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Javaid W. 'Redefining normal: a fresh perspective on oral temperature'. Evid Based Nurs 2024:ebnurs-2023-103847. [PMID: 38631875 DOI: 10.1136/ebnurs-2023-103847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Waleed Javaid
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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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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Ley C, Heath F, Hastie T, Gao Z, Protsiv M, Parsonnet J. Defining Usual Oral Temperature Ranges in Outpatients Using an Unsupervised Learning Algorithm. JAMA Intern Med 2023; 183:1128-1135. [PMID: 37669046 PMCID: PMC10481327 DOI: 10.1001/jamainternmed.2023.4291] [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] [Received: 02/22/2023] [Accepted: 07/05/2023] [Indexed: 09/06/2023]
Abstract
Importance Although oral temperature is commonly assessed in medical examinations, the range of usual or "normal" temperature is poorly defined. Objective To determine normal oral temperature ranges by age, sex, height, weight, and time of day. Design, Setting, and Participants This cross-sectional study used clinical visit information from the divisions of Internal Medicine and Family Medicine in a single large medical care system. All adult outpatient encounters that included temperature measurements from April 28, 2008, through June 4, 2017, were eligible for inclusion. The LIMIT (Laboratory Information Mining for Individualized Thresholds) filtering algorithm was applied to iteratively remove encounters with primary diagnoses overrepresented in the tails of the temperature distribution, leaving only those diagnoses unrelated to temperature. Mixed-effects modeling was applied to the remaining temperature measurements to identify independent factors associated with normal oral temperature and to generate individualized normal temperature ranges. Data were analyzed from July 5, 2017, to June 23, 2023. Exposures Primary diagnoses and medications, age, sex, height, weight, time of day, and month, abstracted from each outpatient encounter. Main Outcomes and Measures Normal temperature ranges by age, sex, height, weight, and time of day. Results Of 618 306 patient encounters, 35.92% were removed by LIMIT because they included diagnoses or medications that fell disproportionately in the tails of the temperature distribution. The encounters removed due to overrepresentation in the upper tail were primarily linked to infectious diseases (76.81% of all removed encounters); type 2 diabetes was the only diagnosis removed for overrepresentation in the lower tail (15.71% of all removed encounters). The 396 195 encounters included in the analysis set consisted of 126 705 patients (57.35% women; mean [SD] age, 52.7 [15.9] years). Prior to running LIMIT, the mean (SD) overall oral temperature was 36.71 °C (0.43 °C); following LIMIT, the mean (SD) temperature was 36.64 °C (0.35 °C). Using mixed-effects modeling, age, sex, height, weight, and time of day accounted for 6.86% (overall) and up to 25.52% (per patient) of the observed variability in temperature. Mean normal oral temperature did not reach 37 °C for any subgroup; the upper 99th percentile ranged from 36.81 °C (a tall man with underweight aged 80 years at 8:00 am) to 37.88 °C (a short woman with obesity aged 20 years at 2:00 pm). Conclusions and Relevance The findings of this cross-sectional study suggest that normal oral temperature varies in an expected manner based on sex, age, height, weight, and time of day, allowing individualized normal temperature ranges to be established. The clinical significance of a value outside of the usual range is an area for future study.
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Affiliation(s)
- Catherine Ley
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Frederik Heath
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
- currently with University of California, Irvine, School of Medicine
| | - Trevor Hastie
- Department of Statistics, School of Humanities and Sciences, Stanford University, Stanford, California
- Division of Biostatistics, Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Zijun Gao
- Department of Statistics, School of Humanities and Sciences, Stanford University, Stanford, California
- currently with USC Marshall Business School, University of Southern California, Los Angeles
| | - Myroslava Protsiv
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
- currently with Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Julie Parsonnet
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
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McCune EP, Lee SA, Konofagou EE. Interdependence of Tissue Temperature, Cavitation, and Displacement Imaging During Focused Ultrasound Nerve Sonication. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:600-612. [PMID: 37256815 PMCID: PMC10332467 DOI: 10.1109/tuffc.2023.3280455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Focused ultrasound (FUS) peripheral neuromodulation has been linked to nerve displacement caused by the acoustic radiation force; however, the roles of cavitation and temperature accumulation on nerve modulation are less clear, as are the relationships between these three mechanisms of action. Temperature directly changes tissue stiffness and viscosity. Viscoelastic properties have been shown to affect cavitation thresholds in both theoretical and ex vivo models, but the direct effect of temperature on cavitation has not been investigated in vivo. Here, cavitation and tissue displacement were simultaneously mapped in response to baseline tissue temperatures of either 30 °C or 38 °C during sciatic nerve sonication in mice. In each mouse, the sciatic nerve was repeatedly sonicated at 1.1-MHz, 4-MPa peak-negative pressure, 5-ms pulse duration, and either 15- or 30-Hz pulse repetition frequency (PRF) for 10 s at each tissue temperature. Cavitation increased by 1.8-4.5 dB at a tissue temperature of 38 °C compared to 30 °C, as measured both by passive cavitation images and cavitation doses. Tissue displacement also increased by 1.3- [Formula: see text] at baseline temperatures of 38 °C compared to 30 °C. Histological findings indicated small increases in red blood cell extravasation in the 38 °C baseline temperature condition compared to 30 °C at both PRFs. A strong positive correlation was found between the inertial cavitation dose and displacement imaging noise, indicating the potential ability of displacement imaging to simultaneously detect inertial cavitation in vivo. Overall, tissue temperature was found to modulate both in vivo cavitation and tissue displacement, and thus, both tissue temperature and cavitation can be monitored during FUS to ensure both safety and efficiency.
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Ajčević M, Buoite Stella A, Furlanis G, Caruso P, Naccarato M, Accardo A, Manganotti P. A Novel Non-Invasive Thermometer for Continuous Core Body Temperature: Comparison with Tympanic Temperature in an Acute Stroke Clinical Setting. SENSORS 2022; 22:s22134760. [PMID: 35808257 PMCID: PMC9269248 DOI: 10.3390/s22134760] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023]
Abstract
There is a growing research interest in wireless non-invasive solutions for core temperature estimation and their application in clinical settings. This study aimed to investigate the use of a novel wireless non-invasive heat flux-based thermometer in acute stroke patients admitted to a stroke unit and compare the measurements with the currently used infrared (IR) tympanic temperature readings. The study encompassed 30 acute ischemic stroke patients who underwent continuous measurement (Tcore) with the novel wearable non-invasive CORE device. Paired measurements of Tcore and tympanic temperature (Ttym) by using a standard IR-device were performed 3−5 times/day, yielding a total of 305 measurements. The predicted core temperatures (Tcore) were significantly correlated with Ttym (r = 0.89, p < 0.001). The comparison of the Tcore and Ttym measurements by Bland−Altman analysis showed a good agreement between them, with a low mean difference of 0.11 ± 0.34 °C, and no proportional bias was observed (B = −0.003, p = 0.923). The Tcore measurements correctly predicted the presence or absence of Ttym hyperthermia or fever in 94.1% and 97.4% of cases, respectively. Temperature monitoring with a novel wireless non-invasive heat flux-based thermometer could be a reliable alternative to the Ttym method for assessing core temperature in acute ischemic stroke patients.
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Affiliation(s)
- Miloš Ajčević
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447-34149 Trieste, Italy; (M.A.); (G.F.); (P.C.); (M.N.); (P.M.)
- Department of Engineering and Architecture, University of Trieste, Via A. Valerio, 10-34127 Trieste, Italy;
| | - Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447-34149 Trieste, Italy; (M.A.); (G.F.); (P.C.); (M.N.); (P.M.)
- Correspondence: ; Tel.: +39-040-399-4075 (ext. 6582); Fax: +39-040-399-4284
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447-34149 Trieste, Italy; (M.A.); (G.F.); (P.C.); (M.N.); (P.M.)
| | - Paola Caruso
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447-34149 Trieste, Italy; (M.A.); (G.F.); (P.C.); (M.N.); (P.M.)
| | - Marcello Naccarato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447-34149 Trieste, Italy; (M.A.); (G.F.); (P.C.); (M.N.); (P.M.)
| | - Agostino Accardo
- Department of Engineering and Architecture, University of Trieste, Via A. Valerio, 10-34127 Trieste, Italy;
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447-34149 Trieste, Italy; (M.A.); (G.F.); (P.C.); (M.N.); (P.M.)
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Naulleau C, Jeker D, Pancrate T, Claveau P, Deshayes TA, Burke LM, Goulet EDB. Effect of Pre-Exercise Caffeine Intake on Endurance Performance and Core Temperature Regulation During Exercise in the Heat: A Systematic Review with Meta-Analysis. Sports Med 2022; 52:2431-2445. [PMID: 35616851 DOI: 10.1007/s40279-022-01692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heat is associated with physiological strain and endurance performance (EP) impairments. Studies have investigated the impact of caffeine intake upon EP and core temperature (CT) in the heat, but results are conflicting. There is a need to systematically determine the impact of pre-exercise caffeine intake in the heat. OBJECTIVE To use a meta-analytical approach to determine the effect of pre-exercise caffeine intake on EP and CT in the heat. DESIGN Systematic review with meta-analysis. DATA SOURCES Four databases and cross-referencing. DATA ANALYSIS Weighted mean effect summaries using robust variance random-effects models for EP and CT, as well as robust variance meta-regressions to explore confounders. STUDY SELECTION Placebo-controlled, randomized studies in adults (≥ 18 years old) with caffeine intake at least 30 min before endurance exercise ≥ 30 min, performed in ambient conditions ≥ 27 °C. RESULTS Respectively six and 12 studies examined caffeine's impact on EP and CT, representing 52 and 205 endurance-trained individuals. On average, 6 mg/kg body mass of caffeine were taken 1 h before exercises of ~ 70 min conducted at 34 °C and 47% relative humidity. Caffeine supplementation non-significantly improved EP by 2.1 ± 0.8% (95% CI - 0.7 to 4.8) and significantly increased the rate of change in CT by 0.10 ± 0.03 °C/h (95% CI 0.02 to 0.19), compared with the ingestion of a placebo. CONCLUSION Caffeine ingestion of 6 mg/kg body mass ~ 1 h before exercise in the heat may provide a worthwhile improvement in EP, is unlikely to be deleterious to EP, and trivially increases the rate of change in CT.
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Affiliation(s)
- Catherine Naulleau
- Performance, Hydration and Thermoregulation Laboratory, Faculty of Physical Activity Sciences, University of Sherbrooke, 2500 boul. de l'Université, Sherbrooke, P.Q., J1K 2R1, Canada
- Institut National du Sport du Québec, Montréal, P.Q., Canada
| | - David Jeker
- Performance, Hydration and Thermoregulation Laboratory, Faculty of Physical Activity Sciences, University of Sherbrooke, 2500 boul. de l'Université, Sherbrooke, P.Q., J1K 2R1, Canada
- Institut National du Sport du Québec, Montréal, P.Q., Canada
| | - Timothée Pancrate
- Performance, Hydration and Thermoregulation Laboratory, Faculty of Physical Activity Sciences, University of Sherbrooke, 2500 boul. de l'Université, Sherbrooke, P.Q., J1K 2R1, Canada
| | - Pascale Claveau
- Performance, Hydration and Thermoregulation Laboratory, Faculty of Physical Activity Sciences, University of Sherbrooke, 2500 boul. de l'Université, Sherbrooke, P.Q., J1K 2R1, Canada
| | - Thomas A Deshayes
- Performance, Hydration and Thermoregulation Laboratory, Faculty of Physical Activity Sciences, University of Sherbrooke, 2500 boul. de l'Université, Sherbrooke, P.Q., J1K 2R1, Canada
- Research Center on Aging, University of Sherbrooke, Sherbrooke, P.Q., Canada
| | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Eric D B Goulet
- Performance, Hydration and Thermoregulation Laboratory, Faculty of Physical Activity Sciences, University of Sherbrooke, 2500 boul. de l'Université, Sherbrooke, P.Q., J1K 2R1, Canada.
- Research Center on Aging, University of Sherbrooke, Sherbrooke, P.Q., Canada.
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Lingam M. The Possible Role of Body Temperature in Modulating Brain and Body Sizes in Hominin Evolution. Front Psychol 2022; 12:774683. [PMID: 35222146 PMCID: PMC8866639 DOI: 10.3389/fpsyg.2021.774683] [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: 09/12/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
Many models have posited that the concomitant evolution of large brains and body sizes in hominins was constrained by metabolic costs. In such studies, the impact of body temperature has arguably not been sufficiently addressed despite the well-established fact that the rates of most physiological processes are manifestly temperature-dependent. Hence, the potential role of body temperature in regulating the number of neurons and body size is investigated by means of a heuristic quantitative model. It is suggested that modest deviations in body temperature (i.e., by a couple of degrees Celsius) might allow for substantive changes in brain and body parameters. In particular, a higher body temperature may prove amenable to an increased number of neurons, a higher brain-to-body mass ratio and fewer hours expended on feeding activities, while the converse could apply when the temperature is lowered. Future studies should, therefore, endeavor to explore and incorporate the effects of body temperature in metabolic theories of hominin evolution, while also integrating other factors such as foraging efficiency, diet, and fire control in tandem.
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Affiliation(s)
- Manasvi Lingam
- Department of Aerospace, Physics and Space Sciences, Florida Institute of Technology, Melbourne, FL, United States
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Correction: One Size Does Not Fit All: Assuming the Same Normal Body Temperature for Everyone is Not Justified. PLoS One 2021; 16:e0259428. [PMID: 34714874 PMCID: PMC8555805 DOI: 10.1371/journal.pone.0259428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Lippi G, Nocini R, Mattiuzzi C, Henry BM. Is body temperature mass screening a reliable and safe option for preventing COVID-19 spread? Diagnosis (Berl) 2021; 9:195-198. [PMID: 34472762 DOI: 10.1515/dx-2021-0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/24/2021] [Indexed: 12/23/2022]
Abstract
With the ongoing coronavirus disease 2019 (COVID-19) pandemic continuing worldwide, mass screening of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) infection is a cornerstone of strategies for limiting viral spread within communities. Although mass screening of body temperature with handheld, non-contact infrared thermometers and thermal imagine scanners is now widespread in a kaleidoscope of social and healthcare settings for the purpose of detecting febrile individuals bearing SARS-CoV-2 infection, this strategy carries some drawbacks, which will be highlighted and discussed in this article. These caveats basically include high rate of asymptomatic SARS-CoV-2 infections, the challenging definition of "normal" body temperature, variation of measured values according to the body district, false negative cases due to antipyretics, device inaccuracy, impact of environmental temperature, along with the low specificity of this symptom for screening COVID-19 in patients with other febrile conditions. Some pragmatic suggestions will also be endorsed for increasing accuracy and precision of mass screening of body temperature. These encompass the regular assessment of body temperature (possibly twice) with validated devices, which shall be constantly monitored over time and used following manufacturer's instructions, the definition of a range of "normal" body temperatures in the local population, patients interrogation on usual body temperature, measurement standardization of one body district, allowance of sufficient environmental acclimatization before temperature check, integration with contact history and other clinical information, along with exclusion of other causes of increased body temperature. We also endorse the importance of individual and primary care physician's regular and repeated check of personal body temperature.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Riccardo Nocini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Camilla Mattiuzzi
- Service of Clinical Governance, Provincial Agency for Social and Sanitary Services, Trento, Italy
| | - Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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