Modeling iatrogenic intraoperative hyperthermia from external warming in children: A pooled analysis from two prospective observational studies

Miller, Clemens; Bräuer, Anselm; Wieditz, Johannes; Klose, Katharina; Pancaro, Carlo; Nemeth, Marcus

doi:10.1111/pan.14580

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…To anticipate the development of iatrogenic hyperthermia through adjusting forced-air warming in a timely manner, accurate temperature monitoring even in the normothermic range is indispensable. 37 204 Nemeth et al Pointwise observed mean and 95% reference intervals are depicted (colour graded). Colour grading denotes that the number of patients analysed decreased over time due to different durations of surgery.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the noninvasive Temple Touch Pro temperature monitoring system compared with oesophageal temperature in paediatric anaesthesia (PETER PAN)

Nemeth

Klose

Asendorf

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND Monitoring peri-operative body temperature in children is currently mainly achieved through invasive devices. The Temple Touch Pro Temperature Monitoring System estimates core temperature noninvasively based on heat flux thermometry. OBJECTIVE To investigate the agreement of this noninvasive sensor against standard oesophageal core temperature. DESIGN A prospective observational study. SETTING University hospital recruiting between April and July 2021.PATIENTS One hundred children (32 girls) aged 6 years or younger scheduled for noncardiac surgery, resulting in 6766 data pairs. Exclusion criteria were contraindication for the insertion of an oesophageal temperature probe, and procedures in which one of the measurement methods would interfere with the surgical field.MAIN OUTCOME MEASURES Primary outcome was the agreement analysis by a Bland-Altman comparison with multiple measurements. Posthoc, we performed another agreement analysis after exclusion of a statistically determined equilibration time. Secondary outcomes were the temperature differences over time and subgroup analysis of hypothermic, normothermic and hyperthermic temperature ranges, age, sex and sensor's side by type III analysis of variance. Further, we correlated the sonographically determined depth of the artery with trueness. RESULTSThe mean difference was -0.078C (95% CI -0.15 to R0.05) with limits of agreement of -1.00 and R0.858C. After adjusting for an equilibration time of 13 min, the mean difference improved to -0.048C (95% CI -0.08 to R0.01) with limits of agreement of -0.68 and R0.608C. Concordance correlation coefficient was 0.83 (95% CI 0.82 to 0.84). Differences between the skin sensor and oesophageal reference increased over time by -0.058C per hour. Subgroup analysis showed no clinically relevant differences. Depth of artery negatively correlated with trueness by 0.038C per millimetre.CONCLUSIONS Although the Temple Touch Pro sensor showed acceptable accuracy after allowing for an equilibration time, it still needs further investigation for routine use in children. This particularly affects accuracy in hypothermic ranges, imprecise positioning and applicability in children with immature or vulnerable skin.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the noninvasive Temple Touch Pro temperature monitoring system compared with oesophageal temperature in paediatric anaesthesia (PETER PAN)

Nemeth

Klose

Asendorf

et al. 2023

European Journal of Anaesthesiology

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“…While the etiologic treatment for malignant hyperthermia is ongoing, maintaining vital functions and correcting biochemical abnormalities is crucial for a good patient outcome. Specifically, the following points should be addressed [ 8 , 34 , 61 , 78 , 85 , 86 , 87 ]:…”

Section: Treatment Of Malignant Hyperthermiamentioning

confidence: 99%

Real Evidence and Misconceptions about Malignant Hyperthermia in Children: A Narrative Review

Frassanito

Sbaraglia

Piersanti

et al. 2023

JCM

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Malignant hyperthermia is a rare but life-threatening pharmacogenetic disorder triggered by exposure to specific anesthetic agents. Although this occurrence could affect virtually any patient during the perioperative time, the pediatric population is particularly vulnerable, and it has a five-fold higher incidence in children compared to adults. In the last few decades, synergistic efforts among leading anesthesiology, pediatrics, and neurology associations have produced new evidence concerning the diagnostic pathway, avoiding unnecessary testing and limiting false diagnoses. However, a personalized approach and an effective prevention policy focused on clearly recognizing the high-risk population, defining perioperative trigger-free hospitalization, and rapid activation of supportive therapy should be improved. Based on epidemiological data, many national scientific societies have produced consistent guidelines, but many misconceptions are common among physicians and healthcare workers. This review shall consider all these aspects and summarize the most recent updates.

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What is the minimum time interval for reporting of intraoperative core body temperature measurements in pediatric anesthesia? A secondary analysis

Miller,

Bräuer,

Wieditz

et al. 2024

J Clin Monit Comput

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Given that perioperative normothermia represents a quality parameter in pediatric anesthesia, numerous studies have been conducted on temperature measurement, albeit with heterogeneous measurement intervals, ranging from 30 s to fifteen minutes. We aimed to determine the minimum time interval for reporting of intraoperative core body temperature across commonly used measurement intervals in children. Data were extracted from the records of 65 children who had participated in another clinical study and analyzed using a quasibinomial mixed linear model. Documented artifacts, like probe dislocations or at the end of anesthesia, were removed. Primary outcome was the respective probability of failing to detect a temperature change of 0.2 °C or more at any one measurement point at 30 s, one minute, two minutes, five minutes, ten minutes, and fifteen minutes, considering an expected probability of less than 5% to be acceptable. Secondary outcomes included the probabilities of failing to detect hypothermia (< 36.0 °C) and hyperthermia (> 38.0 °C). Following the removal of 4,909 exclusions, the remaining 222,366 timestamped measurements (representing just over 60 h of monitoring) were analyzed. The median measurement time was 45 min. The expected probabilities of failing to detect a temperature change of 0.2 °C or more were 0.2% [95%-CI 0.0-0.7], 0.5% [95%-CI 0.0-1.2], 1.5% [95%-CI 0.2–2.6], 4.8% [95%-CI 2.7–6.9], 22.4% [95%-CI 18.3–26.4], and 31.9% [95%-CI 27.3–36.4], respectively. Probabilities for the detection of hyperthermia (n = 9) were lower and omitted for hypothermia due to low prevalence (n = 1). In conclusion, the core body temperature should be reported at intervals of no more than five minutes to ensure the detection of any temperature change in normothermic ranges. Further studies should focus on hypothermic and hyperthermic ranges.

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Modeling iatrogenic intraoperative hyperthermia from external warming in children: A pooled analysis from two prospective observational studies

Cited by 4 publications

References 18 publications

Evaluation of the noninvasive Temple Touch Pro temperature monitoring system compared with oesophageal temperature in paediatric anaesthesia (PETER PAN)

Evaluation of the noninvasive Temple Touch Pro temperature monitoring system compared with oesophageal temperature in paediatric anaesthesia (PETER PAN)

Real Evidence and Misconceptions about Malignant Hyperthermia in Children: A Narrative Review

What is the minimum time interval for reporting of intraoperative core body temperature measurements in pediatric anesthesia? A secondary analysis

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