Neurocritical Care Advanced Practice Providers, Neuro Intensive Care Unit, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, USA.
Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, USA.
Neurocrit Care. 2021 Apr;34(2):449-455. doi: 10.1007/s12028-020-01036-9.
Temperature modulating devices (TMD) currently utilize core temperature measurements during targeted temperature management (TTM) that are currently limited to esophageal (Et), bladder (Bt), or rectal (Rt) temperatures. We assessed the ability of a continuous noninvasive temperature monitor to accurately approximate core temperature during TTM.
All patients undergoing TTM using a gel pad surface TMD and an existing core temperature monitoring device were eligible for this study. Core and continuous noninvasive temperature monitoring values were simultaneously recorded for up to 72 h of TTM. The two sets of temperature data were downloaded from a clinical data acquisition storage system at 1-min intervals. The Bland-Altman method assessed agreement between the core and continuous noninvasive temperature monitor values, by measuring the mean difference (± 2 SD) between these values.
There were 20 subjects that underwent study between January 2018 and March 2018 (55% women, age: 57 ± 14 years old, BMI: 28.9 + 9.8 kg/m, 100% mechanically ventilated). The comparison patient temperature source was predominantly esophageal (n = 10) followed by bladder (n = 5) or rectal (n = 5). There were a total of 999 h of paired patient temperature data from esophageal (50%), bladder (25%), and rectal (25%) temperatures. Bland-Altman analysis demonstrated good agreement with the superficial temperature monitor and core temperature measures in all patients overall, with a difference mean of 0.06 ± 0.39 C (P = 0.99) and no proportional bias noted (β =0.002, P = 0.917).
Continuous noninvasive temperature monitoring is a suitable alternative method for assessing core temperature during TTM. Future studies should focus on developing connectivity with a continuous noninvasive temperature monitor to approximate core temperature during TTM.
目前，温度调节设备（TMD）在目标温度管理（TTM）期间利用核心温度测量，但目前仅限于食管（Et）、膀胱（Bt）或直肠（Rt）温度。我们评估了连续无创温度监测仪在 TTM 期间准确估计核心温度的能力。
所有接受 TTM 治疗的患者均使用凝胶垫表面 TMD 和现有的核心温度监测设备，符合本研究条件。在 TTM 期间，连续无创和核心温度监测值同步记录长达 72 小时。两套温度数据以 1 分钟的间隔从临床数据采集存储系统中下载。 Bland-Altman 法通过测量这两个值之间的平均差值（±2SD），评估核心温度和连续无创温度监测值之间的一致性。
2018 年 1 月至 2018 年 3 月期间共有 20 名患者接受了研究（55%为女性，年龄：57±14 岁，BMI：28.9±9.8kg/m，100%机械通气）。比较患者的温度源主要是食管（n=10），其次是膀胱（n=5）或直肠（n=5）。共有 999 小时的配对患者温度数据来自食管（50%）、膀胱（25%）和直肠（25%）温度。Bland-Altman 分析显示，在所有患者中，表面温度监测仪与核心温度测量值具有良好的一致性，差值平均为 0.06±0.39°C（P=0.99），且无比例偏差（β=0.002，P=0.917）。
连续无创温度监测是 TTM 期间评估核心温度的合适替代方法。未来的研究应侧重于开发与连续无创温度监测仪的连接，以在 TTM 期间近似核心温度。
