Core Temperature In Patients Research Articles

How to get away from the cold: body temperature during surgery.

How to get away from the cold: body temperature during surgery.

Core Temperature Evaluation in Different Body Parts in Patients Undergoing Laparoscope Surgery under Total Intravenous Anesthesia*

Purpose The trend of body temperature change during laparoscopic surgery and the most adequate site for monitoring temperature measurements have not been investigated thoroughly. In this study body temperature change during laparoscopic surgery was measured and measurements of the tympanic, esophageal, and nasopharyngeal core temperatures in surgical patients with total intravenous anesthesia were compared. Methods From February to October 2013, 28 laparoscopic surgical patients were recruited from a tertiary hospital in Seoul. The patients' core temperature was measured 12 times at ten minute intervals from ten minutes after the beginning of endotracheal intubation. Results Repeated measure of core temperatures indicated a significant difference according to body part (p=.033), time of measure (p<.001) and the reciprocal interaction between body part and time of measure (p<.027). The core temperatures were highest at tympany location, lowest at nasopharynx. The amount of temperature change was least for the esophagus (36.10~36.33℃), followed by nasopharynx and tympany. Conclusion The esophageal core temperature showed the highest stability followed by nasopharyngeal and tympanic temperature. Therefore, close observations are required between 10~20minutes after the beginning of the operation. 주요어: 심부체온, 복강경 ìˆ˜ìˆ , ì „ì •ë§¥ ì „ì‹ ë§ˆì·¨ Key words: Core temperature, Laparoscope surgery, Total Intravenous Anesthesia

Validation of computerized sniffer for monitoring perioperative normothermia.

The World Health Organization sets a standard to maintain patient core temperature greater than 36°C throughout the perioperative period. Normothermia (defined as >36°C) in the Operating Room (OR) is an important factor to preventing complications in patients (MI, infection, coagulopathy). Randomized studies suggests that maintaining at higher temperatures may further reduce complications in surgery (less complications for group at 36.4°C than the control group at 36.0°C) [1,2]. Perioperative normothermia is an important but often unrecognized element during anesthesia. Early recognition of hypothermia would allow for appropriate interventions and prevent complications. Manual validation of the diagnostic performance a clinical tool (alert) that would automatically measure changes in core temperature to identify patients who fail to be in range of normothermia during surgery. The clinical tool (alert) was found to be 97 % sensitive.

Preventing inadvertent perioperative hypothermia.

25-90% of all patients undergoing elective surgery suffer from inadvertent postoperative hypothermia, i.e., a core body temperature below 36°C. Compared to normothermic patients, these patients have more frequent wound infections (relative risk [RR] 3.25, 95% confidence interval [CI] 1.35-7.84), cardiac complications (RR 4.49, 95% CI 1.00-20.16), and blood transfusions (RR 1.33, 95% CI 1.06-1.66). Hypothermic patients feel uncomfortable, and shivering raises oxygen consumption by about 40%. This guideline is based on a systematic review of the literature up to and including October 2012 and a further one from November 2012 to August 2014. The recommendations were developed and agreed upon by representatives of five medical specialty societies in a structured consensus process. The patient's core temperature should be measured 1-2 hours before the start of anesthesia, and either continuously or every 15 minutes during surgery. Depending on the nature of the operation, the site of temperature measurement should be oral, naso-/oropharyngeal, esophageal, vesical, or tympanic (direct). The patient should be actively prewarmed 20-30 minutes before surgery to counteract the decline in temperature. Prewarmed patients must be actively warmed intraoperatively as well if the planned duration of anesthesia is longer than 60 minutes (without prewarming, 30 minutes). The ambient temperature in the operating room should be at least 21°C for adult patients and at least 24°C for children. Infusions and blood transfusions that are given at rates of >500 mL/h should be warmed first. Perioperatively, the largest possible area of the body surface should be thermally insulated. Emergence from general anesthesia should take place at normal body temperature. Postoperative hypothermia, if present, should be treated by the administration of convective or conductive heat until normothermia is achieved. Shivering can be treated with medications. Inadvertent perioperative hypothermia can adversely affect the outcome of surgery and the patient's postoperative course. It should be actively prevented.

Cooling Activity is Associated with Neurological Outcome in Patients with Severe Cerebrovascular Disease Undergoing Endovascular Temperature Control.

Neuroprotection through targeted temperature management is currently investigated in patients with severe brain injury in multiple trials. Feedback devices have been shown to precisely reach and maintain target temperature by constantly adjusting cooling activity. We analyzed the association between cooling activity expressed as cool bath temperatures and functional neurological outcome. Data were retrospectively analyzed from a prospective randomized trial on controlled prophylactic normothermia (i.e., 36.5 °C) in patients with severe cerebrovascular disease. Body core temperature of patients who had been randomized to the endovascular group, was controlled using an endovascular cooling device. Cool bath temperature was analyzed over a period of 168 h. Functional neurological outcome was evaluated at 180 days using the modified Rankin Scale. 51 of 102 patients included were randomized to the endovascular group. Cool bath temperature data were available from 47/51 patients. Patients with lower cool bath temperatures reflecting high cooling activity had a more favorable neurological outcome at 180 days (mRS 0-2) than patients with low cooling activity (p < 0.05). We did not find a significant correlation between cool bath temperature and inflammatory markers. High cooling activity of an endovascular feedback device is associated with favorable outcome in patients with severe cerebrovascular disease.

Evidence Suggesting Complement Activation and Haemolysis at Core Temperature in Patients with Cold Autoimmune Haemolytic Anaemia

Background: It is unclear why haemolysis may somewhat persist in patients with cold autoimmune haemolytic anaemia (cAIHA) at 37 °C (core temperature). Methods: Seven patients with cAIHA were included in this study. Serological testing was performed using standard techniques. Bound autoantibodies (aab) on patients' RBCs were analysed by the direct antiglobulin test (DAT), dual antiglobulin test (DDAT) and flow cytometry (FC) using pre-warmed RBCs (37 °C). Temperature-dependent complement binding was determined by incubation of patients' serum samples with group O RBCs and fresh serum complement. Results: The DAT was strongly positive with anti-C3d in all cases, independent of season and outside temperature. Haemolysis usually improved during warm periods of time, but decompensated following febrile infections, and persisted throughout the year, though exposure to the cold was strictly avoided. In addition, trace amounts of IgM aab were infrequently detectable on patients' RBCs even at 37 °C, and complement activation was demonstrated following incubation of RBCs with the causative aab at 37 °C. Conclusions: Binding of trace amounts of IgM aab at 37 °C may provide an explanation for the durable C3d-positive DAT and haemolysis in patients with cAIHA.

Changes in Body Temperature in Incomplete Spinal Cord Injury by Digital Infrared Thermographic Imaging.

ObjectiveTo investigate changes in the core temperature and body surface temperature in patients with incomplete spinal cord injuries (SCI). In incomplete SCI, the temperature change is difficult to see compared with complete spinal cord injuries. The goal of this study was to better understand thermal regulation in patients with incomplete SCI.MethodsFifty-six SCI patients were enrolled, and the control group consisted of 20 healthy persons. The spinal cord injuries were classified according to International Standards for Neurological Classification of Spinal Cord Injury. The patients were classified into two groups: upper (neurological injury level T6 or above) and lower (neurological injury level T7 or below) SCIs. Body core temperature was measured using an oral thermometer, and body surface temperature was measured using digital infrared thermographic imaging.ResultsTwenty-nine patients had upper spinal cord injuries, 27 patients had lower SCIs, and 20 persons served as the normal healthy persons. Comparing the skin temperatures of the three groups, the temperatures at the lower abdomen, anterior thigh and anterior tibia in the patients with upper SCIs were lower than those of the normal healthy persons and the patients with lower SCIs. No significant temperature differences were observed between the normal healthy persons and the patients with lower SCIs.ConclusionIn our study, we found thermal dysregulation in patients with incomplete SCI. In particular, body surface temperature regulation was worse in upper SCIs than in lower injuries. Moreover, cord injury severity affected body surface temperature regulation in SCI patients.

Forced air warming devices in orthopaedics: a focused review of the literature.

The current focus on maintaining normal body temperature in the operating room makes the use of patient warming devices routine—or even mandatory—in many hospitals. Forced air warming devices such as the Bair Hugger (3M Healthcare, St. Paul, Minnesota) maintain or increase core temperature in patients during the perioperative period, with benefits that include reduced surgical wound infections, maintenance of normal coagulation, and faster discharge from the post-anesthesia care unit (PACU)1-5. However, some recent literature has raised concerns regarding a possible increased risk of deep surgical site infections specifically associated with the use of the forced air warming systems in the orthopaedic operating room5-12. One concern is that a convective device could disrupt unidirectional downward laminar airflow, which may be especially critical in joint arthroplasty operating rooms. This concern is based on theoretical mechanisms, laboratory simulations, retrospective case series, and studies showing potentially pathogenic organisms growing in the hoses and filters of forced air warming devices6-12. However, multiple other studies13-15 and a Continuing Education statement by the Association of periOperative Registered Nurses (AORN)16 suggest that proper use of the forced air warming devices mitigates or eliminates this risk while maximizing the benefits of patient warming. The purpose of the present manuscript is to review the current literature on the use of patient warming devices in orthopaedic surgery, specifically in joint arthroplasty. Hypothermia (core body temperature, <36°C) is a constant risk during general anesthesia because of factors such as impaired thermoregulation, heat loss secondary to a cold operating room, redistribution of body heat from the core to the vasodilated periphery, and infusion of cool intravenous fluids. Major adverse consequences of perioperative hypothermia can include adrenergic activation, myocardial ischemia, thermal discomfort, decreased drug metabolism, coagulopathy and increased …

Brain core temperature of patients with mild traumatic brain injury as assessed by DWI-thermometry.

IntroductionThe aim of this study was to assess the brain core temperature of patients with mild traumatic brain injury (mTBI) using a noninvasive temperature measurement technique based on the diffusion coefficient of the cerebrospinal fluid.MethodsThis retrospective study used the data collected from April 2008 to June 2011. The patient group comprised 20 patients with a Glasgow Coma Scale score of 14 or 15 who underwent magnetic resonance imaging within 30 days after head trauma. The normal control group comprised 14 subjects who volunteered for a brain checkup (known in Japan as “brain dock”). We compared lateral ventricular (LV) temperature between patient and control groups. Follow-up studies were performed for four patients.ResultsLV temperature measurements were successfully performed for both patients and controls. Mean (±standard deviation) measured LV temperature was 36.9 ± 1.5 °C in patients, 38.7 ± 1.8 °C in follow-ups, and 37.9 ± 1.2 °C in controls, showing a significant difference between patients and controls (P = 0.017). However, no significant difference was evident between patients and follow-ups (P = 0.595) or between follow-ups and controls (P = 0.465).ConclusionsA reduction in brain core temperature was observed in patients with mTBI, possibly due to a global decrease in metabolism.

Comparison of the efficacy of a forced-air warming system and circulating-water mattress on core temperature and post-anesthesia shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia.

BackgroundIn the present study, we compared changes in body temperature and the occurrence of shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia during warming with either a forced-air warming system or a circulating-water mattress.MethodsForty-six patients were randomly assigned to either the forced-air warming system (N = 23) or circulating-water mattress (N = 23) group. Core temperature was recorded using measurements at the tympanic membrane and rectum. In addition, the incidence and intensity of post-anesthesia shivering and verbal analogue score for thermal comfort were simultaneously assessed.ResultsCore temperature outcomes did not differ between the groups. The incidence (13.0 vs 43.5%, P < 0.05) and intensity (20/2/1/0/0 vs 13/5/3/2/0, P < 0.05) of post-anesthesia shivering was significantly lower in the forced-air system group than in the circulating-water mattress group.ConclusionsThe circulating-water mattress was as effective as the forced-air warming system for maintaining body temperature. However, the forced-air warming system was superior to the circulating-water mattress in reducing the incidence of post-anesthesia shivering.

Maintaining Perioperative Normothermia in the Patient Undergoing Cesarean Delivery

Anesthesia and surgery interfere with normal thermoregulation, and nearly all patients will become hypothermic unless compensatory measures are used. Preoperative patient warming and intraoperative methods using forced air and warmed intravenous fluids are important methods for maintaining patient's core temperature during the perioperative period. The benefits of maintaining normothermia include reductions in postoperative wound infection, the risk of perioperative coagulopathy, and myocardial ischemia. These advantages, demonstrated in patients undergoing general surgery, would be expected in patients undergoing gynecological surgery but have not been specifically studied in that population. Few studies have examined the maternal and neonatal effects of hypothermia after cesarean delivery. The results conflict as to the effectiveness of maternal warming techniques used to prevent it and the effects on neonatal temperature and acid-base status at delivery. Large prospective studies will be required to show significant effects on rates of maternal wound infection after cesarean delivery. European and American national obstetrical organizations have not published recommendations regarding the perioperative thermal regulation for cesarean delivery. We review the physiology of thermal regulation and perioperative thermal management in surgical patients and the literature that has examined perioperative maternal warming for cesarean delivery.

The accuracy of a disposable noninvasive core thermometer

Perioperative hypothermia is still a common occurrence, and it can be difficult to measure a patient's core temperature accurately, especially during regional anesthesia, with placement of a laryngeal mask airway device, or postoperatively. We evaluated a new disposable double-sensor thermometer and compared the resulting temperatures with those of a distal esophageal thermometer and a bladder thermometer in patients undergoing general and regional anesthesia, respectively. Furthermore, we compared the accuracy of the thermometer between regional and general anesthesia, since forehead microcirculation might differ between the two types of anesthesia. We assessed core temperature in 36 general anesthesia patients and 20 patients having regional anesthesia for orthopedic surgery. The temperatures obtained using the double-sensor thermometer were compared with those obtained with the distal esophageal thermometer in the general anesthesia population and those obtained with the bladder thermometer in regional anesthesia patients. In our general anesthesia patients, 90% (95% confidence interval [CI] 85 to 95) of all double-sensor values were within 0.5°C of esophageal temperatures. The average difference (bias) between the esophageal and double-sensor temperatures was -0.01°C. In patients undergoing regional anesthesia 89% (95% CI 80 to 97) of all double-sensor values were within 0.5°C of bladder temperatures. The average difference (bias) between the bladder and double-sensor temperatures was -0.13°C, limits of agreement were -0.65 to 0.40°C. In a perioperative patient population undergoing general or regional anesthesia, the accuracy of the noninvasive disposable double-sensor thermometer is comparable with that of the distal esophageal and bladder thermometers in routine clinical practice. Furthermore, the sensor performed comparably in patients undergoing regional and general anesthesia.

Difficult diagnosis of malignant hyperthermia during laparoscopic surgery

Difficult diagnosis of malignant hyperthermia during laparoscopic surgery

What influence does intermittent pneumatic compression of the lower limbs intraoperatively have on core hypothermia?

Intermittent pneumatic compression (IPC) devices have been widely used for thrombosis prophylaxis in laparoscopic colorectal surgery. However, periodic compression using an IPC device may inject augmented boluses of cool blood from the lower limbs into the central circulation repetitively, thereby causing a reduction in core temperature. The authors therefore conducted a prospective, randomized, double-blind, controlled study to compare the effects of intraoperative IPC on core temperature in patients undergoing laparoscopic colorectal surgery. For this study, 56 patients ages 18-60 years and scheduled to undergo laparoscopic resection for colorectal cancer under general anesthesia were randomly assigned to receive either no IPC (control group) or calf-thigh-length IPC in both legs using the SCD Express (IPC group). Anesthetic, thermal, and pneumoperitoneum management were standardized. Esophageal temperature, as an indicator of core temperature, was measured at 15-min intervals for 2 h after induction of anesthesia. A total of 47 subjects (23 control and 24 IPC subjects) were included in the analysis. The core temperature drop in the IPC group was significantly greater than in the control group, starting from 45 min after induction of anesthesia (P < 0.05). As a result, the total temperature drop during the 2-h study period was significantly greater in the IPC group (1.2 ± 0.3 °C) than in the control group (0.9 ± 0.3 °C) (P = 0.004). Because intraoperative application of IPC carries an increased risk of a core temperature drop, appropriate temperature monitoring and active thermal management are required for surgical patients receiving IPC.

Prospective evaluation of ambient operating room temperature on the core temperature of injured patients undergoing emergent surgery

Although uncomfortable for the operating team, trauma operating room (OR) temperatures have traditionally been kept warm in an attempt to mitigate intraoperative heat loss. The purpose of this study was to examine how ambient OR temperatures impact core temperature in patients undergoing emergent surgery for trauma. Injured adult patients requiring emergent surgery at a Level 1 trauma center were prospectively enrolled between July 2008 and January 2010. Standardized warming measures were used for all patients. Ambient OR temperature was recorded in 5-minute intervals with the Fourier Microlog EC600 temperature data logger. Intraoperative core patient temperatures were compared with ambient OR temperature. Patients experiencing intraoperative core temperature decreases were compared with those who did not, to examine the impact of ambient temperature changes on the risk of perioperative hypothermia. During the 18-month study period, 118 patients requiring emergent surgery (73% laparotomy, 5% thoracotomy, 7% combined, 15% other) were enrolled. Incidence of hypothermia (<35°C) at admission to the OR was 29.7%. Crude mortality increased as the final patient core temperature achieved in the OR decreased (4.2% for temperatures >35°C and as high as 50% for temperatures ≤32°C). Overall, core temperature decreased in 46 patients (39.0%) but remained stable or increased by the end of the procedure in 72 (61%). There were no significant differences in the admission temperature, clinical demographics, or volume of fluids and blood products between the two groups. In a forward logistic regression analysis, a lower ambient OR temperature was not associated with a drop in the patient's core temperature. In this prospective study, the ambient OR temperature did not affect the core temperature of injured patients undergoing emergent surgery. Prognostic study, level III; therapeutic study, level IV.

Local Insufflation of Warm Humidified CO2 Increases Open Wound and Core Temperature During Open Colon Surgery

The open surgical wound is exposed to cold and dry ambient air resulting in heat loss through radiation, evaporation, and convection. Also, general and neuraxial anesthesia decrease the patient's core temperature. Despite routine preventive measures mild intraoperative hypothermia is still common and contributes to postoperative morbidity and mortality. We hypothesized that local insufflation of warm fully humidified CO(2) would increase both the open surgical wound and core temperature. Eighty-three patients undergoing open colon surgery were equally and parallelly randomized to either standard warming measures including forced-air warming, warm fluids, and insulation of limbs and head, or to additional local wound insufflation of warm (37°C) humidified (100% relative humidity) CO(2) at a laminar flow (10 L/min) via a gas diffuser. Wound surface and core temperatures were followed with a heat-sensitive infrared camera and a tympanic thermometer. The mean wound area temperature during surgery was 31.3°C in the warm humidified CO(2) group compared with 29.6°C in the control group (P < 0.001, 95% confidence interval [CI], 1.2°C to 2.3°C). Also, the mean wound edge temperature during surgery was 30.1°C compared with 28.5°C in the control group (P < 0.001, 95% CI, 0.2°C to 0.7°C). Mean core temperature before start of surgery was similar with 36.7°C ± 0.5°C in the warm humidified CO(2) group versus 36.6°C ± 0.5°C in the control group (95% CI, 0.4 to -0.1°C). At end of surgery, the 2 groups differed significantly with 36.9 ± 0.5°C in the warm humidified CO(2) group versus 36.3 ± 0.5°C in the control group (P < 0.001, 95% CI, 0.38°C to 0.82°C). Moreover, only 8 patients of 40 in the warm humidified CO(2) group had a core temperature <36.5°C (20%, 95% CI, 7 to 33%), whereas in the control group this was the case in 24 of 39 (62%, 95% CI, 46% to 78%, P = 0.001) patients (difference of the percentages between the groups 42%, 95% CI, 22% to 61%, P < 0.001). With a cutoff at <36.0°C none of the patients in the warm humidified CO(2) group compared with 7 patients (18%, 95% CI, 5% to 31%, P = 0.005) in the control group was hypothermic at end of surgery (difference of the percentages between the groups 18%, 95% CI, 6% to 30%, P = 0.005). The median (25th/75th percentile) operating time was 181.5 (147.5/288) minutes in the warm humidified CO(2) group versus 217 (149/288) minutes in the control group (P = 0.312). Clinical variables did not show any significant differences between the groups. Insufflation of warm fully humidified CO(2) in an open surgical wound cavity increases surgical wound and core temperatures and helps to maintain normothermia.

Intraoperative Local Insufflation of Warmed Humidified CO2 Increases Open Wound and Core Temperatures: A Randomized Clinical Trial

The open surgical wound is exposed to cold dry ambient air, resulting in substantial heat loss through radiation, evaporation, and convection. At the same time, anesthesia decreases the patient's core temperature. Despite preventive measures, mild intraoperative hypothermia has been associated with postoperative morbidity. We hypothesized that local insufflation of warmed humidified carbon dioxide (CO(2)) would maintain wound and core temperature. Eighty patients undergoing open colon surgery were randomized to standard warming measures, or to additional local wound insufflation of warmed (30 °C) humidified (93 % rH) CO(2) via a gas diffuser. Surface temperature of the open abdominal wound was measured with a heat-sensitive infrared camera, and core temperature was measured with an ear thermometer. Mean operative time was 219 ± 104 and 205 ± 85 min in the CO(2) group and the control group, respectively (p = 0.550). Clinical variables did not differ significantly between the groups. The median wound area and wound edge temperatures were 1.2 °C (p < 0.001) and 1.0 °C (p = 0.002) higher in the CO(2) group, respectively, than in the control group. The mean core temperature after intubation was the same (35.9 °C) in both groups, but at end of surgery core temperature in the two groups differed, with a mean of 36.2 ± 0.5 °C in the CO(2) group and a mean of 35.8 ± 0.5 °C in the control group (p = 0.003). Insufflation of warmed, humidified CO(2) in an open surgical wound cavity prevents intraoperative decrease in surgical wound temperature as well as core temperature.

Maintaining Perioperative Normothermia in the Patient Undergoing Cesarean Delivery

Anesthesia and surgery interfere with normal thermoregulation, and nearly all patients will become hypothermic unless compensatory measures are used. Preoperative patient warming and intraoperative methods using forced air and warmed intravenous fluids are important methods for maintaining patient's core temperature during the perioperative period. The benefits of maintaining normothermia include reductions in postoperative wound infection, the risk of perioperative coagulopathy, and myocardial ischemia. These advantages, demonstrated in patients undergoing general surgery, would be expected in patients undergoing gynecological surgery but have not been specifically studied in that population. Few studies have examined the maternal and neonatal effects of hypothermia after cesarean delivery. The results conflict as to the effectiveness of maternal warming techniques used to prevent it and the effects on neonatal temperature and acid-base status at delivery. Large prospective studies will be required to show significant effects on rates of maternal wound infection after cesarean delivery. European and American national obstetrical organizations have not published recommendations regarding the perioperative thermal regulation for cesarean delivery. We review the physiology of thermal regulation and perioperative thermal management in surgical patients and the literature that has examined perioperative maternal warming for cesarean delivery.

Hyperthermic intrapleural chemotherapy combined with endostar by video-assisted thoracoscopic surgery for lung adenocarcinoma with pleural dissemination.

e17542 Background: Patients with lung adenocarcinoma and malignant pleural effusions have limited life expectancy. The treatment of lung adenocarcinoma with malignant pleural effusions remains controversial. The purpose of our study is to evaluate the use of video-assisted thoracoscopy to perform hyperthermic intrapleural chemotherapy combined with Endostar (recombinant human endostatin) for disseminated pleural adenocarcinoma. Methods: From 2007 to 2010, there were 46 patients with lung adenocarcinoma and pleural dissemination undergoing thoracoscopic surgery and intrathoracic hyperthermic perfusion with chemotherapy in combination of Endostar. After thoracoscopic surgery, the hyperthermic perfusion system was set up for hyperthermic intrapleural chemotherapy. The thoracic cavity was perfused at a speed of approximately 1.8-2.3 L/min with 0.9% normal saline (4-5L), containing cisplatinum (100 mg). The intrathoracic temperature remained between 42°C to 43°C. This process of perfusion lasted for 1 hours. Following this, 2L of 0.45% saline with Endostar (30 mg) at a temperature of 30 °C was put into the pleural cavity and kept for 30 min. Results: There were no peri-operative deaths. During the hyperthermic perfusion, patient's core temperature varied from 36.3ºC and 39.3ºC and pulse from 59 beats/m and 126 beats/m. Intraoperative sinus tachycardia occurred in 2 elderly cases. No hematologic toxicity and nephrotoxicity was observed within one week after surgery. Postoperative pneumonia occurred in 1 elderly case. The median survival time was 21 months. During the follow-up period, only one patient suffered from continuing pleural effusion due to atelectasis, one elderly patient died of heart failure one year after surgery and the remaining patients were completely free from pleural effusion during the last follow-up. Conclusions: Hyperthermic intrapleural chemotherapy combined with Endostar by thoracoscopic surgery offers a safe and effective treatment for lung adenocarcinoma with pleural dissemination. It may be time-consuming, but beneficial and may have an encouraging impact on its long-term survival.

Blanket Warmers Revisited And Temporal Thermometers

I wrote about this in the January/February issue. While I noted that the ECRI Institute recommends that blanket warmers be set no higher than 130F, my explanation of other material on this issue was not clear. The ECRI Institute reached out to me about this, so I'd like to revisit my answer in the interest of patient safety.I had found another article online that concluded temperatures can be set as high as 200F. A key piece of information that I neglected to consider when passing on this information is that the article I looked at addressed the comfort of conscious patients. As patient safety advocates, we must consider what would happen to a patient who is unconscious (or a sensory compromised patient), and cannot verbalize that the blanket placed is too hot. We must also consider the very reason we are using a warmed blanket in the first place. We are not trying to raise the patient's core temperature, but we are trying to minimize the loss of body heat and therefore give the patient a feeling of comfort.Also, while The Joint Commission does not regulate temperature settings for blanket warmer cabinets, it does make note of the ECRI recommendation of 130F. Therefore, the best thing to do is to set those warming cabinets at 130F.ECRI's Mark Bruley, vice president of accident and forensic investigation, adds: “There are common misperceptions among clinicians and blanket warmer vendors about the thermodynamics of heat transfer, patient warming, and the onset of skin burns at moderate temperatures … A temperature of 200F, even in a fluffy blanket, certainly can burn patients. Burns to patients from cloth blankets heated to lower temperatures have done so when the blanket was not unfolded. There is no way to ensure the safe application of a blanket heated above 130F.”We do allow the use of temporal thermometers at our hospital in some areas. Biomedical technicians are not really in the business of making clinical decisions. It is my experience that clinical decisions should be left to clinical professionals. Of course, I am assuming you have the clinical staff to do the research as we have at my hospital. That being said, here is a quick synopsis of how the temporal thermometer works and why our hospital believes it can be used in certain areas.The temporal artery runs very close to the temporal area on the side of the head. This artery is very superficial, lying about 1mm below the skin. The fact that it is so superficial means that it conducts heat very easily to the surface of the skin. And since the artery does not branch off anywhere, the perfusion is high and stable which means the temperature will be more reliable than it might be at near other vessels. Infrared energy is used against a known constant to provide a temperature reading.Our hospital, after much research, has allowed the use of these thermometers in areas where temperatures are taken at a high volume and where there is also another type temperature being recorded at a longer interval. We use them as the recovery room and intensive care. We add them to inventory. We also check them periodically because if they are not cleaned the reading reliability drops markedly. We check them every six months because we have had a high corrective rate on these units. We also educate staff about the cleaning of these units.