Urinary Bladder Temperature Research Articles

Comparison of Wireless Continuous Axillary and Core Temperature Measurement after Major Surgery.

Temperature is considered one of the primary vital signs for detection of complications such as infections. Continuous wireless real-time axillary temperature monitoring is technologically feasible at the general ward, but no clinical validation studies exist. This study compared axillary temperature with a urinary bladder thermometer in 40 major abdominal postoperative patients. The primary outcome was changes in axillary temperature registrations. Secondary outcomes were mean bias between the urinary bladder and the axillary temperatures. Intermittent frontal and tympanic temperature recordings were also collected. Forty patients were monitored for 50 min with an average core temperature of 36.8 °C. The mean bias was -1.0 °C (LoA -1.9 to -0) after 5 min, and -0.8 °C (LoA -1.6 to -0.1) after 10 min when comparing the axillary temperature with the urinary bladder temperature. After 20 min, the mean bias was -0.6 °C (LoA -1.3-0.1). During upper arm abduction, the axilla temperature was reduced to -1.6 °C (LoA -2.9 to -0.3) within 1 min. Temporal skin temperature measurement had a resulted in a mean bias of -0.1 °C (LOA -1.1 to -1.0) compared with central temperature. Compared with the mean tympanic temperature, it was -0.1 °C (LoA -0.9 to -1.0) lower than the urinay bladder temperature. Axillary temperature increased with time, reaching a mean bias of 1 °C between axillary and core temperature within 5 min. Opening the axillary resulted in rapidly lower temperature recordings. These findings may aid in use and designing corrections for continuous axillary temperature monitoring.

BODY TEMPERATURE VARIATION AFTER PACKED CELL TRANSFUSION IN ADULT PATIENTS WITH SEPSIS-WHERE WILL THE PENDULUM STOP?

Background : Critically ill patients with sepsis often require packed cell transfusions (PCTs). Packed cell transfusion causes changes in body's core temperature. Objective : To trace the course and amplitude of body core temperature after PCT in adults with sepsis. Methods : We conducted a population-based retrospective cohort study of patients with sepsis who received one unit of PCT during their hospitalization in a general intensive care unit during 2000-2019. A control group was established by matching each of these patients to a patient who did not receive PCT. We calculated the mean values of urinary bladder temperature for the 24 h before and 24 h after PCT. To evaluate the effect of PCT on body core temperature, multivariable analyses using a mixed linear regression model were performed. Results : The study comprised 1,100 patients who received one unit of PCT and 1,100 matched patients. The mean temperature before PCT was 37.3°C. Immediately from initiation of PCT, body temperature decreased, to a minimum of 37.0°C. During the 24 subsequent hours, the temperature increased gradually and consistently, until a peak temperature of 37.4°C. In a linear regression model, body core temperature increased by a mean 0.06°C in the first 24 h after PCT and decreased by a mean 0.65°C for every 1.0°C increase before PCT. Conclusions : Among critically ill patients with sepsis, PCT itself causes only mild and clinically insignificant temperature changes. Thus, significant changes in core temperature during the 24 h after PCT may indicate an unusual clinical event that requires clinicians' immediate attention.

Comparison of temperature measurements in esophagus and urinary bladder in comatose patients after cardiac arrest undergoing mild therapeutic hypothermia.

Mild therapeutic hypothermia (MTH) is a recommended method of treatment for comatose out-of-hospital cardiac arrest (OHCA) survivors. However, the proper site of temperature measurement in MTH is still not defined. The aim of this study was to compare temperature measurements in the esophagus and urinary bladder in comatose post-OHCA patients treated with MTH. This temperature comparison protocol was a part of a prospective, observational, multicenter cohort study. The study population included 36 unconscious patients after resuscitation for OHCA. The patient's core temperature was independently measured every hour during MTH in the urinary bladder and in the esophagus. The mean temperature was lower in the esophagus (differences during induction phase: 1.04 ± 0.92°C, p < 0.0001; stabilization phase: 0.54 ± 0.39°C, p < 0.0001; rewarming phase: 0.40 ± 0.47°C, p < 0.0001). Nevertheless, a strong correlation between both sites was found (R2 = 0.83, p < 0.001). The decrease in temperature observed in the esophagus during the induction phase was faster when compared with the urinary bladder (1.09 ± 0.71°C/h vs. 0.83 ± 0.41°C/h; p = 0.002). As a consequence, time to reach temperature < 34.0°C was longer when temperature was measured in the urinary bladder (the difference between medians of the time 1.0 [0-1.5] h, p < 0.001). Urinary bladder temperature measurements may lag behind temperature changes measured in the esophagus. Monitoring temperature simultaneously in the esophagus and in the urinary bladder is an accessible and reliable combination, although esophageal measurements seem to better reflect the dynamics of temperature changes, thus it seems to be more appropriate for MTH control. ClinicalTrials.gov Identifier: NCT02611934.

Body surface and body core temperatures and their associations to haemodynamics: The BOSTON-I-study: Validation of a thermodilution catheter (PiCCO) to measure body core temperature and comparison of body surface temperatures to thermodilutionderived Cardiac Index.

Assessment of peripheral perfusion and comparison of surface and body core temperature (BST; BCT) are diagnostic cornerstones of critical care. Infrared non-contact thermometers facilitate the accurate measurement of BST. Additionally, a corrected measurement of BST on the forehead provides an estimate of BCT (BCT_Forehead). In clinical routine BCT is measured by ear thermometers (BCT_Ear). The PiCCO-device (PiCCO: Pulse contour analysis) provides thermodilution-derived Cardiac Index (CI_TD) using an arterial catheter with a thermistor tip in the distal aorta. Therefore, the PiCCO-catheter might be used for continuous BCT-measurement (BCT_PiCCO) in addition to intermittent CI-measurement. To the best of our knowledge, BCT_PiCCO has not been validated compared to standard techniques of BCT-measurement including measurement of urinary bladder temperature (BCT_Bladder). Therefore, we compared BCT_PiCCO to BCT_Ear and BCT_Bladder in 52 patients equipped with the PiCCO-device (Pulsion; Germany). Furthermore, this setting allowed to compare different BSTs and their differences to BCT with CI_TD. BCT_PiCCO, BCT_Ear (ThermoScan; Braun), BCT_Bladder (UROSID; ASID BONZ), BCT_Forehead and BSTs (Thermofocus; Tecnimed) were measured four times within 24h. BSTs were determined on the great toe, finger pad and forearm. Immediately afterwards TPTD was performed to obtain CI_TD. 32 (62%) male, 20 (38%) female patients; APACHE-II 23.8 ±8.3. Bland-Altman-analysis demonstrated low bias and percentage error (PE) values for the comparisons of BCT_PiCCO vs. BCT_Bladder (bias 0.05 ±0.27° Celsius; PE = 1.4%), BCT_PiCCO vs. BCT_Ear (bias 0.08 ±0.38° Celsius; PE = 2.0%) and BCT_Ear vs. BCT_Bladder (bias 0.04 ±0.42° Celsius; PE = 2.2). While BCT_PiCCO, BCT_Ear and BCT_Bladder can be considered interchangeable, Bland-Altman-analyses of BCT_Forehead vs. BCT_PiCCO (bias =-0.63 ±0.75° Celsius; PE = 3.9%) Celsisus, BCT_Ear (bias = -0.58 ±0.68° Celsius; PE = 3.6%) and BCT_Bladder (bias = -0.55 ±0.74° Celsius; PE = 3.9%) demonstrate a substantial underestimation of BCT by BCT_Forehead. BSTs and differences between BCT and BST (DCST) significantly correlated with CI_TD with r-values between 0.230 and 0.307 and p-values between 0.002 and p < 0.001. The strongest association with CI_TD was found for BST_forearm (r = 0.307; p < 0.001). In a multivariate analysis regarding CI_TD and including biometric data, BSTs and and their differences to core-temperatures (DCST), only higher temperatures on the forearm and the great toe, young age, low height and male gender were independently associated with CI_TD. The estimate of CI based on this model (CI_estimated) correlated with CI_TD (r = 0.594; p < 0.001). CI_estimated provided large ROC-areas under the curve (AUC) regarding the critical thresholds of CI_TD ≤ 2.5 L/min/m2 (AUC = 0.862) and CI_TD ≥ 5.0 L/min/m2 (AUC = 0.782). 1.) BCT_PiCCO, BCT_Ear and BCT_Bladder are interchangeable. 2.) BCT_Forehead significantly underestimates BCT by about 0.5° Celsius. 3.) All measured BSTs and DCSTs were significantly associated with CI_TD. 4.) CI_estimated is promising, in particular for the prediction of critical thresholds of CI.

Safety, Feasibility, and Hemodynamic Effects of Mild Hypothermia in Transcatheter Aortic Valve Replacement: The TAVR-CHILL Trial.

The safety, feasibility, and hemodynamic effects of mild hypothermia (MH) induced by transnasal cooling were studied in transcatheter aortic valve replacement (TAVR). MH is a common therapy following cardiac arrest and seems to have favorable effects in myocardial infarction and on hemodynamic stability. In TAVR, hemodynamic instability is common during rapid pacing. Twenty subjects undergoing TAVR were randomized 1:1 to hypothermia or normothermia. Hemodynamic endpoints were mean arterial blood pressure and required dosage of vasoactive and inotropic drugs. Patients were followed up at 6 months. All patients in the MH group (n=10) reached the target temperature of 34°C before first rapid pacing. Tympanic and urinary bladder temperature remained significantly lower in the MH group during the procedure. No adverse effects of cooling were observed. Mean arterial pressure was higher in the MH group (90±20 mm Hg) than in the control group (71±13 mm Hg) at the start of the procedure, at first rapid pacing (94±19 vs. 80±16 mm Hg), and at balloon aortic valvuloplasty (90±17 vs. 73±14 mm Hg). Less norepinephrine was administered to the hypothermia group. Transnasal cooling during TAVR was safe and well tolerated. We observed a more stable hemodynamic profile in the MH group, indicated by higher blood pressure and lower levels of vasoactive drugs required. A larger study of patients with severe ventricular dysfunction is required to more comprehensively investigate the hemodynamic effects of transnasal cooling in TAVR.

Application of urinary bladder temperature monitoring among patients with different cardiac operations

Objective To investigate the value of urinary bladder temperature monitoring among patients with cardiac surgery, and provide reference for clinical perioperative temperature nursing. Methods A total of 60 patients undergoing open cardiac surgery of beating coronary artery bypass grafting (30 with extracorporeal circulation and 30 without extracorporeal circulation) were included in our study during the period of October 2010 to October 2013. Body temperature was monitored at 9 time points during the operation at urinary bladder (BT), rectum (RT), lower esophagus (LT) and nasopharynx (NT), axillary cavity (AT), and compared and analyzed with standard blood temperature (BT) after inserting Swan-Ganz catheter. Results During open cardiac surgery of without extracorporeal circulation, different time of BT, RT, NT, LET had a uniformity of temperature change with blood temperature with no statistical significance (P>0.05), but the AT was lower than BT. In the open cardiac surgery of extracorporeal circulation, the differences between UT, LT, RT and BT had no statistical significance during constant temperature period (P>0.05). During the rapid decrease phase of BT and end of rewarming phase, we painted Bland-Altman picture for different part of body temperature with BT, found that the the difference between LT and BT were (-7.23±2.70) and (0.25±1.05)℃, the difference between RT with BT were (-1.38±1.19), (0.96±2.11)℃, and the difference between UT and BT were (0.37±1.24), (0.52±1.28)℃. Conclusions DynamicUBT monitoring can effecitively reflect core temperature in heart surgery, especially during the temperature rapid decrease phase and rewarming phase for the open cardiac operation of extracorporeal circulation, it is important to guide body temperature nursing in clinical. Key words: Urinary bladder temperature; Dynamic monitoring; Cardiac surgery

The impact of intraoperative hypothermia on early postoperative adverse events after radical esophagectomy for cancer: a retrospective cohort study.

To investigate the correlation between intraoperative body temperature and postoperative adverse effects in patients who underwent esophagectomy procedures. Retrospective cohort study. University Hospital. One hundred twenty-one patients undergoing esophagectomy were enrolled. None. Various perioperative and intraoperative variables were recorded. Hypothermia was defined as a urinary bladder temperature<35°C. Multiple logistic regression analysis was conducted to identify independent significant predictors of postoperative complications. In addition, the authors also determined a cutoff point for intraoperative minimum urinary bladder temperature by analyzing receiver operating characteristic (ROC) curves for occurrence of adverse events at 1 month after surgery. No patients died within 1 month after the surgery. There were 53 patients with early postoperative complications, and 51 had experienced intraoperative hypothermia. Factors that were correlated significantly with complications included age (p=0.02); hypothermia (p<0.01); and doses of ephedrine (p<0.01), phenylephrine (p<0.01), and fentanyl (p<0.01). Multiple logistic regression analysis identified intraoperative hypothermia as a significant independent predictor for the development of early perioperative complications (odds ratio 2.57; 95% confidence interval 1.09-6.08). The area under the ROC curve for body temperature was 0.71, and the cutoff point was 35°C (sensitivity=0.65, specificity=0.72). Intraoperative hypothermia was identified as an independent risk factor for early postoperative adverse events following esophagectomy.

Relationship between blood, nasopharyngeal and urinary bladder temperature during intravascular cooling for therapeutic hypothermia after cardiac arrest

ObjectivesTherapeutic hypothermia improves survival and neurological outcome in patients successfully resuscitated after cardiac arrest. Accurate temperature control during cooling is essential to prevent cooling-related side effects. MethodsProspective observational study of 12 patients assessed during therapeutic hypothermia (32–34°C) achieved by intravascular cooling following cardiac arrest. Simultaneous temperature measurements were taken using a Swan–Ganz catheter (blood temperature BLT), nasopharyngeal probe (nasopharyngeal temperature NPT) and the urinary bladder catheter (urinary bladder temperature UBT). A total of 1728 measurements (144 measurements per patient) were recorded over a 48-h period and analyzed. Blood temperature was considered as the reference measurement. ResultsTemperature profiles obtained from BLT, NPT and UBT compared with the use of analysis of variance did not differ significantly. Pearson correlation revealed that the correlation between BLT and NPT as well as BLT and UBT was statistically significant (r=0.96, p<0.001 and r=0.95, p<0.001, respectively). Bland–Altman analysis proved that the agreement between all measurements was satisfactory and the differences were not clinically important. ConclusionsIn 12 post-cardiac arrest patients undergoing intravascular cooling, both nasopharyngeal and urinary bladder temperature measurements were similar to blood temperatures measured using a pulmonary artery catheter.

Keep the Brain Cool—Endovascular Cooling in Patients With Severe Traumatic Brain Injury: A Case Series Study

As brain temperature is reported to be extensively higher than core body temperature in traumatic brain injury (TBI) patients, posttraumatic hyperthermia is of particular relevance in the injured brain. To study the influence of prophylactic normothermia on brain temperature and the temperature gradient between brain and core body in patients with severe TBI using an intravascular cooling system and to assess the relationship between brain temperature and intracranial pressure (ICP) under endovascular temperature control. Prospective case series study conducted in the neurologic intensive care unit of a tertiary care university hospital. Seven patients with severe TBI with a Glasgow Coma Scale score of 8 or less were consecutively enrolled. Prophylactic normothermia, defined as a target temperature of 36.5°C, was maintained using an intravascular cooling system. Simultaneous measurements of brain and urinary bladder temperature and ICP were taken over a 72-hour period. The mean bladder temperature in normothermic patients was 36.3 ± 0.4°C, and the mean brain temperature was determined as 36.4 ± 0.5°C. The mean temperature difference between brain and bladder was 0.1°C. We found a significant direct correlation between brain and bladder temperature (r = 0.95). In 52.4% of all measurements, brain temperature was higher than core body temperature. The mean ICP was 18 ± 8 mm Hg. Intravascular temperature management stabilizes both brain and body core temperature; prophylactic normothermia reduces the otherwise extreme increase of intracerebral temperature in patients with severe TBI. The intravascular cooling management proved to be an efficacious and feasible method to control brain temperature and to avoid hyperthermia in the injured brain. We could not find a statistically significant correlation between brain temperature and ICP.

Treatment of Resistant Fever: New Method of Local Cerebral Cooling

Fever in neurocritical care patients is common and has a negative impact on neurological outcome. The purpose of this prospective observational study was (1) to evaluate the practicability of cooling with newly developed neck pads in the daily setting of neurointensive care unit (NICU) patients and (2) to evaluate its effectiveness as a surrogate endpoint to indicate the feasibility of neck cooling as a new method for intractable fever. Nine patients with ten episodes of intractable fever and aneurysmal subarachnoid hemorrhage were treated with one of two different shapes of specifically adapted cooling neck pads. Temperature values of the brain, blood, and urinary bladder were taken close meshed after application of the cooling neck pads up to hour 8. The brain, blood, and urinary bladder temperatures decreased significantly from hour 0 to a minimum in hour 5 (P < 0.01). After hour 5, instead of continuous cooling in all the patients, the temperature of all the three sites remounted. This study showed the practicability of local cooling for intractable fever using the newly developed neck pads in the daily setting of NICU patients.

The influence of juvenile capsaicin desenzitization on different sensory processes

Event Abstract Back to Event The influence of juvenile capsaicin desenzitization on different sensory processes Gábor Tuboly1*, Gabriella Kékesi1, Gabor Adam1, Gyorgy Benedek1 and Gyöngyi Horváth1 1 Department of Physiology, University of Szeged, Hungary Introduction: Several data suggest that neonatal versus adult capsaicin desensitization leads to different phenotypes in some respects. The goal of this study was to reveal the effects of high dose capsaicin treatment on different parameters (pain sensitivity, thermoregulation, visceral function) in young but not neonate animals. Methods: 21 days old male Wistar rats, after weaning, were injected for 4 days with capsaicin in increasing doses of 10, 20 50 and 100 mg/kg intraperitoneally. Control animals received physiological saline. The animals were followed up for 3 months and we determined the body weight, the blepharosmasm and paw wiping reflex of the eye exposed to diluted capsaicin, changes in acute and inflammatory pain sensitivity, volume of the urinary bladder and body temperature. Results: The body weight of capsaicin-treated animals decreased temporarily compared to the control group. Capsaicin-treated animals had complete abolishment of eye-wipe responses and blepharospasm, suggesting that desensitization prevented the painful effects of capsaicin eye drops. Both heat and mechanical acute pain sensitivity augmented while pain threshold in inflamed limbs diminished. Ultrasound examination of urinary bladder revealed that the volume was significantly larger compared to untreated animals. Disturbance in thermoregulation has been also observed since desensitized rats had higher body temperature. Our results suggest that juvenile capsaicin desensitization produced sustained changes in several physiological parameters, and these changes are similar to alterations observed after adult capsaicin desensitization. This work was supported by the National Research and development Office, Hungary (OMFB-0066/2005/DNT) and a Hungarian Research Grant (OTKA, K60278). Conference: 12th Meeting of the Hungarian Neuroscience Society, Budapest, Hungary, 22 Jan - 24 Jan, 2009. Presentation Type: Poster Presentation Topic: Pathophysiology and neurology - non-degenerative disorders Citation: Tuboly G, Kékesi G, Adam G, Benedek G and Horváth G (2009). The influence of juvenile capsaicin desenzitization on different sensory processes. Front. Syst. Neurosci. Conference Abstract: 12th Meeting of the Hungarian Neuroscience Society. doi: 10.3389/conf.neuro.01.2009.04.042 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 27 Feb 2009; Published Online: 27 Feb 2009. * Correspondence: Gábor Tuboly, Department of Physiology, University of Szeged, Szeged, Hungary, corp120@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Gábor Tuboly Gabriella Kékesi Gabor Adam Gyorgy Benedek Gyöngyi Horváth Google Gábor Tuboly Gabriella Kékesi Gabor Adam Gyorgy Benedek Gyöngyi Horváth Google Scholar Gábor Tuboly Gabriella Kékesi Gabor Adam Gyorgy Benedek Gyöngyi Horváth PubMed Gábor Tuboly Gabriella Kékesi Gabor Adam Gyorgy Benedek Gyöngyi Horváth Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Urinary bladder and oesophageal temperatures correlate better in patients with high rather than low urinary flow rates during non-cardiac surgery

To investigate the effect of urinary flow rate on the urinary bladder temperature, we compared the accuracy and precision of urinary bladder temperature with oesophageal temperature at both high and low urine flow rates. Twenty-four patients ASA physical status I or II who were undergoing tympanoplasty were randomly assigned to two groups with different intravenous fluid volumes: high (10 mL kg(-1) h(-1), n = 12) and low (3 mL kg(-1) h(-1), n = 12). General anaesthesia was induced with propofol and maintained with sevoflurane (1.5-2.5%) in nitrous oxide and oxygen. Urinary bladder temperature was measured using a Foley urinary catheter; distal oesophageal temperature was measured using a stethoscope thermocouple. These temperatures were measured every 5 min during surgery and the accuracy and precision of urinary bladder temperature with oesophageal temperature were determined using regression and Bland and Altman analyses. The correlation coefficient for oesophageal and urinary bladder temperature was 0.90 in the high urinary volume group and 0.75 in the low urinary volume group. The offset (oesophageal-urinary bladder) was -0.13 +/- 0.32 degrees C and -0.46 +/- 0.45 degrees C, respectively. Urinary bladder temperature appears to be more accurate at high urinary flow rates than at low urinary flow rates for clinical use.

The Effects of Temperature Monitoring Methods and Thermal Management Methods during Spinal Surgery

The precise measurement of body temperature during anesthesia is important to prevent hypothermia.The aim of this study was to compare the urinary bladder temperature to the esophageal, nasopharyngeal, rectal and skin temperatures, and to compare three heating methods during spine surgery. Methods:Forty-two patients with ASA physical status I−II, who were scheduled to undergo spine surgery in the prone position, were included in this study.The patients were randomly divided into 4 groups:Group I was treated without any heating methods; group 2, with fluid-warmers; group 3, with forced air-warmers; and group 4, with a combination of both heating methods.After the induction of anesthesia, the esophageal, nasopharyngeal, rectal, urinary bladder and skin temperature was monitored every 15 minute for 3 hours.The urinary bladder temperature was compared to the esophageal, nasopharyngeal, rectal and skin temperatures. Results:The urinary bladder temperature was found to be higher than the esophageal and the nasopharyngeal temperatures (P ＜ 0.01).The urinary bladder temperature of group 3 was higher than that of group 1 at 180 minutes after induction of anesthesia (P ＜ 0.05).The urinary bladder temperature of group 4 was higher than that of group 1 at 150 minutes (P ＜ 0.05), as well as at 165 and 180 minutes (P ＜ 0.05).The skin temperatures of groups 3 and 4 were higher than group 1 (P ＜ 0.001). Conclusions:The urinary bladder temperature was higher than the esophageal temperature and correlated with the esophageal, nasopharyngeal and rectal temperatures.During spine surgery in the prone position, a forced air-warmer was found to be the most effective but a combination of all the methods tested was found to be even more effective

Core and skin surface temperature course after normothermic and hypothermic cardiopulmonary bypass and its impact on extubation time

Cardiopulmonary bypass is associated with temperature pertubations that influence extubation time. Common extubation criteria demand a minimum value of core temperature only. The aim of this prospective study was to test the hypothesis that changes in core and skin surface temperature are related to extubation time in patients following normothermic and hypothermic cardiopulmonary bypass. Forty patients undergoing cardiac surgery were studied; 28 patients had normothermic cardiopulmonary bypass (nasopharyngeal temperature >35.5 degrees C) and 12 had hypothermic cardiopulmonary bypass (28-34 degrees C). In the intensive care unit, urinary bladder temperature and skin surface temperature gradient (forearm temperature minus fingertip temperature: >0 degrees C = vasoconstriction, < or =0 degrees C = vasodilatation) were measured at 30-min intervals for 10 h postoperatively. At the same intervals, the patients were evaluated for extubation according to common extubation criteria. On arrival in the intensive care unit the mean urinary bladder temperature was 36.8 +/- 0.5 degrees C in the normothermic group and 36.4+/-0.3 degrees C in the hypothermic group (P = 0.014). The skin surface temperature gradient indicated severe vasoconstriction in the both groups. The shift from vasoconstriction to vasodilatation was faster in normothermic cardiopulmonary bypass patients (138+/-65 min) than in patients after hypothermic cardiopulmonary bypass (186+/-61 min, P = 0.034). There was a linear relation between the time to reach a skin surface temperature gradient = 0 degrees C and extubation time (r2 = 0.56, normothermic group; r2 = 0.82, hypothermic group). The transition from peripheral vasoconstriction to vasodilatation is related to extubation time in patients following cardiac surgery under normothermic as well as hypothermic cardiopulmonary bypass.

Axillary and tympanic membrane temperature measurements are unreliable early after cardiopulmonary bypass

Inaccurate measurements of body temperature following cardiopulmonary bypass may be associated with serious complications. The purpose of this study was to determine whether axillary and tympanic temperature measurements correlate with the urinary bladder temperature in the early postcardiac surgery period. Forty-nine adult patients who underwent cardiac surgery under cardiopulmonary bypass at our institution were prospectively studied. Urinary bladder, right axillary, right tympanic and left tympanic temperature measurements were simultaneously recorded at 0, 6, 12 and 18 h following cardiopulmonary bypass. Patients had one to four sets of recordings and a total of 629 temperature measurements were recorded. The mean difference (bias) between the bladder and each of the other methods and limits of agreement were calculated using Bland and Altman method. The mean core body temperature recorded from the bladder on admission to the intensive care unit was 36.4 degrees C. After 6, 12 and 18 h the mean core body temperature was 37.4 degrees C (range: 35.2-39.0), 37.5 degrees C and 37.45 degrees C, respectively. The mean differences (bias) between the bladder temperature and the other three methods were: left tympanic, 0.65 degrees C (95% CI: -0.24 to 1.58); right tympanic, 0.57 degrees C (95% CI: -0.48 to 1.63) and right axillary, 0.55 degrees C (95% CI: -0.27 to 1.36). The axilla and tympanic membrane are unreliable sites for core body temperature measurement early after cardiopulmonary bypass in adult patients and clinical decisions should be based on more reliable methods.

The effect of urine flow rate on urinary bladder temperature in critically ill adults

This study determined the effect of urine flow rate on bladder temperature in critically ill adults. The design was pretest-posttest quasi-experimental. The study took place at a tertiary care center in western Washington. Convenience sampling resulted in an intervention group of 35 and a control group of 25 patients who had undergone cardiac surgery. A diuretic, administered intravenously as part of usual postoperative care, provided variation in the urine flow rate. Urinary bladder temperature (UBT), pulmonary artery temperature (PAT), and urine flow rate data were collected at 2-minute intervals for 60 minutes preintervention and 60 minutes postintervention. Unlike the control group, who experienced no significant change in mean urine flow rate or gradient (0.00 degrees C) from prephase to postphase, the intervention group experienced both a significant and close to 10-fold increase in urine flow rate ( P < .001) and a significant decrease (0.09 degrees C) in mean UBT-PAT gradient ( P < .001). The change in gradient experienced by the intervention group compared with the control group was the result of a net heat loss of 0.05 degrees C in UBT and a net heat gain of 0.04 degrees C in PAT. Although statistically significant, the mean change in UBT-PAT gradient between the intervention and control groups was not clinically important, indicating that bladder temperature remains reliable even with significant changes in urine flow rate.

Perspectives for core and skin surface temperature guided extubation in patients after normothermic cardiopulmonary bypass.

To investigate the relationship between changes in core and skin surface temperature and extubation time in patients following normothermic cardiopulmonary bypass (CPB). Prospective observational study. Intensive care unit (ICU) of a university hospital. Patients admitted to the ICU after cardiac surgery. None. Thirty-two patients undergoing cardiac surgery with the use of normothermic CPB were studied. In the ICU, urinary bladder temperature and skin surface temperature gradient (forearm temperature minus fingertip temperature) were measured at 30-min intervals for 10 h postoperatively. Every half-hour an anaesthesiologist, blinded to temperature measurements, checked the possibility of extubation. On arrival in the ICU the mean skin surface temperature gradient of the patients was 1.9+/-1.6 degrees C, indicating vasoconstriction of the dermal vessels (>0 degrees C = vasoconstriction, <0 degrees C = vasodilation) while the mean urinary bladder temperature was 36.8+/-0.4 degrees C. The change from thermoregulatory vasoconstriction to vasodilation (skin surface temperature gradient of 0 degrees C) was 137+/-49 min after arrival in the ICU. The mean time until extubation was 135+/-55 min after arrival in the ICU. There was a linear relation between a temperature gradient of 0 degrees C and extubation time, r(2)=0.49. Later, 181+/-67 min after arrival in the ICU, the urinary bladder temperature reached its maximum of 38.2+/-0.6 degrees C. This study demonstrates that the transition period from peripheral vasoconstriction to vasodilation provides an opportunity for postoperative extubation.

Changes in body temperature during profound hypothermic cardiopulmonary bypass in adult patients undergoing aortic arch reconstruction.

Our aim was to characterize changes in body temperatures during profound hypothermic cardiopulmonary bypass (CPB) conducted with the sternum opened. In ten adult patients who underwent profound hypothermic (< 20 degrees C) CPB for aortic arch reconstruction, pulmonary arterial temperature (PAT), nasopharyngeal temperature (NPT), forehead deep-tissue temperature (FHT), and urinary bladder temperature (UBT) were recorded every 1 min throughout the surgery. In addition, the CPB venous line temperature (CPBT), a reasonable indicator of mixed venous blood temperature during CPB and believed to best reflect core temperature during stabilized hypothermia on CPB, was recorded during the period of total CPB. PAT began to change immediately after the start of cooling or rewarming, closely matching the CPBT ( r = 0.98). During either situation, the other four temperatures lagged behind PAT ( P < 0.05); however, NPT followed PAT more closely than the other three temperatures ( P < 0.05). During stabilized hypothermia, PAT, NPT, and FHT, but not UBT, closely matched the CPBT, with gradients of less than 0.5 degrees C. During induction of profound hypothermia and its reversal on total CPB with the heart in situ, a PA catheter thermistor, presumably because of its placement immediately behind the superior vena cava, would provide a reliable measure of the mixed venous blood temperature. During stabilized profound hypothermia, PAT, NPT, and FHT, but not UBT, serve as a reliable index of core temperature.

Monitoring Bladder Temperatures in the OR

Temperature monitoring via the urinary bladder has become common in the OR, often replacing monitoring at the rectal site. A systematic, integrated review and synthesis of the literature was undertaken to assess the validity of using the urinary bladder as a site for temperature measurement in the OR. During steady thermal states, bladder temperature performed well, providing temperatures similar to those of core sites. In contrast, poor performance was demonstrated during rapid thermal changes, such as during the rapid cooling and rewarming phases of cardiopulmonary bypass. At such times, a significant lag in response rate at the bladder site was noted by multiple investigators. This delayed responsiveness during thermally dynamic states, however, may provide information regarding the adequacy of rewarming during bypass at sites intermediate between the core and periphery. Limited research indicates that urinary bladder temperature may be influenced by urine flow rate, and additional research is required in this area. The cost effectiveness of this method of temperature measurement requires investigation as well.

Mild hypothermia therapy for patients with severe brain injury

The authors present a group of patients with severe head injuries in which deliberate mild hypothermia was carried out together with the standard treatment protocol according to the European Brain Injury Consortium. Thirty patients with severe head injuries with Glasgow Coma Scale (GCS) score of 3–8 were enrolled into the study. The subjects were divided into two groups. The average age in the hypothermic group of 15 patients was 35 years. The average GCS was 4.5 at the site of accident. Eight patients (53%) sustained associated severe injuries of other organs. The average age of the 15 patients in the normothermic control group was 39 years with an average GCS of 4.3. All the patients in the normothermic group and 11 patients in the hypothermic group underwent neurosurgery, five of them also decompressive craniotomy. Artificial ventilation with continuous monitoring of intracranial pressure (ICP), cerebral perfusion pressure (CPP), arterial blood pressure, jugular bulb oximetry and urinary bladder temperature were instituted in the ICU. Cooling to a core temperature of 34 °C in the hypothermic group was achieved by forced air cooling in combination with circulating-water mattress cooling (Blanketrol II, Cincinnati Sub-Zero) and maintained for 72 h. The difference in the Glasgow Outcome Scale (GOS) between the hypothermic and normothermic groups of patients after 6 months was not statistically significant ( P value 0.0843). In the hypothermic group, however, good neurological outcome (GOS 4 and 5) was reached in 13 patients (87%), which represents a 40% increase compared with the normothermic control group in which good neurological outcome was reached in 7 patients (47%). Mean normothermia ICP value of 18±2 mmHg was significantly ( P value 0.0007) reduced during mild hypothermia therapy to 12±2 mmHg. Mean normothermia CPP value of 72±3 mmHg significantly increased ( P value 0.0007) during this time to 80±4 mmHg with unchanged systolic arterial pressure ( P value 0.9013). There were no cardiac or coagulopathy-related complications. Our results showed that mild therapeutic hypothermia could be useful in improving the outcome and neurological recovery in patients with severe head injuries.