Impact of Prewarming on Maintaining Perioperative Body Temperature: A Randomized Clinical Trial.

PURPOSE: To determine the prewarming effect on body temperature in the perioperative period of patients undergoing conventional abdominal surgery and the level of thermal comfort. DESIGN: A randomized controlled clinical trial. METHODS: A Brazilian oncology hospital located in São Paulo. A total of 99 patients aged 18 years or over undergoing elective conventional abdominal surgeries, with a minimum duration of 1 hour of anesthesia. The study was carried out from 2019 to 2021. Patients were randomized into 3 groups: prewarming with a blanket and cotton sheet (control; n = 33); prewarming with a forced-air warming system for 20 minutes (intervention 1; n = 33); prewarming with a forced-air warming system for 30 minutes (intervention 2; n = 33). Central temperature was measured by a zero-heat-flux temperature sensor every 20 minutes from the preoperative period until the surgery end time. The level of thermal comfort was determined through self-report during the preanesthetic and postanesthetic periods. FINDINGS: There was a significant difference between the temperatures between the groups (P = .048), with evidence of greater benefit in maintaining the temperature in the group that received the prewarming intervention for 20 minutes. There was no significant difference between the percentage of temperatures below 36 °C among the groups (P = .135). Patients in the intervention groups were more comfortable during the postanesthetic recovery period than those in the control group (P = .048). Only 7 (8.24%) patients had postoperative chills (P = .399) and more than half of these incidents occurred in the control group (4; 13.3%). CONCLUSIONS: Prewarming for 20 minutes obtained the best results, showing the lowest average of temperature episodes below 36 °C during the intraoperative period and greater thermal comfort as reported by patients.

Skin conductance algesimeter is unreliable during sudden perioperative temperature increases.

OBJECTIVES: Pain assessment in anesthetized and non-communicative patients remains a challenge. Clinical signs such as tachycardia, hypertension, sweat and tears, have a low specificity for pain and should therefore ideally be replaced by more specific monitoring techniques. Skin conductance variability has been demonstrated to establish a patients' sensitivity to pain, but may be influenced by temperature changes that leads to profuse sweating. The aim of this pilot study was to test skin conductance changes during sudden temperature changes due to hyperthermic intraperitoneal chemotherapy (HIPEC) perfusation. METHODS: We investigated skin conductance algesimeter (SCA) in ten consecutive patients undergoing cytoreductive surgery and HIPEC. Results from the SCA was compared to other standard physiological variables at seven time points during the surgical procedure, in particular during the period with hyperthermic intraabdominal perfusion leading to an increase in the patients core temperature. RESULTS: Nine out of ten patients had an increase in the SCA measurements during the HIPEC phase correlating the increase in temperature. CONCLUSION: SCA is unreliable to detect increased pain sensation during sudden perioperative temperature changes in adult patients.

Evaluation of different body temperature measurement methods for patients in the intraoperative period / Evaluación de distintos métodos para medir la temperatura corporal de los pacientes durante el período intraoperatorio / Avaliação de diferentes métodos de mensuração da temperatura corporal de pacientes no período intraoperatório

Objectives: this study aimed at estimating and comparing the reliability of temperature measurements obtained using a peripheral infrared temporal thermometer, a central cutaneous thermometer ("Zero-Heat-Flux Cutaneous thermometer") and an esophageal or nasopharyngeal thermometer among elective surgical patients in the intraoperative period. Method: a longitudinal study with repeated measures carried out by convenience sampling of 99 patients, aged at least 18 years old, undergoing elective abdominal cancer surgeries, with anesthesia lasting at least one hour, with each patient having their temperature measured by all three methods. Results: the intraclass correlation coefficient showed a low correlation between the measurements using the peripheral temporal thermometer and the central cutaneous (0.0324) and esophageal/nasopharyngeal (-0.138) thermometers. There was a high correlation (0.744) between the central thermometers evaluated. Conclusion: the data from the current study do not recommend using infrared temporal thermometers as a strategy for measuring the body temperature of patients undergoing anesthetic-surgical procedures. Central cutaneous thermometers and esophageal/nasopharyngeal thermometers are equivalent for detecting intraoperative hypothermia.

Objetivos: el objetivo de este estudio fue estimar y comparar la confiabilidad de mediciones de temperatura obtenidas por medio de un termómetro temporal infrarrojo periférico, un termómetro cutáneo central ("Termómetro cutáneo Zero-Heat-Flux ") y un termómetro esofágico o nasofaríngeo en pacientes sometidos a cirugías electivas durante el período intraoperatorio. Método: estudio longitudinal con mediciones repetidas llevado a cabo con una muestra por conveniencia de 99 pacientes, de al menos 18 años de edad, sometidos a cirugías electivas por cáncer abdominal, con anestesia de al menos una hora de duración, y midiendo la temperatura de cada paciente con los tres métodos. Resultados: el coeficiente de correlación intraclase indicó una correlación baja entre las mediciones realizadas con el termómetro temporal periférico y los termómetros cutáneo (0,0324) y esofágico/nasofaríngeo (-0,138) centrales. Se registró una correlación alta (0,744) entre los termómetros centrales evaluados. Conclusión: los datos del presente estudio no recomiendan utilizar termómetros temporales infrarrojos como estrategia para medir la temperatura corporal de pacientes sometidos a procedimientos anestésico-quirúrgicos. Los termómetros cutáneos centrales y los esofágicos/nasofaríngeos son equivalentes para detectar hipotermia intraoperatoria.

Objetivos: este estudo teve como objetivo estimar e comparar a confiabilidade das medições de temperatura obtidas com um termômetro temporal infravermelho periférico, um termômetro cutâneo central (" Zero-Heat-Flux ") e um termômetro esofágico ou nasofaríngeo entre pacientes cirúrgicos eletivos no período intraoperatório. Método: estudo longitudinal com medidas repetidas realizado por amostragem de conveniência de 99 pacientes, com 18 anos ou mais, submetidos a cirurgia eletiva de câncer abdominal, com duração de anestesia de pelo menos uma hora, com cada paciente tendo sua temperatura medida pelos três métodos. Resultados: o coeficiente de correlação intraclasse mostrou uma baixa correlação entre as medições usando o termômetro temporal periférico e os termômetros cutâneo central (0,0324) e esofágico/nasofaríngeo (-0,138). Houve uma alta correlação (0,744) entre os termômetros centrais avaliados. Conclusão: os dados do presente estudo não recomendam o uso de um termômetro infravermelho temporal como estratégia para medir a temperatura corporal de pacientes submetidos a procedimentos anestésico-cirúrgicos. O termômetro cutâneo central e o termômetro esofágico/nasofaríngeo são equivalentes para detectar hipotermia intraoperatória.

Head cooling wrap could suppress the elevation of core temperature after cardiac surgery during forced-air warming in a pediatric intensive care unit: a randomized clinical trial.

PURPOSE: The main aim of the current trial was to explore our hypothesis that cooling head wraps lower the core temperature more effectively than ice packs on the head during forced-air warming after pediatric cardiac surgeries. METHODS: This study was a single-center Randomized Controlled Trial. Participants were children with a weight ≤ 10 kg and hyperthermia during forced-air warming after cardiac surgeries. When the core temperature reached 37.5 °C, ice packs on the head (group C) or a cooling head wrap (group H) were used as cooling devices to decrease the core temperature. The primary outcome was the core temperature. The secondary outcomes were the foot surface temperature and heart rate. We measured all outcomes every 30 min for 240 min after the patient developed hyperthermia. We conducted two-way ANOVA as a pre-planned analysis and also the Bonferroni test as a post hoc analysis. RESULTS: Twenty patients were randomly assigned to groups C and H. The series of core temperatures in group H were significantly lower than those in group C (p < 0.0001), and post hoc analysis showed that there was no significant difference in core temperatures at T0 between the two groups and statistically significant differences in all core temperatures at T30-240 between the two groups. There was no difference between the two groups' surface temperatures and heart rates. CONCLUSIONS: Compared to ice packs on the head, head cooling wraps more effectively suppress core temperature elevation during forced-air warming after pediatric cardiac surgery.

Analysis of Factors Associated With Continued Cooling of Core Temperature After Prolonged Cold-Water Swimming.

PURPOSE: To assess the factors associated with continued cooling duration of core temperature (Tcore°) after prolonged outdoor cold-water swimming. METHODS: We designed a cohort study among swimmers participating in an outdoor cold-water swim during qualifying for the English Channel Swim. The day before the event, the participants completed a demographic questionnaire, and body composition was measured using bioelectrical impedance analysis (mBCA 525, Seca). The swimming event consisted of laps over a 1000-m course, for up to 6 hours, in water at 12.5 to 13 °C. Tcore° was measured using an ingestible temperature sensor (e-Celsius, BodyCap) during and up to 1 hour after the swim. RESULTS: A total of 14 participants (38 [11] y; N = 14, n = 11 males, n = 8 in swimming costume and n = 6 in wetsuit) were included. Before swimming, Tcore° was 37.54 (0.39) °C. The participants swam for an average of 194.00 (101.94) minutes, and mean Tcore° when exiting the water was 35.21 (1.30) °C. The duration of continued cooling was 25 (17) minutes with a minimum Tcore° of 34.66 (1.26) °C. Higher body mass index (r = .595, P = .032) and fat mass (r = .655, P = .015) were associated with longer continued cooling, independent of wetsuit wear. Also, the rate of Tcore° drop during swimming (-1.22 [1.27] °C/h) was negatively correlated with the rate of Tcore° gain after swimming (+1.65 [1.23] °C/h, r = -.682, P = .007). CONCLUSION: Increased body mass index and fat mass were associated with Tcore° continued cooling duration after prolonged outdoor cold-water swimming at 12.5 to 13 °C. The rate of Tcore° drop during swimming was negatively correlated with the rate of rewarming.

Feasibility, Acceptability, and Performance of a Continuous Temperature Monitor in Older Adults and Staff in Congregate-Living Facilities.

OBJECTIVES: Residents of congregate-living facilities are susceptible to disability and mortality from infection given the presence of advanced age, multimorbidity, and frailty-as demonstrated in the recent COVID pandemic. This study assessed the feasibility, acceptability, and applicability of a continuous temperature monitoring device in a congregate-living facility with residents of independent living, assisted living, and their care-providing staff. We hypothesized that a wearable device compared with daily manual temperature assessment would be well tolerated and more effective at detecting temperature variances than current standard of care body temperature assessment. DESIGN: Feasibility study. SETTING AND PARTICIPANTS: Residents of assisted and independent living and staff of a retirement community. METHODS: Thirty-five participants, including residents in assisted- and independent-living facilities (25) and staff (10) were enrolled in a 90-day feasibility study and wore a continuous temperature sensor from March to July 2021. Primary outcomes included study completion, ability to reapply the sensor, temperature data acquisition, and data availability from the sensors. A secondary analysis of the temperature data involved comparing the method of obtaining temperature using the continuous monitoring device against standard of care using traditional manual thermometers. RESULTS: Overall, 91.3% of residents, who were in the study during the first reapplication, were able to apply the device without assistance (21 of 23), and 80% of resident participants completed the study (20 of 25). For staff participants, completion rates and reapplication rates were 100%. Data acquisition rates from the continuous temperature devices were much higher than manual temperatures. Four episodes of fever were detected by the devices; manual temperature checks did not identify these events. CONCLUSIONS AND IMPLICATIONS: Continuous temperature monitoring in an older adult population and the staff in congregate-living facilities is feasible and acceptable. This approach identified fever undetected by current standard of care indicating the capability of this device for earlier detection of fevers.

Efeitos oxi-hemodinâmicos de diferentes banhos no leito: ensaio clínico randomizado cruzado / Efectos oxihemodinámicos de diferentes baños en cama: ensayo clínico aleatorizado cruzado / Oxy-hemodynamic effects of different bed baths: a randomized crossover clinical trial

Resumo Objetivo Comparar o tempo de execução do banho no leito pelo método tradicional e a seco e seus efeitos sobre as alterações oxi-hemodinâmicas em pacientes críticos. Métodos Ensaio clínico randomizado crossover, aberto, com 50 pacientes submetidos aos dois tipos de banho no leito: tradicional e a seco. Avaliou-se o tempo de execução dos banhos e as variáveis oxi-hemodinâmicas (temperatura timpânica e axilar, saturação de oxigênio arterial, frequência respiratória, frequência cardíaca e pressão arterial média), obtidas no início dos banhos, aos dez minutos, no início e no fim da lateralização dos pacientes, ao final do procedimento e 15 minutos depois. Para análise utilizou-se Teste T de Student pareado e modelo de equações de estimação generalizadas. Resultados O banho no leito a seco foi executado em menor tempo que o tradicional (18,59 versus 26,45 minutos; p<0,001). No banho tradicional, ao longo do tempo, houve redução da temperatura axilar e elevação da frequência respiratória (p<0,001). No banho a seco, apenas a temperatura axilar sofreu alteração, tornando-se menor que o valor inicial (p<0,001). Conclusão O banho a seco foi superior ao tradicional em decorrência do menor tempo de execução e menor instabilidade oxi-hemodinâmica dos pacientes entre os períodos observados. A monitorização dos pacientes é fundamental para identificar tais alterações.

Resumen Objetivo Comparar el tiempo de ejecución del baño en cama mediante el método tradicional y a seco y sus efectos sobre las alteraciones oxihemodinámicas en pacientes críticos. Métodos Ensayo clínico aleatorizado crossover, abierto, con 50 pacientes sometidos a dos tipos de baño en cama: tradicional y a seco. Se evaluó el tiempo de ejecución de los baños y las variables oxihemodinámicas (temperatura timpánica y axilar, saturación del oxígeno arterial, frecuencia respiratoria, frecuencia cardíaca y presión arterial promedio), obtenidas al comienzo de los baños, a los diez minutos, al comienzo y al final de la lateralización de los pacientes, al final del procedimiento y 15 minutos después. Para el análisis se utilizó el Test-T de Student pareado y el modelo de ecuaciones de estimación generalizadas. Resultados El baño en cama a seco fue ejecutado en menor tiempo que el tradicional (18,59 versus 26,45 minutos; p<0,001). En el baño tradicional, a lo largo del tiempo, hubo reducción de la temperatura axilar y elevación de la frecuencia respiratoria (p<0,001). En el baño a seco, solo la temperatura axilar estuvo alterada, fue menor que el valor inicial (p<0,001). Conclusión El baño a seco fue superior al tradicional como consecuencia del menor tiempo de ejecución y menor inestabilidad oxihemodinámica de los pacientes entre los períodos observados. El monitoreo de los pacientes es fundamental para identificar tales alteraciones.

Abstract Objective To compare the bed bath execution time using the traditional and dry method and its effects on the oxy-hemodynamic changes in critically ill patients. Methods This is a crossover, open, randomized clinical trial, with 50 patients submitted to two types of bed bath: traditional and dry. The duration of the baths and the oxy-hemodynamic variables (tympanic and axillary temperature, arterial oxygen saturation, respiratory rate, heart rate and mean arterial pressure), obtained at the beginning of the baths, at ten minutes, at the beginning and at the end of patient lateralization, at the end of the procedure and 15 minutes later. Paired Student's t-test and generalized estimating equations model were used for analysis. Results Dry bed bath was performed in less time than the traditional bath (18.59 versus 26.45 minutes; p<0.001). In traditional bath, over time, there was a reduction in axillary temperature and an increase in respiratory rate (p<0.001). In the dry bath, only the axillary temperature changed, becoming lower than the initial value (p<0.001). Conclusion Dry bath was superior to the traditional one, due to the shorter time of execution and lesser oxy-hemodynamic instability of patients between the periods observed. Monitoring patients is essential to identify such changes.

Thermal suit connected to a forced-air warming unit for preventing intraoperative hypothermia: A randomised controlled trial.

BACKGROUND: Inadvertent intraoperative hypothermia is a common occurrence in surgical patients. A thermal suit is an option for passive insulation. However, active warming is known to be more effective. Therefore, we hypothesised that a forced-air warming (FAW) unit connected to the thermal suit is superior to a commercial FAW blanket and a warming mattress in breast cancer surgery. METHODS: Forty patients were randomised to this prospective, clinical trial to wear either the thermal suit or conventional hospital clothes under general anaesthesia. The Thermal suit group had a FAW unit set to 38°C and connected to the legs of the suit. The Hospital clothes group had a lower body blanket set to 38°C and a warming mattress set to 37°C. Core temperature was measured with zero-heat-flux sensor. The primary outcome was core temperature on admission to the recovery room. RESULTS: There was no difference in mean core temperatures at anaesthetic induction (P = .4) or on admission to the recovery room (P = .07). One patient in the Thermal suit group (5%) vs six patients in the Hospital clothes group (32%) suffered from intraoperative hypothermia (P = .04, 95% CI 1.9%-49%). Mean skin temperatures (MSTs) were higher in the Thermal suit group during anaesthesia. No burns or skin irritations were reported. Two patients in the Thermal suit group sweated. CONCLUSIONS: A thermal suit connected to a FAW unit was not superior to a commercial FAW blanket, although the incidence of intraoperative hypothermia was lower in patients treated with a thermal suit.

Genome-wide association study on the body temperature changes of a broiler-type strain Taiwan country chickens under acute heat stress.

Body temperature is the simplest parameter for evaluating the physiological conditions of animals under thermal stress. Genome-wide association studies (GWAS) have identified candidate genes related to economic traits in domestic animals. The present study conducted a GWAS on body temperature changes in a broiler-type strain Taiwan country chickens (TCCs) under acute heat stress. A total of two hundred 30-week-old roosters of a broiler-type strain TCCs were used. The roosters were subjected to acute heat stress at 38 °C for 4 h, and their body temperature was recorded before and during heat stress. The change in body temperature (ΔT) of each rooster was calculated according to the difference between the initial temperature and the highest body temperature during heat stress. The roosters were categorized according to survival and ΔT at the end into dead, susceptible, resistant, and intermediate groups. Collected red blood cells were genotyped using a 600 K chicken single-nucleotide polymorphism (SNP) array. A GWAS for ΔT was conducted using the Cochran-Armitage trend test. Significant SNPs were annotated as candidate genes according to the nearest genes. Results indicated that the ΔT of the heat-resistant group was significantly lower than that of the heat-susceptible group. A total of 17 SNPs belonging to 8 candidate genes, 352 SNPs for 78 candidate genes, and 174 significant SNPs for 63 candidate genes were identified in the association analyses in the dead vs. survival, resistant vs. susceptible, and intermediate vs. susceptible groups, respectively. The annotated candidate genes are associated with apoptosis, cellular response to external stimuli, and signal transduction pathways. In conclusion, the significant SNPs located in and proximal to genes in the GWAS analysis were related to apoptosis or responses to external stimuli which serve as potential candidates underlying physiological adaptation to heat stress or thermotolerance in chickens.

Thermoregulation in Hypertensive Rats during Exercise: Effects of Physical Training / Termorregulação durante o Exercício em Ratos Hipertensos: Efeitos do Treinamento Físico

Abstract Background: Spontaneously hypertensive rats (SHR) show deficit in thermal balance during physical exercise. Objective: To assess the effects of low-intensity physical exercise training on thermal balance of hypertensive rats undergoing an acute exercise protocol. Methods: Sixteen-week-old male Wistar rats and SHR were allocated into four groups: control Wistar rats (C-WIS), trained Wistar (T-WIS), control SHR (C-SHR) and trained SHR (T-SHR). Treadmill exercise training was performed for 12 weeks. Blood pressure, resting heart rate and total exercise time was measured before and after the physical exercise program. After the exercise program, a temperature sensor was implanted in the abdominal cavity, and the animals subjected to an acute exercise protocol, during which internal body temperature, tail skin temperature and oxygen consumption until fatigue were continuously recorded. Mechanical efficiency (ME), work, heat dissipation threshold and sensitivity were calculated. Statistical significance was set at 5%. Results: Physical training and hypertension had no effect on thermal balance during physical exercise. Compared with C-WIS, the T-WIS group showed higher heat production, which was counterbalanced by higher heat dissipation. Hypertensive rats showed lower ME than normotensive rats, which was not reversed by the physical training. Conclusion: Low-intensity physical training did not affect thermal balance in SHR subjected to acute exercise.

Resumo Fundamento: Ratos espontaneamente hipertensos (SHR) apresentam déficits no balanço térmico durante o exercício físico. Objetivo: Avaliar os efeitos do treinamento físico de baixa intensidade sobre o balanço térmico de ratos hipertensos submetidos a um protocolo de exercício físico agudo. Métodos: Ratos machos Wistar e SHR, com 16 semanas de idade, foram divididos em quatro grupos experimentais: Wistar controle (WIS-C), Wistar treinado (WIS-T), SHR controle (SHR-C) e SHR treinado (SHR-T). O treinamento físico em esteira rolante foi realizado durante 12 semanas. A pressão arterial, a frequência cardíaca de repouso e o tempo de exercício foram medidos previamente e após o programa de treinamento físico. Após o programa de treinamento físico, um sensor de temperatura foi implantado na região intraperitoneal e os ratos foram submetidos a um protocolo de exercício físico agudo com registros contínuos da temperatura corporal interna, temperatura da pele da cauda e do consumo de oxigênio até a fadiga. A eficiência mecânica (EM), o trabalho, o limiar e a sensibilidade para dissipação de calor foram calculados. Para as análises estatísticas o nível de significância adotado foi de 5%. Resultados: O treinamento físico e a hipertensão arterial não alteraram o balanço térmico durante o exercício físico. O grupo WIS-T quando comparado ao WIS-C, apresentou maior produção de calor, que foi contrabalanceado por uma maior dissipação de calor. Os animais hipertensos apresentaram menor EM em comparação aos animais normotensos, e o treinamento físico não foi capaz de reverter esta alteração. Conclusão: O treinamento físico de baixa intensidade não provocou alterações no balanço térmico de ratos hipertensos submetidos a um protocolo de exercício físico agudo.

Uhthoff's phenomenon in a patient with multiple sclerosis during the perioperative period for hip surgery. Case report / Fenómeno de Uhthoff en paciente con esclerosis múltiple durante perioperatorio de cirugía de cadera. Reporte de un caso

Abstract Increase in body temperature is associated with neurological deficit exacerbations in patients with multiple sclerosis (MS). These are corrected with the resolution of hyperthermia, in what is known as Uhthoff's phenomenon. A 65-year-old patient with primary progressive MS, admitted because of hip fracture, developed acute respiratory failure in association with elevation in body temperature (38 °C) due to an increase in room temperature. Additional tests ruled out infection, pulmonary thromboembolism, or other concomitant processes. The patient's respiratory condition improved following a change in room temperature and the use of pharmacological treatment for hyperthermia. She was taken to surgery under general anesthesia 3 days after admission, with tight temperature monitoring, and surgery proceeded uneventfully. Anesthetic management in patients with MS is important, requiring close control of body temperature to avoid comorbidities and perioperative complications.

Resumen El aumento de la temperatura corporal se asocia a exacerbación de déficits neurológicos en pacientes con esclerosis múltiple (EM) que se corrigen con la resolución de la hipertermia, proceso denominado fenómeno de Uhthoff. Una paciente de 65 años con EM primaria progresiva, hospitalizada por fractura de cadera, presentó un cuadro de insuficiencia respiratoria aguda en relación al aumento de temperatura corporal (38 °C) debido a un incremento en la temperatura ambiental. Las pruebas complementarias descartaron patología infecciosa, tromboembolismo pulmonar y otros procesos intercurrentes. La paciente presentó mejoría respiratoria tras modificar la temperatura de la habitación y recibir tratamiento farmacológico para la hipertermia. Al tercer día de ingreso fue operada bajo anestesia general con control estricto de temperatura corporal, sin incidencias. Es importante el manejo anestésico en pacientes con EM, siendo el control estricto de la temperatura corporal necesario para evitar comorbilidad y complicaciones perioperatorias.

Development of a method for estimating oesophageal temperature by multi-locational temperature measurement inside the external auditory canal.

We aimed to develop a practical method to estimate oesophageal temperature by measuring multi-locational auditory canal temperatures. This method can be applied to prevent heatstroke by simultaneously and continuously monitoring the core temperatures of people working under hot environments. We asked 11 healthy male volunteers to exercise, generating 80 W for 45 min in a climatic chamber set at 24, 32 and 40 °C, at 50% relative humidity. We also exposed the participants to radiation at 32 °C. We continuously measured temperatures at the oesophagus, rectum and three different locations along the external auditory canal. We developed equations for estimating oesophageal temperatures from auditory canal temperatures and compared their fitness and errors. The rectal temperature increased or decreased faster than oesophageal temperature at the start or end of exercise in all conditions. Estimated temperature showed good similarity with oesophageal temperature, and the square of the correlation coefficient of the best fitting model reached 0.904. We observed intermediate values between rectal and oesophageal temperatures during the rest phase. Even under the condition with radiation, estimated oesophageal temperature demonstrated concordant movement with oesophageal temperature at around 0.1 °C overestimation. Our method measured temperatures at three different locations along the external auditory canal. We confirmed that the approach can credibly estimate the oesophageal temperature from 24 to 40 °C for people performing exercise in the same place in a windless environment.

Capillary refill time in febrile neutropenia / Tempo de enchimento capilar e neutropenia febril

Summary Introduction: Febrile neutropenia is a major cause of morbidity and mortality in patients presenting this condition following chemotherapy against several malignancies. Objective: To evaluate if capillary refill time (CRT) allows the prediction of poor clinical outcome with or without antibiotic dose escalation. Method: Capillary refill time was assessed in 50 patients with febrile neutropenia at its nadir after chemotherapy admitted to the emergency department at Hospital Universitário de Brasília. All patients included had a minimum average arterial blood pressure of 75 mmHg, O2/FiO2 saturation rate > 300, and 15 points in the Glasgow coma scale. Inclusion depended on at least three of the systemic inflammatory response syndrome (SIRS) criteria, suspected infection, and neutropenia after chemotherapy. Capillary refill time was calculated by pressing the index finger for 15 seconds, and then timing the return to the initial color. We studied whether there is a relationship between CRT and antibiotic escalation. The gold standard used to gravity was the level of lactate. Results: 31 patients had CRT ≥ 3 seconds, which it is associated with increased serum concentration of lactate (> 2 mmol/L; p<0.05). 32 patients underwent antibiotic escalation, which it is associated with CRT ≥ 3 seconds (p<0.01). Conclusion: CRT higher than three seconds was effective to predict antibiotic escalation.

Resumo Introdução: a neutropenia febril é uma das principais causas de morbimortalidade nos pacientes neutropênicos febris pós-quimioterapia para neoplasias diversas. Objetivo: avaliar se o tempo de enchimento capilar (TEC) é capaz de predizer pior desfecho clínico, pelo escalonamento ou não da antibioticoterapia. Método: foi pesquisado o TEC em 50 pacientes neutropênicos febris no nadir de pós-quimioterapia, que deram entrada no departamento de emergência do Hospital Universitário de Brasília. Todos os incluídos estavam com uma pressão arterial média mínima de 75 mmHg, relação saturação de O2/FiO2 > 300 e escala de coma de Glasgow de 15. Os critérios de inclusão foram pelo menos três da síndrome da resposta inflamatória sistêmica (SRIS), suspeita de infecção e neutropenia pós-quimioterapia. O TEC foi calculado através da pressão sobre o indicador por 15 segundos e cronometrado o tempo de retorno à cor inicial. Foi estudado se há relação entre valor encontrado no TEC e escalonamento de antibiótico. O padrão-ouro utilizado para gravidade foi o nível de lactato. Resultados: trinta e um pacientes tiveram o TEC ≥ 3 segundos, que se associou com o aumento da concentração de lactato (> 2 mmol/L; p<0,05). Trinta e dois pacientes tiveram escalonados seus antibióticos, que se associou com o TEC ≥ 3 segundos (p<0,01). Conclusão: o TEC maior que três segundos mostrou-se eficaz para predizer escalonamento de antibiótico.

In vivo temperature rise in anesthetized human pulp during exposure to a polywave LED light curing unit.

OBJECTIVES: This in vivo study evaluated pulp temperature (PT) rise in human premolars during exposure to a light curing unit (LCU) using selected exposure modes (EMs). METHODS: After local Ethics Committee approval, intact first upper premolars, requiring extraction for orthodontic reasons, from 8 volunteers, received infiltrative and intraligamental anesthesia. The teeth (n=15) were isolated using rubber dam and a minute pulp exposure was attained. A sterile probe from a wireless, NIST-traceable, temperature acquisition system was inserted directly into the coronal pulp chamber, and real time PT (°C) was continuously monitored while the buccal surface was exposed to polywave light from a LED LCU (Bluephase 20i, Ivoclar Vivadent) using selected EMs allowing a 7-min span between each exposure: 10-s either in low (10-s/L) or high (10-s/H); 5-s-turbo (5-s/T); and 60-s-high (60-s/H) intensities. Peak PT values and PT increases from baseline (ΔT) after exposure were subjected to one-way, repeated measures ANOVAs, and Bonferroni's post hoc tests (α=0.05). Linear regression analysis was performed to establish the relationship between applied radiant exposure and ΔT. RESULTS: All EMs produced higher peak PT than the baseline temperature (p<0.001). The 60-s/H mode generated the highest peak PT and ΔT (p<0.001), with some teeth exhibiting ΔT higher than 5.5°C. A significant, positive relationship between applied radiant exposure and ΔT (r(2)=0.916; p<0.001) was noted. SIGNIFICANCE: Exposing intact, in vivo anesthetized human upper premolars to a polywave LED LCU increases PT, and depending on EM and the tooth, PT increase can be higher than the critical ΔT, thought to be associated with pulpal necrosis.

Use of an external-cooling device for the treatment of heat stroke.

Heat stroke is caused by losing control of one's body temperature. It can be life threatening without proper treatment. In this case report, we describe a heat stroke patient treated with an external-cooling device, which is commonly used for therapeutic hypothermia after cardiac arrest. A 67-year-old woman was found unconscious with spontaneous breathing in a sauna. Her body temperature was 40.5°C when she arrived at the emergency department, and she was diagnosed with heat stroke. At seven hours after applying the Arctic Sun Temperature Management System (Medivance), her body temperature declined to 36.5°C, with neurologic improvement (Glasgow Coma Scale score increased from 3 to 12). She was admitted to an intensive care unit and discharged 14 days after admission without any neurological sequelae. In conclusion, an external-cooling device can be used effectively for heat stroke, in addition to therapeutic hypothermia after cardiac arrest.

A new method to detect significant basal body temperature changes during a woman's menstrual cycle.

OBJECTIVE: To compare the results of a computer programme based on the Trigg's tracking system (TTS) identification of the basal body temperature (BBT) shift day from daily records of BBT values (TTS transition day), with the BBT shift day identified from the same records using the Sensiplan(®) symptothermal method of natural family planning. METHODS: A computer programme was written to display the daily BBT readings for 364 menstrual cycles from 51 women aged 24 to 35 years, obtained from the German Natural Family Planning (NFP) database. The TTS transition day so identified from each record was then compared with the BBT shift day estimated from the same record by the Sensiplan(®) method. RESULTS: Total agreement between the methods was obtained for 81% (294/364) of the cycles and 18% (67) cycles differed by ± 1 day. For the 364 pairs of values distributed among 51 women the medians of the differences between the TTS transition day and Sensiplan(®) initial day of the BBT rise (shift day) were not significantly different (χ(2) = 65.28, df = 50, p = 0.07205). CONCLUSION: The advantages of the tracking signal algorithm are that in many cases it was possible to identify the BBT shift day on that very day - rather than only some days later - and to estimate the probability that a transition had occurred from the different values of the tracking signal.

Combined chemohyperthermia: 10-year single center experience in 160 patients with nonmuscle invasive bladder cancer.

PURPOSE: Nonmuscle invasive bladder cancer is characterized by a high recurrence rate. New adjuvant treatments are needed to decrease this high number of recurrences. We present the results of more than 10 years of experience with chemohyperthermia in patients with nonmuscle invasive bladder cancer. MATERIALS AND METHODS: Using standardized medical record forms we prospectively collected patient and tumor characteristics of patients treated with chemohyperthermia between 2002 and 2013. Median followup was 75.6 months. Recurrence-free survival was the primary objective. The secondary objective was to observe recurrence-free survival differences in 1) the epirubicin group vs the mitomycin group and 2) the highly recurrent (greater than 2 recurrences in 24 months) nonmuscle invasive bladder cancer group vs the other groups. RESULTS: A total of 160 patients with nonmuscle invasive bladder cancer were included in study, including 20 (13%) treated with epirubicin and 129 (81%) previously treated with bacillus Calmette-Guérin. One and 2-year recurrence-free survival was 60% and 47%, respectively. Muscle invasive progression was seen in 4% of cases. Two-year recurrence-free survival in the epirubicin and mitomycin groups was 55% and 46%, respectively (p = 0.30). The highly recurrent nonmuscle invasive bladder cancer group had significant decreased recurrence-free survival compared to other groups (p <0.01). Patients treated with 2 or fewer vs greater than 2 transurethral bladder tumor resections before chemohyperthermia had higher recurrence-free survival (p = 0.01). On multivariable analysis the highly recurrent cancer criteria remained independently associated with decreased recurrence-free survival (HR 2.40, 95% CI 1.30-4.43, p = 0.01). CONCLUSIONS: Chemohyperthermia is an effective approach to nonmuscle invasive bladder cancer for which standard intravesical treatments fail. Patients with highly recurrent disease before chemohyperthermia have lower recurrence-free survival. Furthermore, recurrence-free survival appears to improve with earlier chemohyperthermia. No significant differences were observed between the 2 chemotherapy agents.

Risk of hypothermia in a new olympic event: the 10-km marathon swim

INTRODUCTION: There are no available data addressing the potential clinical risks of open-water swimming competitions. OBJECTIVE: Address the risks of hypothermia and hypoglycemia during a 10-km open-water swimming competition in order to alert physicians to the potential dangers of this recently-introduced Olympic event. METHODS: This was an observational cross-sectional study, conducted during a 10-km open-water event (water temperature 21ºC). The highest ranked elite open-water swimmers in Brazil (7 men, 5 women; ages 21±7 years old) were submitted to anthropometrical measurements on the day before competition. All but one athlete took maltodextrine ad libitum during the competition. Core temperature and capillary glycemia data were obtained before and immediately after the race. RESULTS: Most athletes (83 percent) finished the race with mild to moderate hypothermia (core temperature <35ºC). The body temperature drop was more pronounced in female athletes (4.2±0.7ºC vs. male: 2.7±0.8ºC; p=0.040). When data from the athlete who did not take maltodextrine was excluded, capillary glycemia increased among athletes (pre 86.6±8.9 mg/dL; post 105.5±26.9 mg/dL; p=0.014). Time to complete the race was inversely related to pre- competition body temperature in men (r=-0.802; p=0.030), while it was inversely correlated with the change in capillary glycemia in women (r=-0.898; p=0.038). CONCLUSION: Hypothermia may occur during open-water swimming events even in elite athletes competing in relatively warm water. Thus, core temperature must be a chief concern of any physician during an open-water swim event. Capillary glycemia may have positive effects on performance. Further studies that include more athletes in a controlled setting are warranted.

Malaria treatment and prevention in pregnancy: indications for use and adverse events associated with use of chloroquine or mefloquine.

In sub-Saharan Africa, women frequently report a variety of symptoms during pregnancy, some of which indicate possible illness. Given the adverse impact of malaria in pregnancy, these events may be important for at least two reasons: it may be possible to use reported fever illness as a determinant of which women need an antimalarial intervention, and, it is possible that adverse symptoms following the antimalarial intervention may be important determinants of continued adherence to the prevention regimen. In a cohort of pregnant women enrolled at first antenatal clinic visit in rural Malawi, we evaluated reported fever, determined parasitemia, and placed the women on antimalarial regimens containing chloroquine (CQ) or mefloquine (MQ). We then systematically evaluated reported symptoms following antimalarial drug use after initial therapeutic doses and subsequent prophylactic doses, and monitored women throughout their pregnancy and at delivery. Among 4,187 enrolled women, 1,048 (25%) reported at least one febrile episode during pregnancy before their first antenatal clinic visit. Factors associated with this reported fever included low parity, enrollment in the rainy season, human immunodeficiency virus seropositivity, use of antimalarial prophylaxis before enrollment, high socioeconomic status, normal (compared to low) maternal height and weight, and literacy. Fever before the first antenatal clinic visit was reported by 24.4% of parasitemic women and 25.4% of aparasitemic women; the sensitivity and specificity of fever to identify parasitemic women was 24% and 71%, respectively. In contrast, the sensitivity and specificity of first or second pregnancy to identify parasitemic women was 71% and 57%, respectively. Among women on a CQ or MQ regimen, approximately 60% reported side effects (e.g., itching, dizziness, and gastrointestinal disturbances) after a treatment dose and approximately 25% reported side effects after a prophylactic dose; rates and types of symptoms reported were similar in the CQ and MQ groups. Few serious side effects were observed and rates of fetal loss were low and similar in the groups. Reliance on fever illness will be wholly inadequate to identify parasitemic women; therefore, our findings support existing World Health Organization recommendations that presumptive treatment and prevention regimens should be offered to all pregnant women. When resources are inadequate to offer antimalarial prophylaxis to all pregnant women, women in their first or second pregnancy may be a more appropriate target group than pregnant women with reported fever. Education regarding expected minor side effects may reduce rates of poor compliance and improve the effectiveness of the prevention effort.

PIP: 4187 pregnant women with parasitemia attending 4 prenatal care clinics in rural Mangochi District, Malawi, were assigned to 1 of 4 regimens of antimalarial treatment and/or prophylaxis and followed through delivery. The aim was to examine maternal fever and to evaluate side effects and the frequency of adverse reproductive outcomes for their possible association with malaria or the antimalarial drug regimens. The regimens were 3 regimens for chloroquine (CQ), 1 of which was the current standard of care in Malawi, and a mefloquine (MQ) regimen. 25% of the pregnant women claimed to have had at least 1 febrile episode before their first prenatal care visit. Blood smear tests revealed the parasitemia prevalence rate at enrollment to be 44.4%. The sensitivity of fever to identify parasitemic pregnant women was 24%. Fever's specificity was 71%. Only high density parasitemia (10,000 parasites/sq m) was associated with fever (44.9% vs. 25.4% for no parasitemia; odds ratio [OR] = 2.54; p 0.000001). Other significant factors associated with high fever were low parity, enrollment in the rainy season, HIV seropositivity, use of antimalarial prophylaxis before enrollment, high socioeconomic status, normal maternal height and weight, and literacy. The sensitivity of first or second pregnancy to identify parasitemic women was 71%. Its specificity was 57%. About 60% of women from both CQ and MQ treatment groups had side effects after a treatment dose. About 25% had side effects after a prophylactic dose. The leading side effects were itching, dizziness, and gastrointestinal disturbances. There were few serious side effects. Among all women, the spontaneous abortion rate was 1.2% and the stillbirth rate was 3.9%. Women in the CQ and MQ treatment groups had similar abortion and stillbirth rates. Based on these findings, the researchers concluded that using fever as a means to identify parasitemic women is unreliable. They recommend antimalarial treatment and/or prophylaxis for all pregnant women, but when resources are limited it should be administered to women in their first or second pregnancy.

Temperature drop in normal term newborn infants born at the University Hospital, Kuala Lumpur.

A prospective study of temperature drop in 141 normal term newborn infants delivered vaginally at the labour ward, University Hospital, Kuala Lumpur were studied. The effect of various manoeuvres on the temperature drop were also studied. They were randomized into 3 study groups, 63 cases where the babies were wiped with dry cloth alone, 37 cases where the babies were put into a plastic bag immediately after birth and lastly 41 cases where the babies were wiped with dry cloth and then inserted into a plastic bag. There was significant temperature drop in all the 3 groups maximum in the first 15 minutes and the fall continued for 1 hour after delivery (p less than 0.001). This shows that in an air-conditioned labour ward in a tropical country the temperature fall in newborn infants can be significant. This study also showed that plastic is a poor insulator against significant temperature drop.

PIP: Health workers in the labor ward at the University Hospital in Kuala Lumpur, Malaysia, wiped 104 normal, full-term, newborns with only a dry cloth and then wrapped 63 of then in dry linen, including the head, and placed the remaining 41 infants in a sealed plastic bag with an opening for the head and a small opening at the anus. They wrapped the heads of these 41 infants with a dry linen cloth. They put 37 other normal, full-term newborns directly in the plastic bag without first wiping them with a dry cloth. The researchers wanted to evaluate the decrease in temperature in normal-term infants after delivery in an air conditioned room and to determine what various techniques reduced the rate of temperature decreases, specifically to determine whether plastic effectively insulates the infant. The mean birth weights of all 3 groups were not statistically different (overall mean birth weight = 3132 gm). Rectal temperatures fell precipitously in the first 15 minutes in all 3 groups (p .0001, e.g., infants in plastic without first being wiped, 37.45-36.8 degrees Celsius). The rate of temperature drop was essentially the same for all 3 groups (0.8-0.98 degrees Celsius). The temperature still fell significantly, but less abruptly, during the next 60 minutes (p .0001). These findings suggested that plastic did not effectively protect the infant from heat loss in an air conditioned environment. The researchers intended to conduct another study investigating the insulting capabilities of the silver swaddler--a potential device to prevent hypothermia.