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Koh W, Chakravarthy M, Simon E, Rasiah R, Charuluxananan S, Kim TY, Chew STH, Bräuer A, Ti LK. Perioperative temperature management: a survey of 6 Asia-Pacific countries. BMC Anesthesiol 2021; 21:205. [PMID: 34399681 PMCID: PMC8365903 DOI: 10.1186/s12871-021-01414-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/17/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Anesthesia leads to impairments in central and peripheral thermoregulatory responses. Inadvertent perioperative hypothermia is hence a common perioperative complication, and is associated with coagulopathy, increased surgical site infection, delayed drug metabolism, prolonged recovery, and shivering. However, surveys across the world have shown poor compliance to perioperative temperature management guidelines. Therefore, we evaluated the prevalent practices and attitudes to perioperative temperature management in the Asia-Pacific region, and determined the individual and institutional factors that lead to noncompliance. METHODS A 40-question anonymous online questionnaire was distributed to anesthesiologists and anesthesia trainees in six countries in the Asia-Pacific (Singapore, Malaysia, Philippines, Thailand, India and South Korea). Participants were polled about their current practices in patient warming and temperature measurement across the preoperative, intraoperative and postoperative periods. Questions were also asked regarding various individual and environmental barriers to compliance. RESULTS In total, 1154 valid survey responses were obtained and analyzed. 279 (24.2%) of respondents prewarm, 508 (44.0%) perform intraoperative active warming, and 486 (42.1%) perform postoperative active warming in the majority of patients. Additionally, 531 (46.0%) measure temperature preoperatively, 767 (67.5%) measure temperature intraoperatively during general anesthesia, and 953 (82.6%) measure temperature postoperatively in the majority of patients. The availability of active warming devices in the operating room (p < 0.001, OR 10.040), absence of financial restriction (p < 0.001, OR 2.817), presence of hospital training courses (p = 0.011, OR 1.428), and presence of a hospital SOP (p < 0.001, OR 1.926) were significantly associated with compliance to intraoperative active warming. CONCLUSIONS Compliance to international perioperative temperature management guidelines in Asia-Pacific remains poor, especially in small hospitals. Barriers to compliance were limited temperature management equipment, lack of locally-relevant standard operating procedures and training. This may inform international guideline committees on the needs of developing countries, or spur local anesthesiology societies to publish their own national guidelines.
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Affiliation(s)
- Wenjun Koh
- Department, of Anaesthesia, National University Hospital, Singapore, Singapore
| | - Murali Chakravarthy
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospital, Bangalore, Karnataka, India
| | - Edgard Simon
- Department of Anesthesiology, Philippine General Hospital, University of the Philippines, Ermita, Manila, Philippines
| | - Raveenthiran Rasiah
- Department of Anesthesiology, Avisena Specialist Hospital, Shah Alam, Selangor, Malaysia
| | - Somrat Charuluxananan
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Tae-Yop Kim
- Department of Anesthesiology, Konkuk University Medical Center, Gwangjin-gu, Seoul, Republic of Korea
| | - Sophia T H Chew
- Department of Anaesthesia, Singapore General Hospital, Singapore, Singapore
| | - Anselm Bräuer
- Department of Anesthesiology, University Hospital Goettingen, Goettingen, Germany
| | - Lian Kah Ti
- Department, of Anaesthesia, National University Hospital, Singapore, Singapore.
- Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Mutchnick I, Thatikunta M, Braun J, Bohn M, Polivka B, Daniels MW, Vickers-Smith R, Gump W, Moriarty T. Protocol-driven prevention of perioperative hypothermia in the pediatric neurosurgical population. J Neurosurg Pediatr 2020; 25:548-554. [PMID: 32059179 DOI: 10.3171/2019.12.peds1980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 12/02/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Perioperative hypothermia (PH) is a preventable, pathological, and iatrogenic state that has been shown to result in increased surgical blood loss, increased surgical site infections, increased hospital length of stay, and patient discomfort. Maintenance of normothermia is recommended by multiple surgical quality organizations; however, no group yet provides an ergonomic, evidence-based protocol to reduce PH for pediatric neurosurgery patients. The authors' aim was to evaluate the efficacy of a PH prevention protocol in the pediatric neurosurgery population. METHODS A prospective, nonrandomized study of 120 pediatric neurosurgery patients was performed. Thirty-eight patients received targeted warming interventions throughout their perioperative phases of care (warming group-WG). The remaining 82 patients received no extra warming care during their perioperative period (control group-CG). Patients were well matched for age, sex, and preparation time intraoperatively. Hypothermia was defined as < 36°C. The primary outcome of the study was maintenance of normothermia preoperatively, intraoperatively, and postoperatively. RESULTS WG patients were significantly warmer on arrival to the operating room (OR) and were 60% less likely to develop PH (p < 0.001). Preoperative forced air warmer use both reduced the risk of PH at time 0 intraoperatively and significantly reduced the risk of any PH intraoperatively (p < 0.001). All patients, regardless of group, experienced a drop in core temperature until a nadir occurred at 30 minutes intraoperatively for the WG and 45 minutes for the CG. At every time interval, from preoperatively to 120 minutes intraoperatively, CG patients were between 2 and 3 times more likely to experience PH (p < 0.001). All patients were warm on arrival to the postanesthesia care unit regardless of patient group. CONCLUSIONS Preoperative forced air warmer use significantly increases the average intraoperative time 0 temperature, helping to prevent a fall into PH at the intraoperative nadir. Intraoperatively, a strictly and consistently applied warming protocol made intraoperative hypothermia significantly less likely as well as less severe when it did occur. Implementation of a warming protocol necessitated only limited resources and an OR culture change, and was well tolerated by OR staff.
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Affiliation(s)
- Ian Mutchnick
- 1Division of Pediatric Neurosurgery, Norton Children's Hospital/Norton Neuroscience Institute, Louisville
- 2Department of Neurosurgery, University of Louisville
| | | | - Julianne Braun
- 1Division of Pediatric Neurosurgery, Norton Children's Hospital/Norton Neuroscience Institute, Louisville
| | - Martha Bohn
- 3Division of Operative Services, Norton Children's Hospital, Louisville, Kentucky
| | - Barbara Polivka
- 4University of Kansas School of Nursing, Kansas City, Kansas
| | - Michael W Daniels
- 5Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville; and
| | | | - William Gump
- 1Division of Pediatric Neurosurgery, Norton Children's Hospital/Norton Neuroscience Institute, Louisville
- 2Department of Neurosurgery, University of Louisville
| | - Thomas Moriarty
- 1Division of Pediatric Neurosurgery, Norton Children's Hospital/Norton Neuroscience Institute, Louisville
- 2Department of Neurosurgery, University of Louisville
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The incidence of hyperthermia during cochlear implant surgery in children. The Journal of Laryngology & Otology 2017; 131:900-906. [PMID: 28807061 DOI: 10.1017/s0022215117001682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Inadvertent hyperthermia during anaesthesia is a rare but life-threatening complication. We have encountered several cases of severe hyperthermia in paediatric patients undergoing anaesthesia for cochlear implantation. METHODS This study aimed to describe the clinical characteristics of children who developed hyperthermia while undergoing cochlear implantation, and to explore possible mechanisms and predisposing factors. The anaesthetic charts of all patients aged under 18 years who underwent cochlear implantation, or mastoid or ophthalmic surgery, between 1 January 2006 and 31 December 2009, at Soroka Medical Center in Beer Sheva, Israel, were reviewed. Patients undergoing mastoid and ophthalmic surgical procedures were used as controls. RESULTS A larger percentage of patients who underwent cochlear implant surgery (10 per cent) developed hyperthermia compared to controls (0.7 per cent, p < 0.05). In five of the seven cases, hyperthermia appeared in combination with tachycardia and hypercapnia, adhering to the clinical triad of malignant hyperthermia. CONCLUSION Patients undergoing cochlear implantation are susceptible to developing intra-operative hyperthermia. This article describes the hyperthermic events that occur during paediatric cochlear implantation, and attempts to identify potential triggers of hyperthermia.
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Brown MJ, Curry TB, Hyder JA, Berbari EF, Truty MJ, Schroeder DR, Hanson AC, Kor DJ. Intraoperative Hypothermia and Surgical Site Infections in Patients with Class I/Clean Wounds: A Case-Control Study. J Am Coll Surg 2017; 224:160-171. [DOI: 10.1016/j.jamcollsurg.2016.10.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 01/05/2023]
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Imani F, Karimi Rouzbahani HR, Goudarzi M, Tarrahi MJ, Ebrahim Soltani A. Skin Temperature Over the Carotid Artery, an Accurate Non-invasive Estimation of Near Core Temperature. Anesth Pain Med 2016; 6:e31046. [PMID: 27110528 PMCID: PMC4834665 DOI: 10.5812/aapm.31046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/17/2015] [Accepted: 09/07/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND During anesthesia, continuous body temperature monitoring is essential, especially in children. Anesthesia can increase the risk of loss of body temperature by three to four times. Hypothermia in children results in increased morbidity and mortality. Since the measurement points of the core body temperature are not easily accessible, near core sites, like rectum, are used. OBJECTIVES The purpose of this study was to measure skin temperature over the carotid artery and compare it with the rectum temperature, in order to propose a model for accurate estimation of near core body temperature. PATIENTS AND METHODS Totally, 124 patients within the age range of 2 - 6 years, undergoing elective surgery, were selected. Temperature of rectum and skin over the carotid artery was measured. Then, the patients were randomly divided into two groups (each including 62 subjects), namely modeling (MG) and validation groups (VG). First, in the modeling group, the average temperature of the rectum and skin over the carotid artery were measured separately. The appropriate model was determined, according to the significance of the model's coefficients. The obtained model was used to predict the rectum temperature in the second group (VG group). Correlation of the predicted values with the real values (the measured rectum temperature) in the second group was investigated. Also, the difference in the average values of these two groups was examined in terms of significance. RESULTS In the modeling group, the average rectum and carotid temperatures were 36.47 ± 0.54°C and 35.45 ± 0.62°C, respectively. The final model was obtained, as follows: Carotid temperature × 0.561 + 16.583 = Rectum temperature. The predicted value was calculated based on the regression model and then compared with the measured rectum value, which showed no significant difference (P = 0.361). CONCLUSIONS The present study was the first research, in which rectum temperature was compared with that of skin over carotid artery, to find a safe location with easier access and higher accuracy for estimating near core body temperature. Results obtained in this study showed that, using a model, it is possible to evaluate near core body temperature in children, by measuring skin temperature over carotid artery.
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Affiliation(s)
- Farsad Imani
- Department of Anesthesia, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mehrdad Goudarzi
- Department of Anesthesia, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Tarrahi
- Department of Epidemiology and Biostatics, School of Public Health, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Alireza Ebrahim Soltani
- Department of Anesthesia, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Beltramini AM, Salata RA, Ray AJ. Thermoregulation and Risk of Surgical Site Infection. Infect Control Hosp Epidemiol 2015; 32:603-10. [DOI: 10.1086/660017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Surgical site infections (SSIs) occur in approximately 2%–5% of patients undergoing surgery in the acute care setting in the United States. These infections result in increased length of stay, higher risk of death, and increased cost of care compared with that in uninfected surgical patients. Given the inclusion of maintenance of perioperative normothermia for all major surgeries as a means of lowering the risk of infection in the Surgical Care Improvement Project 2009, we prepared a summary of the literature to determine the strength and quantity of the evidence underlying the performance measure. Although the data are generally supportive of perioperative normothermia as a means of reducing the risk of SSIs, a more rigorous approach using standard SSI definitions as well as standardized temperature measurements (and timing thereof) will further delineate the role played by temperature regulation in SSI development.
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Stauffer PR, Snow BW, Rodrigues DB, Salahi S, Oliveira TR, Reudink D, Maccarini PF. Non-invasive measurement of brain temperature with microwave radiometry: demonstration in a head phantom and clinical case. Neuroradiol J 2014; 27:3-12. [PMID: 24571829 DOI: 10.15274/nrj-2014-10001] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 12/14/2013] [Indexed: 12/27/2022] Open
Abstract
This study characterizes the sensitivity and accuracy of a non-invasive microwave radiometric thermometer intended for monitoring body core temperature directly in brain to assist rapid recovery from hypothermia such as occurs during surgical procedures. To study this approach, a human head model was constructed with separate brain and scalp regions consisting of tissue equivalent liquids circulating at independent temperatures on either side of intact skull. This test setup provided differential surface/deep tissue temperatures for quantifying sensitivity to change in brain temperature independent of scalp and surrounding environment. A single band radiometer was calibrated and tested in a multilayer model of the human head with differential scalp and brain temperature. Following calibration of a 500MHz bandwidth microwave radiometer in the head model, feasibility of clinical monitoring was assessed in a pediatric patient during a 2-hour surgery. The results of phantom testing showed that calculated radiometric equivalent brain temperature agreed within 0.4°C of measured temperature when the brain phantom was lowered 10°C and returned to original temperature (37°C), while scalp was maintained constant over a 4.6-hour experiment. The intended clinical use of this system was demonstrated by monitoring brain temperature during surgery of a pediatric patient. Over the 2-hour surgery, the radiometrically measured brain temperature tracked within 1-2°C of rectal and nasopharynx temperatures, except during rapid cooldown and heatup periods when brain temperature deviated 2-4°C from slower responding core temperature surrogates. In summary, the radiometer demonstrated long term stability, accuracy and sensitivity sufficient for clinical monitoring of deep brain temperature during surgery.
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Affiliation(s)
- Paul R Stauffer
- Departments of Radiation Oncology and Biomedical Engineering, Duke University; Durham, NC, USA - Department of Radiation Oncology, Thomas Jefferson University; Philadelphia PA, USA -
| | - Brent W Snow
- Department of Surgery and Urology, University of Utah; Salt Lake City, UT, USA - Thermimage Inc.; Salt Lake City, UT, USA
| | - Dario B Rodrigues
- Departments of Radiation Oncology and Biomedical Engineering, Duke University; Durham, NC, USA - CEFITEC, FCT, New University of Lisbon; Caparica, Portugal
| | - Sara Salahi
- Departments of Radiation Oncology and Biomedical Engineering, Duke University; Durham, NC, USA - ANSYS, Inc.; Irvine, CA, USA
| | - Tiago R Oliveira
- Departments of Radiation Oncology and Biomedical Engineering, Duke University; Durham, NC, USA - Institute of Physics, University of São Paulo; São Paulo, Brazil
| | | | - Paolo F Maccarini
- Departments of Radiation Oncology and Biomedical Engineering, Duke University; Durham, NC, USA
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Jay O, Molgat-Seon Y, Chou S, Murto K. Skin temperature over the carotid artery provides an accurate noninvasive estimation of core temperature in infants and young children during general anesthesia. Paediatr Anaesth 2013; 23:1109-16. [PMID: 24112764 DOI: 10.1111/pan.12262] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND The accurate measurement of core temperature is an essential aspect of intraoperative management in children. Invasive measurement sites are accurate but carry some health risks and cannot be used in certain patients. An accurate form of noninvasive thermometry is therefore needed. Our aim was to develop, and subsequently validate, separate models for estimating core temperature using different skin temperatures with an individualized correction factor. METHODS Forty-eight pediatric patients (0-36 months) undergoing elective surgery were separated into a modeling group (MG, n = 28) and validation group (VG, n = 20). Skin temperature was measured over the carotid artery (Tsk_carotid ), upper abdomen (Tsk_abd ), and axilla (Tsk_axilla ), while nasopharyngeal temperature (Tnaso ) was measured as a reference. RESULTS In the MG, derived models for estimating Tnaso were: Tsk_carotid + 0.52; Tsk_abd + (0.076[body mass] + 0.02); and Tsk_axilla + (0.081[body mass]-0.66). After adjusting raw Tsk_carotid, Tsk_abd , and Tsk_axilla values in the independent VG using these models, the mean bias (Predicted Tnaso - Actual Tnaso [with 95% confidence intervals]) was +0.03[+0.53, -0.50]°C, -0.05[+1.02, -1.07]°C, and -0.06[+1.21, -1.28°C], respectively. The percentage of values within ±0.5°C of Tnaso was 93.2%, 75.4%, and 66.1% for Tsk_carotid, Tsk_abd , and Tsk_axilla , respectively. Sensitivity and specificity for detecting hypothermia (Tnaso < 36.0°C) was 0.88 and 0.91 for Tsk_carotid , 0.61 and 0.76 for Tsk_abd , and 0.91 and 0.73 for Tsk_axilla . Goodness-of-fit (R(2) ) relative to the line-of-identity was 0.74 (Tsk_carotid ), 0.34 (Tsk_abd ), and 0.15 (Tsk_axilla ). CONCLUSIONS Skin temperature over the carotid artery, with a simple correction factor of +0.52°C, provides a viable noninvasive estimate of Tnaso in young children during elective surgery with a general anesthetic.
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Affiliation(s)
- Ollie Jay
- Faculty of Health Sciences, Thermal Ergonomics Laboratory, University of Ottawa, Ottawa, ON, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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Manejo de la temperatura en el perioperatorio y frecuencia de hipotermia inadvertida en un hospital general. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.rca.2013.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Temperature management during the perioperative period and frequency of inadvertent hypothermia in a general hospital. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rcae.2013.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Temperature management during the perioperative period and frequency of inadvertent hypothermia in a general hospital☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1097/01819236-201341020-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Influence of hydatidiform mole follow-up setting on postmolar gestational trophoblastic neoplasia outcomes: a cohort study. Obstet Gynecol Surv 2012; 67:436-46. [PMID: 22838246 DOI: 10.1097/ogx.0b013e3182605ccd] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the influence of hydatidiform mole (HM) management setting (reference center versus other institutions) on gestational trophoblastic neoplasia (GTN) outcomes. METHODS This cohort study included 270 HM patients attending Botucatu Trophoblastic Diseases Center (BTDC, São Paulo State University, Brazil) between January 1990 and December 2009 (204 undergoing evacuation and entire postmolar follow-up at BTDC and 66 from other institutions [OIs]). GTN characteristics and outcomes were analyzed and compared according to HM management setting. The confounding variables assessed included age, gravidity, parity, number of abortions and HM type (complete or partial). Postmolar GTN outcomes were compared using Mann-Whitney's test, chi2 test or Fisher's exact test. RESULTS Postmolar GTN occurred in 34 (34/204 = 16.7%) BTDC patients and in 27 (27/66 = 40.9%) of those initially treated in other institutions. BTDC patients showed lower metastasis rate (5.8% vs. 48%, p = 0.003) and lower median FIGO (2002) score (2.00 [1.00, 3.00] vs. 4.00 [2.00, 7.00], p = 0.003]. Multiagent chemotherapy to treat postmolar GTN was required in 2 BTDC cases (5.9%) and in 8 OI cases (29.6%) (p = 0.017). Median time interval between molar evacuation and chemotherapy onset was shorter among BTDC patients (7.0 [6.0, 10.0] vs. 10.0 [7.0, 16.0], p = 0.040). CONCLUSION BTDC patients showed GTN characteristics indicative of better prognosis. This underscores the importance of GTD specialist centers.
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Engelen S, Himpe D, Borms S, Berghmans J, Van Cauwelaert P, Dalton JE, Sessler DI. An evaluation of underbody forced-air and resistive heating during hypothermic, on-pump cardiac surgery*. Anaesthesia 2011; 66:104-10. [DOI: 10.1111/j.1365-2044.2010.06609.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zeiner A, Klewer J, Sterz F, Haugk M, Krizanac D, Testori C, Losert H, Ayati S, Holzer M. Non-invasive continuous cerebral temperature monitoring in patients treated with mild therapeutic hypothermia: an observational pilot study. Resuscitation 2010; 81:861-6. [PMID: 20398992 DOI: 10.1016/j.resuscitation.2010.03.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 02/25/2010] [Accepted: 03/11/2010] [Indexed: 11/30/2022]
Abstract
AIM OF THE STUDY To investigate if body temperature as measured with a prototype of a non-invasive continuous cerebral temperature sensor using the zero-heat-flow method to reflect the oesophageal temperature (core temperature) during mild therapeutic hypothermia after cardiac arrest. METHODS In patients over 18 years old with restoration of spontaneous circulation after cardiac arrest, a temperature sensor that uses the zero-heat-flow principle was placed on the forehead during the periods of cooling and re-warming. This temperature was compared to oesophageal temperature as the primary temperature-monitoring site. To assess agreement, we used the Bland-Altman approach and Lin's concordance correlation coefficient. RESULTS From September 2008 to April 2009, data from 19 patients were analysed. The median time from restoration of spontaneous circulation until temperature sensor application was 53min (interquartile range, 31; 96). All sensors were removed when a core temperature of 36 degrees C was reached. These measurements were in agreement with oesophageal temperature measurements. No allergic reaction, rash or other irritation occurred on the skin around or under the probes. Bland-Altman results showed a bias of -0.12 degrees C and 95% limits of agreement of -0.59 and +0.36 degrees C. Lin's concordance correlation coefficient was 0.98. CONCLUSIONS Body temperature measurements using a non-invasive continuous cerebral temperature sensor prototype that uses the zero-heat-flow method accurately reflected oesophageal temperature measurements during mild therapeutic hypothermia in patients with restoration of spontaneous circulation after cardiac arrest.
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Affiliation(s)
- Andrea Zeiner
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20/6D, Wien, Austria
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