scholarly journals Insight into the use of tympanic temperature during target temperature management in emergency and critical care: a scoping review

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Michela Masè ◽  
Alessandro Micarelli ◽  
Marika Falla ◽  
Ivo B. Regli ◽  
Giacomo Strapazzon
Keyword(s):  
Core Temperature ◽  
Scoping Review ◽  
Brain Temperature ◽  
Temperature Measurements ◽  
Tympanic Temperature ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Temperature Changes ◽  
Clinical Conditions

Abstract Background Target temperature management (TTM) is suggested to reduce brain damage in the presence of global or local ischemia. Prompt TTM application may help to improve outcomes, but it is often hindered by technical problems, mainly related to the portability of cooling devices and temperature monitoring systems. Tympanic temperature (TTy) measurement may represent a practical, non-invasive approach for core temperature monitoring in emergency settings, but its accuracy under different TTM protocols is poorly characterized. The present scoping review aimed to collect the available evidence about TTy monitoring in TTM to describe the technique diffusion in various TTM contexts and its accuracy in comparison with other body sites under different cooling protocols and clinical conditions. Methods The scoping review was conducted following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews (PRISMA-ScR). PubMed, Scopus, and Web of Science electronic databases were systematically searched to identify studies conducted in the last 20 years, where TTy was measured in TTM context with specific focus on pre-hospital or in-hospital emergency settings. Results The systematic search identified 35 studies, 12 performing TTy measurements during TTM in healthy subjects, 17 in patients with acute cardiovascular events, and 6 in patients with acute neurological diseases. The studies showed that TTy was able to track temperature changes induced by either local or whole-body cooling approaches in both pre-hospital and in-hospital settings. Direct comparisons to other core temperature measurements from other body sites were available in 22 studies, which showed a faster and larger change of TTy upon TTM compared to other core temperature measurements. Direct brain temperature measurements were available only in 3 studies and showed a good correlation between TTy and brain temperature, although TTy displayed a tendency to overestimate cooling effects compared to brain temperature. Conclusions TTy was capable to track temperature changes under a variety of TTM protocols and clinical conditions in both pre-hospital and in-hospital settings. Due to the heterogeneity and paucity of comparative temperature data, future studies are needed to fully elucidate the advantages of TTy in emergency settings and its capability to track brain temperature.

scholarly journals Effects of Target Temperature Management on the Outcome of Septic Patients with Fever

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Ye Gao ◽  
Jianjun Zhu ◽  
Chenyu Yin ◽  
Jianliang Zhu ◽  
Tao Zhu ◽  
...  
Keyword(s):  
Low Temperature ◽  
Clinical Outcomes ◽  
Core Temperature ◽  
T Lymphocyte ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Hemodynamic Changes ◽  
Temperature Group ◽  
Immune Factors

Objectives. To investigate the effects of target temperature management on hemodynamic changes, inflammatory and immune factors, and clinical outcomes of sepsis patients with fever. Methods. Patients diagnosed with sepsis with a core temperature of ≥39°C were randomly divided into two groups: a low-temperature group (LT group: 36.5°C–38°C) and a high-temperature group (HT group: 38.5°C–39.5°C). A target core temperature was achieved within 6 hrs posttreatment and maintained for 24 hrs. Then, the hemodynamic changes, inflammatory and immune factors, and clinical outcomes were evaluated. Results. Compared with the HT group, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) showed a significant decrease in the LT group (P<0.05). In contrast, IL-4 and IL-10 were higher in the LT group than in the HT group (P<0.05). The CD4-T lymphocyte (CD4+), CD8-T lymphocyte (CD8+), and monocytic human leukocyte antigen-DR (mHLA-DR) in the LT group were higher than in the HT group (P<0.05). The ICU stay and the anti-infection treatment costs were higher in the LT group (P<0.05). Conclusion. Low-temperature management of patients resulted in a low level of proinflammatory cytokines. Excessive temperature control in sepsis patients with fever may be harmful.

Abstract 107: Cardiac Arrest Outcomes After Target Temperature Management With an Esophageal Cooling Device

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Marvin A Wayne ◽  
Cedar Anderson ◽  
Rick Fisher ◽  
Donald Berry ◽  
J.Brad Diestelhorst
Keyword(s):  
Cardiac Arrest ◽  
Core Temperature ◽  
Temperature Control ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Entire Cohort ◽  
New Device ◽  
Icu Discharge ◽  
Intravascular Catheters

Introduction: Optimal patient care after cardiac arrest includes targeted temperature management (TTM). Methods typically utilized for patient temperature control, including ice-packs, servo-controlled surface pads, and intravascular catheters. A new device placed in the esophagus that cools from the patient’s core may offer advantages over other methods. It avoids risks from intravascular catheters, reduces shivering from surface contact, and allows core temperature control to be rapidly performed, after placement, by nursing staff. Hypothesis: Using a nurse driven protocol we sought to quantify patient outcomes, after TTM, using an esophageal device, in our mixed-population intensive care unit. Methods: We reviewed the charts of all patients treated with esophageal TTM as part of our standard post-arrest bundle at our advanced community medical center. We recorded patient age, gender, target temperature, TTM initiation time, the time goal temperature was attained, and patient survival. Results: A total of 54 patients were treated with esophageal TTM over the study period, from August 2016 to November 2018. Of these 2 recovered and had treatment discontinued prior to reaching target, leaving 52 for analysis (19 female, 33 male, age 18-79, median age 62.5). Nurses placed all ETM devices, and target temperatures varied by clinician preference, from 32°C to 36°C. Survival to ICU discharge was 51.9% for the entire cohort, with male survival (61%) greater than female (37%), p=0.10; however, Cfor the entire cohort was 219 minutes (IQR 81-415). Survivors exhibited longer times to achieve goal temperature (median 180 minutes in non-survivors vs. 255 minutes in survivors). Conclusions: Esophageal TTM offers a nurse-driven approach to obtain rapid core temperature management, with good outcomes in our patient population. As seen elsewhere, surviving patients require longer times to reach target temperature.

scholarly journals Is Esophageal Temperature Better to Estimate Brain Temperature during Target Temperature Management in a Porcine Model of Cardiopulmonary Resuscitation?

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Heng Li ◽  
Zhengfei Yang ◽  
Yuanshan Liu ◽  
Zhixin Wu ◽  
Weibiao Pan ◽  
...  
Keyword(s):  
Brain Temperature ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Central Vein ◽  
Target Temperature ◽  
Esophageal Temperature ◽  
Priority Method ◽  
Resuscitated Patients ◽  
Cost Efficient ◽  
Body Cooling

Brain temperature monitoring is important in target temperature management for comatose survivors after cardiac arrest. Since acquisition of brain temperature is invasive and unrealistic in scene of resuscitation, we tried to sought out surrogate sites of temperature measurements that can precisely reflect cerebral temperature. Therefore, we designed this controlled, randomized animal study to investigate whether esophageal temperature can better predict brain temperature in two different hypothermia protocols. The results indicated that esophageal temperature had a stronger correlation with brain temperature in the early phase of hypothermia in both whole and regional body cooling protocols. It means that esophageal temperature was considered as priority method for early monitoring once hypothermia is initiated. This clinical significance of this study is as follows. Since resuscitated patients have unstable hemodynamics, collecting temperature data from esophagus probe is cost-efficient and easier than the catheter in central vein. Moreover, it can prevent the risk of iatrogenic infection comparing with deep vein catheterization, especially in survivors with transient immunoexpressing in hypothermia protocol.

Abstract 23: The Usefulness of Neuron-Specific Enolase in Cerebrospinal Fluid to Predict Neurological Prognosis in Cardiac Arrest Survivors Who Underwent Target Temperature Management: A Prospective Observational Study

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Jung Soo Park
Keyword(s):  
Cerebrospinal Fluid ◽  
Cardiac Arrest ◽  
Observational Study ◽  
Neurological Outcome ◽  
Prospective Observational Study ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Outcome Group

Aim: We aimed to investigate the prognostic performance between serum NSE and cerebrospinal fluid (CSF) NSE for 6-month neurologic outcome in OHCA survivors underwent target temperature management (TTM). Hypothesis: We hypothesized that the NSE levels measured in the CSF would affect the change, earlier and more sensitively than serum, according to severity of hypoxic brain damage. Methods: This single-centre prospective observational study included out-of-hospital cardiac arrest (OHCA) patients underwent TTM. NSE levels were assessed in blood and CSF samples obtained immediately (Day 0), and 24 h (Day 1), 48 h (Day 2), and 72 h (Day 3) after return of spontaneous circulation (ROSC). The primary outcome was the 6-month neurological outcome. Results: We enrolled 34 patients (males, 24; 70.6%), 16 (47.1%) had a poor neurologic outcome. CSF NSE and serum NSE values were significantly higher in the poor outcome group compared to the good outcome group at each time point, except for serum Day 0. CSF NSE and serum NSE had area under curve (AUC) of 0.819-0.972 and 0.648-0.920, respectively. CSF NSE prognostic performances were significant higher than serum NSE at Day 1 and showed excellent AUC values (0.969; 95% Confidential Interval [CI] 0.844-0.999) and high sensitivity (93.8%; 95% CI 69.8-99.8) at 100% specificity. Conclusion: We found CSF NSE values were highly predictive and sensitive markers of 6-month poor neurological outcome in OHCA survivors treated with TTM at Day 1 after ROSC. Thus, CSF NSE level at day 1 after ROSC can be a useful early prognosticator in OHCA survivors.

Usefulness of the Degree of Blood–brain Barrier Disruption to Predict Neurological Prognosis in Cardiac Arrest Survivors who Wnderwent Target Temperature Management: A Retrospective Study

2020 ◽  
Author(s):  
Ga Ram Jeon ◽  
Hong Joon Ahn ◽  
Jung Soo Park ◽  
Insool Yoo ◽  
Yeonho You ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Blood Brain Barrier ◽  
Neurological Outcome ◽  
Scoring System ◽  
Brain Barrier ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Neurological Outcomes ◽  
Poor Neurological Outcome

Abstract Background: This study aimed to compare the day-specific association of blood–brain barrier (BBB) disruption with neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors treated with target temperature management (TTM).Methods: This retrospective single-center study included 68 OHCA survivors, who underwent TTM between April 2018 and December 2019. The albumin quotient (QA) was calculated as [albuminCSF] / [albuminserum] immediately (day 1), and at 24 h (day 2), 48 h (day 3), and 72 h (day 4) after return of spontaneous circulation (ROSC). The degree of BBB disruption was weighted using the following scoring system: 0.07 ≥ QA (normal), 0.01 ≥ QA > 0.007 (mild), 0.02 ≥ QA > 0.01 (moderate), and QA > 0.02 (severe). This system gave it 0 (normal), 1 (mild), 4 (moderate), and 9 (severe) points. Poor neurological outcome was determined at six months after ROSC and was defined as cerebral performance categories 3–5.Results: We enrolled 68 patients (males, 48; 71%); 37 (54%) of them had a poor neurological outcome. The distributions of this outcome at six months in patients with moderate and severe BBB disruption versus the other groups were 19/22 (80%) vs. 18/46 (50%) on day 1, 31/37 (79%) vs. 6/31 (32%) on day 2, 32/37 (81%) vs. 5/31 (30%) on day 3, and 32/39 (85%) vs. 5/29 (30%) on day 4 (P < 0.001). Using ROC analyses, the optimal cutoff values of QA levels for prediction of neurological outcomes were determined as: day 1, > 0.009 (sensitivity 56.8%, specificity 87.1%); day 2, > 0.012 (sensitivity 81.1%, specificity 87.1%); day 3, > 0.013 (sensitivity 83.8%, specificity 87.1%); day 4, > 0.013 (sensitivity 86.5%, specificity 87.1%); sum of all time points, > 0.039 (sensitivity 89.5%, specificity 79.4%); and scoring system, > 9 (sensitivity 91.9%, specificity 87.1%). Conclusions: Our results suggested that QA is a useful tool for predicting neurological outcomes in OHCA survivors treated with TTM. However, the prediction of poor neurological outcome using QA showed low sensitivity at 100% specificity. Thus, it could be used as part of a multimodal approach than as a single prognostic prediction tool.

286: EFFECT OF TARGET TEMPERATURE MANAGEMENT IN THE ICU AFTER CARDIAC ARREST STRATIFIED BY RSO2

2018 ◽  
Vol 46 (1) ◽  
pp. 125-125
Author(s):  
Yuka Nakatani ◽  
Takeo Nakayama ◽  
Kei Nishiyama ◽  
Yoshimitsu Takahashi
Keyword(s):  
Cardiac Arrest ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature
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