Zero-heat-flux core temperature monitoring system: an observational secondary analysis to evaluate agreement with naso-/oropharyngeal probe during anesthesia

West, Nicholas; Cooke, Erin; Morse, Dan J.; Merchant, Richard; Görges, Matthias

doi:10.1007/s10877-019-00411-y

Cited by 17 publications

(16 citation statements)

References 32 publications

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“…First, like other studies, we applied T Eso as a reference method [16] which may not be as accurate as directly measured blood temperature but has been proven to correlate well with core body temperature derived with pulmonary artery temperature measurements [7,23]. Second, by using equidistant 5-minintervals we may not have detected an eventual time lag within these intervals, especially compared to other studies using shorter time-intervals [15,16]. However, a 5-mininterval was shown to be efficient [15].…”

Section: Limitationsmentioning

confidence: 97%

“…An isothermal tunnel corrects the varying temperature of the skin surface [9]. Multiple studies confirmed its clinically acceptable accuracy in adults [9][10][11][12][13][14][15], but there is limited evidence in children [16,17]. A recent meta-analysis revealed substantial differences and a need for further studies in children was formulated [8].…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative zero-heat-flux thermometry overestimates esophageal temperature by 0.26 °C: an observational study in 100 infants and young children

Nemeth¹,

Lovric²,

Asendorf³

et al. 2020

J Clin Monit Comput

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In pediatric anesthesia, deviations from normothermia can lead to many complications, with infants and young children at the highest risk. A measurement method for core temperature must be clinically accurate, precise and should be minimally invasive. Zero-heat-flux (ZHF) temperature measurements have been evaluated in several studies in adults. We assessed the agreement between the 3M Bair Hugger™ temperature measurement sensor (TZHF) and esophageal temperature (TEso) in children up to and including 6 years undergoing surgery with general anesthesia. Data were recorded in 5 min-intervals. We investigated the accuracy of the ZHF sensor overall and in subgroups of different age, ASA classification, and temperature ranges by Bland–Altman comparisons of differences with multiple measurements. Change over time was assessed by a linear mixed model regression. Data were collected in 100 children with a median (1st–3rd quartile) age of 1.7 (1–3.9) years resulting in 1254 data pairs. Compared to TEso (range from 35.3 to 39.3 °C; median 37.2 °C), TZHF resulted in a mean bias of +0.26 °C (95% confidence interval +0.22 to +0.29 °C; 95% limits of agreement −0.11 to +0.62 °C). Lin’s concordance correlation coefficient was 0.89. There was no significant or relevant change of temperature over time (0.006 °C per hour measurement interval, p = 0.199) and no relevant differences in the subgroups. Due to the mean bias of +0.26 °C in TZHF, the risk of hypothermia may be underestimated, while the risk of hyperthermia may be overestimated. Nevertheless, because of its high precision, we consider ZHF valuable for intraoperative temperature monitoring in children and infants.

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Section: Limitationsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Intraoperative zero-heat-flux thermometry overestimates esophageal temperature by 0.26 °C: an observational study in 100 infants and young children

Nemeth¹,

Lovric²,

Asendorf³

et al. 2020

J Clin Monit Comput

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show abstract

“…West et al’s secondary analysis of agreement of ZHF compared with nasopharynx or oropharynx measurements excluded data from six out of 200 participants due to device failure. 24 Data recording or retrieval problems were also reported by Boisson et al, 21 Pesonen et al, 23 Iden et al, 19 Jack et al, 25 and Eshraghi et al 15 Concerns regarding quality of manually recorded data are well-founded. However, our findings and previous studies suggest potential superiority of automatically recorded temperatures, as discussed by Freundlich, 37 may be undermined by retrieval issues and device failures that are not easily resolved during complex procedures.…”

Section: Discussionmentioning

confidence: 90%

“… 21 However, the device is potentially less prone to operator error than other non-invasive peripheral devices (which estimate core temperature via correction factor) including aural canal thermometry, which requires careful placement and visualization of the tympanic membrane for optimal efficiency, which under normal clinical circumstances is not conducted. The ease of use, patient tolerability, and continuous monitoring capability 22 , 24 suggests that the ZHF device may offer a viable option to improve compliance with consistent temperature measurement guidelines across perioperative care phases and multidisciplinary care providers. 3 , 44 Yet the utility and application of the device is inhibited by, importantly, lesser measurement accuracy and specificity, along with practical concerns regarding retrieval of raw values from the unit.…”

Section: Discussionmentioning

confidence: 99%

“…The device has been validated in populations including cardiac surgery, 15 , 17 , 18 gynecology, 19 , 20 trauma, 19 major abdominal surgery, 21 , 22 neurosurgery, 23 vascular, 17 urologic, 22 and combined elective surgeries. 24 , 25 A recent meta-analysis compared the device to core temperature in 22 comparisons from 16 studies: the pooled estimate for mean bias was 0.03°C, 16 however the clinical utility of the device was not evaluated. Limited studies have assessed the accuracy of the device during orthopedic surgery, nor have studies assessed patient acceptability.…”

Section: Introductionmentioning

confidence: 99%

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Zero-Heat-Flux and Esophageal Temperature Monitoring in Orthopedic Surgery: An Observational Study

Munday¹,

Higgins²,

Jones³

et al. 2021

JMDH

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Perioperative hypothermia prevention requires regular, accurate, and consistent temperature monitoring. Zero-heat-flux (ZHF) thermometry offers a non-invasive, measurement method that can be applied across all surgical phases. The purpose of this study was to measure agreement between the zero-heat-flux device and esophageal monitoring, sensitivity, and specificity to detect hypothermia and patient acceptability amongst patients undergoing upper and lower limb orthopedic surgery. Patients and Methods: This prospective, observational study utilized Bland-Altman analysis and Lin's concordance coefficient to measure agreement between devices, sensitivity and specificity to detect hypothermia and assessed patient acceptability amongst 30 patients between December 2018 and June 2019. Results: Bias was observed between devices via Bland Altman, with bias dependent on actual temperature. The mean difference ranged from −0.16°C at 34.9°C (where the mean of ZHF was lower than the esophageal device) to 0.46°C at 37.25°C (where the mean of ZHF was higher than esophageal device), with 95% limits of agreement (max) upper LOA = 0.80 to 1.41, lower LOA = −1.12 to −0.50. Seventy-five percentage of zero-heat-flux measurements were within 0.5°C of esophageal readings. Patient acceptability was high; 96% (n=27) stated that the device was comfortable. Conclusion: ZHF device achieved lesser measurement accuracy with core (esophageal) temperature compared to earlier findings. Nonetheless, due to continuous capability, noninvasiveness and patient reported acceptability, the device warrants further evaluation.

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Accuracy and precision of zero-heat-flux temperature measurements with the 3M™ Bair Hugger™ Temperature Monitoring System: a systematic review and meta-analysis

Conway

Bittner

Phan

et al. 2020

J Clin Monit Comput

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Zero-heat-flux core temperature monitoring system: an observational secondary analysis to evaluate agreement with naso-/oropharyngeal probe during anesthesia

Cited by 17 publications

References 32 publications

Intraoperative zero-heat-flux thermometry overestimates esophageal temperature by 0.26 °C: an observational study in 100 infants and young children

Intraoperative zero-heat-flux thermometry overestimates esophageal temperature by 0.26 °C: an observational study in 100 infants and young children

Zero-Heat-Flux and Esophageal Temperature Monitoring in Orthopedic Surgery: An Observational Study

Accuracy and precision of zero-heat-flux temperature measurements with the 3M™ Bair Hugger™ Temperature Monitoring System: a systematic review and meta-analysis

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