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

Wolfgang Huber; Claudia Wiedemann; Tobias Lahmer; Joseph Hoellthaler; Henrik Einwächter; Matthias Treiber; Christoph Schlag; Roland Schmid; Markus Heilmaier; Wolfgang Huber; Claudia Wiedemann; Tobias Lahmer; Joseph Hoellthaler; Henrik Einwächter; Matthias Treiber; Christoph Schlag; Roland Schmid; Markus Heilmaier

doi:10.3934/mbe.2020059

Mathematical Biosciences and Engineering

2020, Volume 17, Issue 2: 1132-1146. doi: 10.3934/mbe.2020059

Previous Article Next Article

Research article Special Issues

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

Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany

Received: 13 July 2019 Accepted: 26 August 2019 Published: 14 November 2019

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.
- body core temperature,
- body surface temperature,
- toe temperature,
- infrared thermometer,
- Cardiac Index,
- transpulmonary thermodilution,
- PiCCO,
- urinary bladder thermistor,
- thermofocus
Citation: Wolfgang Huber, Claudia Wiedemann, Tobias Lahmer, Joseph Hoellthaler, Henrik Einwächter, Matthias Treiber, Christoph Schlag, Roland Schmid, Markus Heilmaier. 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[J]. Mathematical Biosciences and Engineering, 2020, 17(2): 1132-1146. doi: 10.3934/mbe.2020059

Related Papers:

Abstract

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.

References

[1]	W. Huber, R. Zanner, G. Schneider, et al., Assessment of regional perfusion and organ function: Less and non-invasive techniques, Front. Med. (Lausanne), 6 (2019), 50.
[2]	G. Hariri, J. Joffre, G. Leblanc, et al., Narrative review: Clinical assessment of peripheral tissue perfusion in septic shock, Ann. Intensive Care, 9 (2019), 37.
[3]	A. Lima and J. Bakker, Clinical assessment of peripheral circulation, Curr. Opin. Crit. Care, 21 (2015), 226-231.
[4]	R. C. Bone, R. A. Balk, F. B. Cerra, et al., Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine, Chest, 101 (1992), 1644-1655.
[5]	H. Apa, S. Gozmen, N. Bayram, et al., Clinical accuracy of tympanic thermometer and noncontact infrared skin thermometer in pediatric practice: An alternative for axillary digital thermometer, Pediatr. Emerg. Care, 29 (2013), 992-997.
[6]	S. R. Dod, G. A. Lancaster, J. V. Craig, et al., In a systematic review, infrared ear thermometry for fever diagnosis in children finds poor sensitivity, J. Clin. Epidemiol., 59 (2006), 354-357.
[7]	C. B. Mogensen, M. B. Vilhelmsen, J. Jepsen, et al., Ear measurement of temperature is only useful for screening for fever in an adult emergency department, BMC Emerg. Med., 18 (2018), 51.
[8]	C. B. Mogensen, L. Wittenhoff, G. Fruerhoj, et al., Forehead or ear temperature measurement cannot replace rectal measurements, except for screening purposes, BMC Pediatr., 18 (2018), 15.
[9]	M. Benzinger, Tympanic thermometry in surgery and anesthesia, JAMA, 209 (1969), 1207-1211.
[10]	R. B. Schock, A. Janata, W. F. Peacock, et al., Time to cooling is associated with resuscitation outcomes, Ther. Hypothermia Temp. Manag., 6 (2016), 208-217.
[11]	M. E. Bone and R. O. Feneck, Bladder temperature as an estimate of body temperature during cardiopulmonary bypass, Anaesthesia, 43 (1988), 181-185.
[12]	J. Shin, J. Kim, K. Song, et al., Core temperature measurement in therapeutic hypothermia according to different phases: Comparison of bladder, rectal, and tympanic versus pulmonary artery methods, Resuscitation, 84 (2013), 810-817.
[13]	J. K. Lilly, J. P. Boland, S. Zekan, Urinary bladder temperature monitoring: a new index of body core temperature, Crit. Care Med., 8 (1980), 742-724.
[14]	N. E. Christensen, N. Juul, F. Vestergard, et al., Use of bladder thermistor catheters in an intensive care unit. Comparative study of core temperature measurements with bladder thermometers and rectal thermometers in an intensive care unit, Ugeskr. Laeger, 155 (1993), 2347-2349.
[15]	R. A. Henker, S. D. Brown and D. W. Marion, Comparison of brain temperature with bladder and rectal temperatures in adults with severe head injury, Neurosurgery, 42 (1998), 1071-1075.
[16]	P. J. Hofkens, A. Verrijcken, K. Merveille, et al., Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: Results of a survey and state-of-the-art review, Anaesth. Intens. Ther., 47 (2015), 89-116.
[17]	W. Huber, A. Umgelter, W. Reindl, et al., Volume assessment in patients with necrotizing pancreatitis: a comparison of intrathoracic blood volume index, central venous pressure, and hematocrit, and their correlation to cardiac index and extravascular lung water index, Crit. Care Med., 36 (2008), 2348-2354.
[18]	W. Huber, J. Hoellthaler, T. Schuster T, et al., Association between different indexations of extravascular lung water (EVLW) and PaO2/FiO2: a two-center study in 231 patients, PLoS One, 9 (2014), e103854.
[19]	D. Krizanac, P. Stratil, D. Hoerburger, et al., Femoro-iliacal artery versus pulmonary artery core temperature measurement during therapeutic hypothermia: an observational study, Resuscitation, 84 (2013), 805-809.
[20]	S. Bourcier, C. Pichereau, P.Y. Boelle, et al., Toe-to-room temperature gradient correlates with tissue perfusion and predicts outcome in selected critically ill patients with severe infections, Ann. Intensive Care, 6 (2016), 63.
[21]	R. J. Henning, F. Wiener, S. Valdes, et al., Measurement of toe temperature for assessing the severity of acute circulatory failure, Surg. Gynecol. Obstet., 1149 (1979), 1-7.
[22]	H. R. Joly and M. H. Weil, Temperature of the great toe as an indication of the severity of shock, Circulation, 39 (1969), 131-138.
[23]	J. L. Vincent, J. J. Moraine, P. van der Linden, Toe temperature versus transcutaneous oxygen tension monitoring during acute circulatory failure, Intens. Care Med., 14 (1988), 64-68.
[24]	B. Ibsen, Treatment of shock with vasodilators measuring skin temperature on the big toe, Ten years' experience in 150 cases, Dis. Chest, 52 (1967), 425-429.
[25]	B. M. Schey, D. Y. Williams and T. Bucknall, Skin temperature as a noninvasive marker of haemodynamic and perfusion status in adult cardiac surgical patients: An observational study, Intens. Crit. Care Nurs., 25 (2009), 31-37.
[26]	B. M. Schey, D. Y. Williams and T. Bucknall, Skin temperature and core-peripheral temperature gradient as markers of hemodynamic status in critically ill patients: A review, Heart Lung, 39 (2010), 27-40.
[27]	M. E. van Genderen, J. Paauwe, J. de Jonge, et al., Clinical assessment of peripheral perfusion to predict postoperative complications after major abdominal surgery early: A prospective observational study in adults, Crit. Care, 18 (2014), R114.
[28]	W. Huber, T. Kraski, B. Haller, et al. Room-temperature vs iced saline indicator injection for transpulmonary thermodilution, J. Crit. Care, 29 (2014), e7-e14.
[29]	E. Atas Berksoy, O. Bag, S. Yazici, et al., Use of noncontact infrared thermography to measure temperature in children in a triage room, Medicine (Baltimore), 97 (2018), e9737. doi: 10.1097/MD.0000000000009737
[30]	S. Sollai, C. Dani, E. Berti, et al., Performance of a non-contact infrared thermometer in healthy newborns, BMJ Open, 6 (2016), e008695.
[31]	M. U. Selent, N. M. Molinari, A. Baxter, et al., Mass screening for fever in children: A comparison of 3 infrared thermal detection systems, Pediatr. Emerg. Care, 29 (2013), 305-313.
[32]	C. G. Teran, J. Torrez-Llanos, T. E. Teran-Miranda, et al., Clinical accuracy of a non-contact infrared skin thermometer in paediatric practice, Child Care Health Dev., 38 (2012), 471-476.
[33]	S. G. Sakka, C. C. Ruhl, U. J. Pfeiffer, et al., Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution, Intensive Care Med. 26 (2000), 180-187.
[34]	P. Faybik, H. Hetz, A. Baker, et al., Iced versus room temperature injectate for assessment of cardiac output, intrathoracic blood volume, and extravascular lung water by single transpulmonary thermodilution, J. Crit. Care, 19 (2004), 103-107.
[35]	T. Maeda, E. Hamaguchi, N. Kubo, et al., The accuracy and trending ability of cardiac index measured by the fourth-generation FloTrac/Vigileo system and the Fick method in cardiac surgery patients, J. Clin. Monit. Comput., 33 (2019), 767-776.
[36]	A. Umgelter, R. M. Schmid, W. Huber, Questionable design to validate the ProAQT/Pulsioflex device, Anesth. Analg., 125 (2017), 1417-1420.
[37]	G. Weil, C. Motamed, A. Eghiaian, et al., Comparison of Proaqt/Pulsioflex((R)) and oesophageal Doppler for intraoperative haemodynamic monitoring during intermediate-risk abdominal surgery, Anaesth. Crit. Care Pain Med., 38 (2019), 153-159.
[38]	M. Sumiyoshi, T. Maeda, E. Miyazaki, et al., Accuracy of the ClearSight system in patients undergoing abdominal aortic aneurysm surgery, J. Anesth., 33 (2019), 364-371.

Reader Comments

Your name:*

Email:*
© 2020 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)