Keohane Niamh, Driver Jennifer, Mullhi Randeep, Chipp Elizabeth, Torlinska Barbara, Torlinski Tomasz
Worcestershire Royal Hospital, Worcestershire Acute Hospitals NHS Trust, Worcester WR5 1DD, UK.
Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK.
Eur Burn J. 2025 Mar 2;6(1):11. doi: 10.3390/ebj6010011.
The association between hypothermia and poor outcomes in severe burn injury is well established. However, the significance of the core-peripheral temperature gradient has not previously been investigated. Institutional guidance at our burns centre advocates avoiding hypothermia and targeting a body temperature between 37.5 and 39.5 °C. The core-peripheral temperature gap should be ≤2 °C, based on expert opinion. Data from 61 patients admitted to the Intensive Care Unit (ICU) with severe burns between 2016 and 2022 were analysed. A higher core temperature at 48 h, avoidance of hypothermia and a core-peripheral temperature gap > 2 °C were associated with reduced odds of mortality. The mean core body temperature and core-peripheral temperature gap increased over the first 48 h (r = 0.5, < 0.001). All non-survivors had a core-peripheral gap < 2 °C at 48 h. Survivors had a higher mean 48 h gap (1.6 [95%CI:1.3-1.9]) than non-survivors (0.8 [95%CI:0.2-1.4; = 0.04]). Our findings support previous studies suggesting that avoiding hypothermia and achieving a higher target temperature are associated with reduced mortality. However, it challenges the previous expert consensus that a lower core-peripheral gap indicates better outcomes. Further research with a larger cohort of patients is required to identify whether a higher core-peripheral temperature gap predicts outcomes in critically ill patients with severe burns.
体温过低与严重烧伤患者预后不良之间的关联已得到充分证实。然而，此前尚未对核心体温与外周体温梯度的意义进行研究。我们烧伤中心的机构指南提倡避免体温过低，将体温目标设定在37.5至39.5°C之间。根据专家意见，核心体温与外周体温的差值应≤2°C。对2016年至2022年间收入重症监护病房（ICU）的61例严重烧伤患者的数据进行了分析。伤后48小时较高的核心体温、避免体温过低以及核心体温与外周体温的差值>2°C与死亡几率降低相关。在最初的48小时内，平均核心体温和核心体温与外周体温的差值有所升高（r = 0.5，P<0.001）。所有非幸存者在伤后48小时的核心体温与外周体温差值均<2°C。幸存者伤后48小时的平均差值（1.6[95%CI：1.3 - 1.9]）高于非幸存者（0.8[95%CI：0.2 - 1.4]；P = 0.04）。我们的研究结果支持了此前的研究，即避免体温过低并达到较高的目标温度与死亡率降低相关。然而，这对之前专家的共识提出了挑战，即较低的核心体温与外周体温差值表明预后更好。需要对更多患者进行进一步研究，以确定较高的核心体温与外周体温差值是否能预测重症严重烧伤患者的预后。
