Temperature management and monitoring practices during adult cardiac surgery under cardiopulmonary bypass: results of a Canadian national survey

Abstract

Contemporary management of adult cardiac surgery under CPB still involves induction of mild to moderate systemic hypothermia. Significant practice variation exists across the country with respect to target temperatures for cooling and rewarming, as well as the site for temperature monitoring. This probably reflects the lack of definitive evidence. There is a need for well-conducted clinical trials to provide more robust evidence regarding temperature management.

The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass—Temperature Management During Cardiopulmonary Bypass

“…Owing to differences in interpreting the literature and the paucity of published guidelines in this clinical area, there is extensive variability in the conduct of managing perfusate temperature during CPB. A recent survey of perfusionists found that 1) in more than 90% of centers, mildly hypothermic perfusion of 32°C to 34°C is routinely used and 63% achieve that temperature without active cooling; 2) during CPB, the most common sites for measuring temperature are nasopharyngeal (NP, 84%), venous return (75%), arterial line (72%), bladder (41%), and rectum (28%); 3) 19% of centers reported routinely calibrating their in-line temperature probes; and 4) 44% of centers exceed the 37°C peak temperature limit for the arterial line temperature during rewarming ( 3 ). Although temperature management strategies are frequently reported in the literature, the rationale for these practices is often underreported or absent.…”

The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass—Temperature Management During Cardiopulmonary Bypass

“…A recent survey of perfusionists found that (1) in more than 90% of centers, mildly hypothermic perfusion of 32 to 34 C is routinely used and 63% achieve that temperature without active cooling; (2) during CPB, the most common sites for measuring temperature are nasopharyngeal (NP, 84%), venous return (75%), arterial line (72%), bladder (41%), and rectum (28%); (3) 19% of centers reported routinely calibrating their in-line temperature probes, and (4) 44% of centers exceed the 37 C peak temperature limit for the arterial line temperature during rewarming [3]. Although temperature management strategies are frequently reported in the literature, the rationale for these practices is often underreported or absent.…”

“…A number of sites for routine core and cerebral temperature management have been reported, including NP, tympanic membrane, bladder, esophagus, rectum, pulmonary artery, jugular bulb (JB), arterial inflow, and venous return [3]. A single, easily monitored, optimal core temperature site has not been reported, although the intravascular and intracorporeal location of a pulmonary artery catheter probably renders this site the best access for core temperature recording.…”

Physiological Parameters of Artificial Blood Circulation From the Position of the Evidence Based Medicine (Part 2)

“…Недавний опрос в Канаде показал: 1) более 90% центров рутинно используют поверхностную гипотермию (32-34°C), причем 63% достигают ее без активного охлаждения; 2) во время ИК наиболее распространенными местами измерения температу-ры являются носоглотка -84%, венозный возврат в аппарат искусственного кровообращения (АИК) -75%, выход артериальной крови из оксигенатора -72%, мочевой пузырь -41%, прямая кишка -28%; 3) лишь 19% центров рутинно калибруют темпе-ратурные датчики; 4) в 44% центров превышают температуру 37°C в артериальной линии во время согревания [8]. Хотя температурные стратегии часто упоминаются в литературе, обоснования для той или иной практики часто недостаточно описы-ваются или вовсе отсутствуют.…”

“…Описано большое количество мест для рутин-ного измерения центральной температуры тела, включая носоглотку, барабанную перепонку, мо-чевой пузырь, пищевод, прямую кишку, легочную артерию, луковицу яремной вены, артериальную и венозную магистрали ИК [8]. При этом не име-ется единой, легко мониторируемой, оптимальной точки измерения температуры ядра тела, хотя ин-траваскулярное и интракорпоральное размещение катетера в легочной артерии, возможно, представ-ляет лучшее место для мониторинга центральной температуры тела.…”