambient temperature in the MRI suite. This quality improvement project aimed to reduce the risk of hypothermia during pediatric neurosurgery laser ablation procedures with iMRI. The primary aim was to increase the mean lowest core temperature in pediatric patients with epilepsy during iMRI procedures by 1 °C from a baseline mean lowest core temperature of 34.2 ± 1.2 °C within 10 months and sustain for 10 months.
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14
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Nitschke T, Groene P, Acevedo AC, Kammerer T, Schäfer ST. Coagulation under Mild Hypothermia Assessed by Thromboelastometry. Transfus Med Hemother 2021; 48:203-209. [PMID: 34539313 DOI: 10.1159/000513922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction While previous studies have shown a significant impact of extreme hypo- and hyperthermia on coagulation, effects of much more frequently occurring perioperative mild hypothermia are largely unknown. This study therefore aimed to analyze the effects of mild hypothermia using rotational thromboelastometry in vitro. Materials and Methods Twelve healthy volunteers were included in this study. Standard thromboelastometric tests (EXTEM, INTEM, FIBTEM) were used to evaluate coagulation in vitro at 39, 37, 35.5, 35, and 33°C. Beyond standard thromboelastometric tests, we also evaluated the effects of mild hypothermia on the TPA-test (ClotPro, Enicor GmbH, Munich, Germany), a new test which aims to detect fibrinolytic capacity by adding tissue plasminogen activator to the sample. Data are presented as the median with 25/75th percentiles. Results Extrinsically activated coagulation (measured by EXTEM) showed a significant increase in clot formation time (CFT; 37°C: 90 s [81/105] vs. 35°C: 109 s [99/126]; p = 0.0002), while maximum clot firmness (MCF) was not significantly reduced. Intrinsically activated coagulation (measured by INTEM) also showed a significant increase in CFT (37°C: 80 s [72/88] vs. 35°C: 94 s [86/109]; p = 0.0002) without significant effects on MCF. Mild hypothermia significantly increased both the lysis onset time (136 s [132/151; 37°C] vs. 162 s [141/228; 35°C], p = 0.0223) and lysis time (208 s [184/297; 37°C] vs. 249 s [215/358; 35°C]; p = 0.0259). Conclusion This demonstrates that even under mild hypothermia coagulation is significantly altered in vitro. Perioperative temperature monitoring and management are greatly important and can help to prevent mild hypothermia and its adverse effects. Further investigation and in vivo testing of coagulation under mild hypothermia is needed.
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Affiliation(s)
- Tobias Nitschke
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Groene
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Tobias Kammerer
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany.,Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Simon T Schäfer
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
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Toledo LV, Santos BXD, Salgado PDO, Souza LMD, Brinati LM, Januário CDF, Ercole FF. Changes in body temperature of critically ill patients submitted to bed bathing: a crossover clinical trial. Rev Bras Enferm 2021; 74:e20200969. [PMID: 34037151 DOI: 10.1590/0034-7167-2020-0969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/01/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to compare tympanic and axillary body temperature values of critical patients before and after the traditional and dry bed bath. METHODS this is a randomized, open crossover clinical trial conducted with 50 adult critical patients. All patients received both types of bed bathing. The tympanic and axillary temperature values were measured at the beginning and end of the baths. The Wilcoxon test or paired Student's t test was used. RESULTS elderly and male patients predominated. There was no significant difference between tympanic temperature medians measured during the traditional bed bath (p=0.707) and dry bath (p=0.101). Axillary temperature means reduced at the end of the baths (p=0.001), being 36.12ºC in the traditional bath and 35.92ºC in dry bath. CONCLUSIONS bed bath, regardless of the method used, caused a reduction in critical patients' axillary temperature.
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Affiliation(s)
| | | | | | | | | | - Carla de Fátima Januário
- Universidade Federal de Minas Gerais, Hospital das Clínicas. Belo Horizonte, Minas Gerais, Brazil
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16
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Pires MPO, Peterlini MAS, Ullman AJ, Bulmer AC, Rickard CM, Pedreira MLG. Effect of warming and infusion of red blood cell concentrates on markers of haemolysis: An ex vivo simulation study. Aust Crit Care 2020; 34:235-240. [PMID: 33069589 DOI: 10.1016/j.aucc.2020.08.003] [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: 03/12/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Transfusion of red blood cell (RBC) concentrates is a common procedure to restore blood volume and tissue oxygen delivery in patients with trauma. Although RBC warmers may prevent hypothermia, some warming or infusion equipment may lead to haemolysis and patient injury. OBJECTIVES The aim of this study was to test the effect of (i) RBC warming and (ii) administration via manual vs. pump infusion on haemolysis. METHODS This experimental ex vivo study studied haemolysis markers of RBC injury. The sample consisted of 90 RBC infusions in two simulations, randomly, 45 warmed RBC infusions and 45 nonwarmed RBC infusions, in two or three stages: before the intervention (baseline-warming, N= 45; nonwarming, N= 45), after water bath warming at 42 °C (warmed, N= 45), and then after the warmed or nonwarmed RBCs were infused by manual or pump infusion at a rate of 100 mL/h (infusion-warming, N= 45; nonwarming, N= 45). RESULTS Warmed RBCs showed significantly lower total haemoglobin (Hb) and haematocrit levels and increase in free Hb levels, haemolysis levels, and lactate dehydrogenase (LDH) activity (all p<0.05) than baseline RBCs. Pump infusion RBCs were associated with reduced total Hb and increased free Hb, haemolysis, and potassium (K) levels (all p<0.05) compared with warmed RBCs. In contrast, manual infusion of warmed RBCs resulted in significantly reduced total Hb levels and increased LDH activity (both <0.05). After infusion, total Hb, free Hb, haematocrit, haemolysis, and LDH values were significantly different for warmed vs. nonwarmed RBCs (p<0.05). CONCLUSIONS Haemolysis biomarkers increase with RBC warming and infusion, especially when using infusion pumps. Critically ill patients should be carefully monitored for possible complications during and after RBC infusion.
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Affiliation(s)
- Maria Paula Oliveira Pires
- Safety, Technology and Care Research Group, Department of Paediatric Nursing, Universidade Federal de São Paulo (Federal University of Sao Paulo), R. Napoleão de Barros, 754 - Vila Clementino, Sao Paulo, SP, 04024-002, Brazil; Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, 170 Kessels Road Nathan, Qld, 4111, Brisbane, Queensland, Australia; Paulista University, Health Sciences Institution, R. Vergueiro, 1211 - Aclimação, Sao Paulo, SP, 01533-000, Brazil.
| | - Maria Angélica Sorgini Peterlini
- Safety, Technology and Care Research Group, Department of Paediatric Nursing, Universidade Federal de São Paulo (Federal University of Sao Paulo), R. Napoleão de Barros, 754 - Vila Clementino, Sao Paulo, SP, 04024-002, Brazil.
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, 170 Kessels Road Nathan, Qld, 4111, Brisbane, Queensland, Australia.
| | - Andrew C Bulmer
- Alliance for Vascular Access Teaching and Research Group, School of Medical Science, Menzies Health Institute Queensland, Griffith University, Parklands Dr Southport, Qld, 4215, Gold Coast, Queensland, Australia.
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, 170 Kessels Road Nathan, Qld, 4111, Brisbane, Queensland, Australia.
| | - Mavilde Luz Gonçalves Pedreira
- Safety, Technology and Care Research Group, Department of Paediatric Nursing, Universidade Federal de São Paulo (Federal University of Sao Paulo), R. Napoleão de Barros, 754 - Vila Clementino, Sao Paulo, SP, 04024-002, Brazil; Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, 170 Kessels Road Nathan, Qld, 4111, Brisbane, Queensland, Australia.
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Wagner D, Hooper V, Bankieris K, Johnson A. The Relationship of Postoperative Delirium and Unplanned Perioperative Hypothermia in Surgical Patients. J Perianesth Nurs 2020; 36:41-46. [PMID: 33067117 DOI: 10.1016/j.jopan.2020.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to investigate associations between postoperative delirium (POD) and unplanned perioperative hypothermia (UPH) among adults undergoing noncardiac surgery. DESIGN A retrospective, exploratory design was used. METHODS A retrospective, exploratory study was conducted using electronic medical record data abstracted from a purposive convenience sample of adult patients undergoing noncardiac surgery from January 2014 to June 2017. FINDINGS The analyzed data set included 22,548 surgeries, of which 9% experienced POD. Logistic regression indicated that American Society of Anesthesiologists (ASA) class was the strongest predictor of POD (χ2 = 1,207.11, df = 4, inclusive of all ASA class terms). A significant relationship between UPH and POD (χ2 = 54.94, df = 4, inclusive of all UPH terms) and a complex relationship among UPH, patient age, ASA class, and POD were also found. CONCLUSIONS Results support a relationship between UPH and POD. Notably, there is also a complex relationship in the noncardiac surgery population among UPH, age, ASA class, and POD. Preliminary understanding of this relationship is based on the pathophysiological response to surgical stress. Further research is indicated.
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Affiliation(s)
- Doreen Wagner
- Wellstar School of Nursing, Kennesaw State University, Kennesaw, GA
| | - Vallire Hooper
- Center for Nursing Research, College of Nursing, East Tennessee State University, Johnson City, TN.
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Ertuğrul B, Özden D. The effect of physical restraint on neurovascular complications in intensive care units. Aust Crit Care 2019; 33:30-38. [PMID: 31079994 DOI: 10.1016/j.aucc.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 03/09/2019] [Accepted: 03/14/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To reduce the neurovascular complications caused by physical restraint in intensive care patients, there is a need to examine the occurrence of neurovascular complications and their rate. OBJECTIVES The objective of this research was to investigate the effect of physical restraint on the occurrence of neurovascular complications and their rate. METHODS A prospective observational cohort study was carried out. A total of 90 patients from anaesthesia and internal intensive care units participated in this study. Patients were assessed at intervals of 24 h for 4 days using the following instruments: Individual Characteristics Form, Richmond Agitation-Sedation Scale (RASS), Behavioral Pain Scale, and Complication Diagnostic Diary. RESULTS Redness (p < 0.001), limb movement (p < 0.001), oedema (p < 0.001), and colour complication (p < 0.001) increased, whereas pulse strength (p < 0.001) decreased in physically restrained sites on the arm from day 1 to day 4. Redness was increased in patients physically restrained with all types of materials (p < 0.001; p < 0.001; p = 0.020). Although there was a statistically significant difference in terms of movement (p = 0.006; p = 0.003) and oedema (p < 0.001; p < 0.001), both with a roll of gauze and tough cuff, these complications were not significantly different in patients restrained with green foam tie (p > 0.05). According to logistic regression analysis, material type, position of the limb, space between the physical restraint and limb, age, RASS, and pain were independent risk factors for neurovascular complications. RASS and pain were independent protective factors against movement complications. CONCLUSIONS The duration of physical restraint increases neurovascular complications. This study revealed that nurses did not regularly check the restrained wrist and did not focus on the peripheral circulation. It is necessary to develop training programs, standards, and appropriate follow-up strategies in intensive care units in Turkey.
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Affiliation(s)
- Büşra Ertuğrul
- Dokuz Eylul University, Institute of Health Sciences, Nursing Faculty, Izmir, Turkey.
| | - Dilek Özden
- Dokuz Eylul University, Institute of Health Sciences, Nursing Faculty, Izmir, Turkey
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19
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And the award goes to..... Aust Crit Care 2019. [DOI: 10.1016/s1036-7314(19)30071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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20
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Kim J, Oh TK, Lee J, Kim S, Song IA. Association of Immediate Postoperative Temperature in the Surgical Intensive Care Unit with 1-Year Mortality: Retrospective Analysis Using Digital Axillary Thermometers. Acute Crit Care 2019; 34:53-59. [PMID: 31723905 PMCID: PMC6849047 DOI: 10.4266/acc.2019.00255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/08/2018] [Accepted: 11/27/2018] [Indexed: 12/22/2022] Open
Abstract
Background Postoperative body temperature is closely associated with prognosis although there is limited research regarding this association at Postoperative intensive care unit (ICU) admission. Furthermore, no studies have used digital axillary thermometers to measure Postoperative body temperature. This study investigated the association between mortality and Postoperative temperature measured using a digital axillary thermometer within 10 minutes after ICU admission. Methods This retrospective observational study evaluated data from adult patients admitted to an ICU after elective or emergency surgery. The primary outcome was 1-year mortality after ICU admission. Multivariable logistic regression analysis with restricted cubic splines was used to evaluate the association between temperature and outcomes. Results We evaluated data from 5,868 patients admitted between January 1, 2013 and May 31, 2016, including 5,311 patients (90.5%) who underwent noncardiovascular surgery and 557 patients (9.5%) who underwent cardiovascular surgery. Deviation from the median temperature (36.6℃) was associated with increases in 1-year mortality (≤ 36.6℃: linear coefficient, -0.531; P<0.001 and ≥36.6℃: spline coefficient, 0.756; P<0.001). Similar statistically significant results were observed in the noncardiovascular surgery group, but not in the cardiovascular surgery group. Conclusions An increase or decrease in body temperature (vs. 36.6℃) measured using digital axillary thermometers within 10 minutes of Postoperative ICU admission was associated with increased 1-year mortality. However, no significant association was observed after cardiovascular surgery. These results suggest that Postoperative temperature is associated with longterm mortality in patients admitted to the surgical ICU in the Postoperative period.
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Affiliation(s)
- Jiwook Kim
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jaebong Lee
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Saeyeon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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