A reply

Abstract

We note with interest the comments of Dr Wendy Fallis. She challenges our view that the mouth is not ideal for temperature measurement in patients with severe head injury. We presume Dr Fallis includes her own ‘state-of–the-science review [1] to support mouth temperature monitoring in orally intubated patients. We agree that the mouth is a valid monitoring site, long used in healthy and sick adults and children. Perhaps Dr Fallis has missed the point we were making in our short correspondence that in patients with severe head injury, other issues frequently of a practical nature influence the choice of a) the site and b) the method for temperature measurement. In this respect the unique issues relating to the management of head-injured patients have been overlooked by Dr Fallis. Our reasons for suggesting that mouth temperature is not ideal are two-fold. First, maintaining accurate placement of thermistors within the sublingual pocket when neurosurgical patients start to wake up is difficult. Patients become agitated and disorientated and chew on probes in situ in the mouth. Accurate temperature monitoring remains important, but it is difficult to ensure that an oral thermistor remains optimally placed, particularly when regular mouth care may disturb the position. In addition, mucosal ulceration is common in orally intubated patients. Additional probes in the mouth exacerbate this problem. The second reason is that neurointensive care patients are often haemodynamically unstable. Indeed, Dr Fallis herself raises a note of caution for the use of the sublingual pocket in such patients [1]. Oral gastric tubes are also, of necessity, placed in the mouth, often delivering iced cold fluids to the stomach (as an aid to intragastric cooling). Little is known of the impact of ice cold feeds on mouth temperature. From our own detailed monitoring of brain and body temperature in patients with severe brain injury, it is our considered opinion that when accurate temperature monitoring is essential, as it is in brain injured patients, other sites for continuous core temperature measurement, e.g. rectum or bladder, are more appropriate than the mouth.