Carvalho Hugo, Najafi Nadia, Poelaert Jan
Department of Anesthesiology and Perioperative Medicine, Universitair Ziekenhuis Brussel (UZBrussel)-Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Paediatr Anaesth. 2019 Aug;29(8):865-871. doi: 10.1111/pan.13653. Epub 2019 May 27.
Maintenance of thermal homeostasis is of crucial importance in the anesthetized pediatric patient. Gold-standard methods for central core temperature measurement are however inappropriately invasive and impractical in daily practice. The SpotOn sensor uses zero-heat-flux thermometry technology and claims to bypass the invasiveness of classical methods and still accurately display central core temperatures. Up to date no formal analysis of this method in children has taken place.
The primary objective was to assess the accuracy in comparison with esophageal temperature; the secondary objective concerned the safety of the SpotOn sensor in the pediatric patients.
Fifty-four children aged 1-12 years with an American Society of Anesthesiology classification I or II scheduled to undergo elective surgical procedures under general anesthesia for a minimum of 30 minutes were included. Exclusion criteria included: fragile forehead skin, procedures impeding proper SpotOn placement, thoracoscopic or gastroesophageal procedures, coagulopathy, hemodynamic instability, or vasoactive medication use. After sevoflurane induction, an esophageal temperature probe was placed in the lower third of the esophagus, and a SpotOn sensor on the lateral forehead. Temperatures were recorded in pairs per 1 minute intervals. Temperatures were subjected to bias analysis with 0.5°C as the a priori established clinical significance cutoff.
Bland-Altman analysis revealed the two methods differed on average 0.14°C (95% limits of agreement: -0.39 to 0.66), with 89.5% of the differences being under 0.5°C. No significant differences could be found between the two methods for the established 0.5°C cutoff. Linear regression analysis determined the following linear regression equation: 0.837x + 5.86 (R = 0.738). Lin's concordance correlation coefficient of 0.83 (95% CI: 0.81-0.84). No complications were observed with the use of the SpotOn sensor.
SpotOn revealed itself as accurate as an esophageal temperature probe when estimating central core temperatures under ideal conditions and over a narrow range of temperatures. No adverse effects were observed with the use of the SpotOn sensor.
维持热稳态对麻醉状态下的儿科患者至关重要。然而，金标准的中心体温测量方法在日常实践中具有不适当的侵入性且不实用。SpotOn传感器采用零热流测温技术，宣称可避免传统方法的侵入性，且仍能准确显示中心体温。目前尚未对该方法在儿童中的应用进行正式分析。
主要目的是评估与食管温度相比的准确性；次要目的关注SpotOn传感器在儿科患者中的安全性。
纳入54名年龄在1至12岁、美国麻醉医师协会分级为I或II级、计划在全身麻醉下接受择期手术且手术时间至少30分钟的儿童。排除标准包括：前额皮肤脆弱、手术妨碍SpotOn正确放置、胸腔镜或胃食管手术、凝血功能障碍、血流动力学不稳定或使用血管活性药物。七氟醚诱导后，将食管温度探头置于食管下三分之一处，在额头侧面放置SpotOn传感器。每隔1分钟成对记录温度。以0.5°C作为预先设定的具有临床意义的临界值对温度进行偏倚分析。
Bland-Altman分析显示，两种方法平均相差0.14°C（95%一致性界限：-0.39至0.66），89.5%的差异在0.5°C以下。对于设定的0.5°C临界值，两种方法之间未发现显著差异。线性回归分析确定了以下线性回归方程：0.837x + 5.86（R = 0.738）。林氏一致性相关系数为0.83（95%CI：0.81 - 0.84）。使用SpotOn传感器未观察到并发症。
在理想条件下且在较窄温度范围内估计中心体温时，SpotOn显示出与食管温度探头一样准确。使用SpotOn传感器未观察到不良反应。
