Temperature management on cardiopulmonary bypass: Is it standardised across Great Britain and Ireland?

Browne, Lorraine

doi:10.1177/0267659121995996

Cited by 6 publications

(4 citation statements)

References 52 publications

(72 reference statements)

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“…Another important issue is body temperature management.As we all known, wide incision, massive infusion uid and blood in such surgery make maintain body temperature is very di culty. CPB can effectively manage the temperature 19 , to maintain the high temperature of normal value before the downtime of CPB. There are many ways to maintain body temperature in case of hypothermia after CPB, such as using water blanket, warm air heater and infusion heater.…”

Section: Discussionmentioning

confidence: 99%

Management of anesthesia and cardiopulmonary bypass of pediatric abdominal tumor invading inferior vena caval and right atrium: our clinical experience

et al. 2023

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Objective Abdominal tumor with inferior vena caval (IVC) and right atrium tumor thrombus is relatively rare in children. In this paper,we summarize the management of anesthesia and cardiopulmonary bypass(CPB) during the multidisciplinary treatment(MDT). Methods We retrospectively analyzed the clinical data of children with abdominal tumor with inferior vena caval and right atrium tumor thrombus from January 2012 to December 2022,who had been performed surgeon under CPB. We summarize the management of anesthesia and CPB, intraoperative hemorrhage ,arterial blood gas, blood transfusion, postoperative outcome,follow-up and so on. Results 6 pediatric patients with IVC and right atrium tumor thrombus from abdominal tumor underwent surgical treatment with CPB. The primary malignancies were nephroblastom (n = 2), renal clear cell carcinoma(n = 1) and hepatoblastoma (n = 3). In all cases the primary tumor and tumor thrombus were completely removed. In all these patients, the mean age was 25.8 months (range 14-41months). The mean operative time was 459.8 min (range 365–580 min) and the mean anaesthesia time was 553.1 min (range 450–745 min). The mean cardiopulmonary bypass time was 150.3 min (range 91–261) .The mean cardiopulmonary bypass time was 150.3 min (range 91–261 min). The mean aortic block time was 46.1min (range 24–68 min) and the mean hypothermic circulatory arrest time was 22 min (range 3–46 min).The mean volume of red blood concentrates (RBC) transfuion was 5.1U(range 3-9.5U). There were all survival and no serious complications occurred after operation untill December 2022 for the follow-up. Conclusions Pediatric abdominal tumor with IVC and right atrium tumor thrombus is relatively rare, and the management of anesthesia and CPB for this multidisciplinary surgical treatment have not been reported.Thus, our report provides clinical experience of the management of anesthesia and CPB. Induction of anesthesia steadily and intraoperative massive hemorrhage are the major challenges during anesthetic management, as well as the management of intraoperative critical situations.

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Section: Discussionmentioning

confidence: 99%

Management of anesthesia and cardiopulmonary bypass of pediatric abdominal tumor invading inferior vena caval and right atrium: our clinical experience

et al. 2023

Preprint

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“…Studies have also shown that the tympanic membrane temperatures are lower than hypothalamic temperatures and can change in opposite directions [19]. Although the arterial outlet temperatures have been shown to correlate well with jugular bulb temperatures, in a survey of cardiac surgeons in the United Kingdom, only 33% rely on the arterial outlet temperature, and thus, it is not universally used [20]. While pulmonary artery catheters and jugular bulb catheters have excellent intra-class correlation (> 90%) and are considered to approximate brain temperatures best, they are invasive catheters and are currently not the standard of care [19].…”

Section: Discussionmentioning

confidence: 99%

Performance of the transoesophageal echocardiography probe as an oesophageal temperature monitor in patients undergoing cardiac surgery with cardiopulmonary bypass: a prospective observational study

Misra

Das

Srinivasan

2023

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Core temperature monitoring is critical during cardiopulmonary bypass (CPB). In this prospective observational study, we investigated the performance of the transoesophageal echocardiography (TOE) probe for core (oesophageal) temperature monitoring during CPB. METHODS Thirty adult patients, 18–70 years of either gender, undergoing cardiac surgery with CPB were enrolled. All patients received a reusable nasopharyngeal probe for monitoring core temperatures. In addition, the oesophageal temperatures were monitored with the TOE probe. The arterial outlet temperatures at the membrane oxygenator were also monitored and taken as the reference standard. Monitoring was performed every 5 min until 20 min, and then at 30 min during both the cooling and rewarming periods. RESULTS During cooling, the oesophageal and nasopharyngeal temperatures lagged behind the arterial outlet temperatures. However, the intra-class correlation of the oesophageal temperatures with the arterial outlet temperatures was better (range 0.58–0.74) than the correlation of the nasopharyngeal temperatures with the arterial outlet temperatures (range 0.46–0.62). During rewarming, the performance of the TOE probe was significantly superior to the nasopharyngeal probe. After 15 and 20 min of rewarming, there was a difference of ∼1°C between the oesophageal and nasopharyngeal temperatures. At 30 min of rewarming, the oesophageal and the arterial outlet temperatures were similar, while the nasopharyngeal temperatures still lagged by 0.5°C. Bias was significantly less both during cooling and warming between the oesophageal temperatures and arterial outlet temperatures. CONCLUSIONS Performance of the TOE probe as an oesophageal temperature probe is superior to the nasopharyngeal probe during CPB. Clinical trial registration number CTRI no 2020/10/028228; ctri.nic.in.

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“…20 We usually use nasopharyngeal temperature monitoring during cardiac surgery with a double purpose: to have a second estimate of brain temperature (along with that obtained in the arterial branch of the oxygenator) and to monitor the temperature during weaning from CPB. Although nasopharyngeal is possibly the most used temperature probe worldwide in perfusion and is one of the methods recommended by the current guidelines for weaning from CPB and immediate postbypass temperature measurement (recommendation class IIa, level of evidence C), 14,21 only 52% of adult cardiac centers throughout Great Britain and Ireland monitor nasopharyngeal temperatures during CPB; 21 that figure reflects an insufficient degree of monitoring of a parameter that is crucial during cardiovascular surgery. However, despite its popularity, the nasopharyngeal probe may not provide an accurate measurement of brain temperature.…”

Section: Discussionmentioning

confidence: 99%

Reliability of different body temperature measurement sites during normothermic cardiac surgery

et al. 2022

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Introduction Patients undergoing cardiac surgery can experience significant thermal changes during the perioperative period and, for that reason, it is essential to monitor temperatures with adequate accuracy and precision during cardiopulmonary bypass (CPB). The primary aim of the current study was to measure the discrepancies between temperatures at different body sites during normothermic or mild hypothermic CPB. Methods 48 patients undergoing cardiac surgery participated in our study. Simultaneous temperatures were measured at nasopharynx, pulmonary artery, arterial outlet, venous inlet, forehead using a heat flux sensor, and urinary bladder at 5-min intervals throughout surgery. The Bland-Altman plot for repeated measures was used to assess concordance between methods. Results The duration of surgery was 360 min (interquartile range (IQR) 300–412), while the median cross-clamp time was 135 min (IQR 101–169). During the CPB time, the average difference between arterial outlet and nasopharyngeal temperature was −0.16°C (95% limits of agreement of ±0.93). The bias between arterial outlet and the venous inflow was 0.16°C and the 95% limits of agreement were −0.63 to 0.95°C. The Bland-Altman analysis showed an average difference between oxigenator arterial outlet and bladder probe of −0.62 (95% limits of agreement of ±1.3). The average difference between arterial outlet and Tcore™ temperatures was 0.08°C (95% limits of agreement of ±1.46). 25 patients (52.08%) presented nasopharyngeal temperatures higher than 37°C in the post-CPB period, but none of them exceeded 38°C. Conclusions Perfusionists should be cautious when using the nasopharyngeal site as the only surrogate of brain temperature, even in normothermic cardiac surgery because the precision of measurements is not entirely adequate.

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Temperature management on cardiopulmonary bypass: Is it standardised across Great Britain and Ireland?

Cited by 6 publications

References 52 publications

Management of anesthesia and cardiopulmonary bypass of pediatric abdominal tumor invading inferior vena caval and right atrium: our clinical experience

Management of anesthesia and cardiopulmonary bypass of pediatric abdominal tumor invading inferior vena caval and right atrium: our clinical experience

Performance of the transoesophageal echocardiography probe as an oesophageal temperature monitor in patients undergoing cardiac surgery with cardiopulmonary bypass: a prospective observational study

Reliability of different body temperature measurement sites during normothermic cardiac surgery

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