Abstract
Purpose
To compare distal oesophageal (reference) temperature with “deep-sternal,” “deep-forehead,” and tracheal temperatures, establishing the accuracy and precision of each.
Methods
We studied 20 patients undergoing general anaesthesia for gynaecological surgery. Their lungs were mechanically ventilated with a circle system, at a fresh-gas flow rate of 6 L·min−1 Respiratory gases were not warmed or humidified, Tracheal temperatures were recorded from a Trachelon® tube inserted ≈21 cm. Deepbody temperatures were measured at the sternum and forehead using a Coretemp® thermometer. The principle of the method is to null thermal flux through a cutaneous disk, thus obliterating thermal gradients between the sides of the disk, skin surface, and subcutaneous tissues. Distal oesophageal temperatures were measured from thermocouples incorporated into oesophageal stethoscopes. Tracheal and deep-tissue temperatures were compared with oesophageal temperature using regression and Bland and Altman analyses.
Results
Tracheal, sternal, and forehead temperatures correlated similarly with distal oesophageal temperature, correlation coefficients (r2) being 0.7 in each, case. The offset (oesophageal temperature minus study site) was considerably larger for tracheal temperature (0.7°C) than for the other sites (0.2°C). However, the precision was only 0.3°C at each site.
Conclusion
Our data suggest that tracheal temperatures may not be an adequate substitute for conventional core-temperature monitoring sites. In contrast, the accuracy and precision of deep-tissue temperature monitoring at the sternum and forehead was sufficient for clinical use.
Résumé
Objectif
Comparer la température oesophagienne distale (référence) avec la température sternale profonde, frontale profonde et tracheale, dans le but de vérifier l’exactitude et la précision de chacune des méthodes.
Méthodes
Vingt patientes subissant un intervention gynécologique ont été étudiées. Elles étaient ventilées mécaniquement à l’aide d’un circuit circulaire, avec un débit de’gaz frais de 6 L·min−1. Les gaz respiratoires n’étaient ni réchauffés ni humidifiés. La température tracheale était enregistrée sur un tube Trachelon® inséré à 21 cm. Les températures corporelles profondes étaient mesurées au sternum et sur le front avec un thermomètre Coretemp®. Le principe de la méthode est d’annuler le flux thermique à travers un disque cutané, et d’oblitérer ainsi les gradients thermiques ertre les côtés du disque, la surface cutanée et le tissu sous-cutané. La température oesophagienne distale était mesurée à l’aide de thermocouples incorporés dans des stéthoscopes oesophagiens. La température tracheale et celle des tissus profonds étaient comparées par analyse de régression et par la méthode de Bland et Altman.
Résultats
Les températures distale, sternale et frontale étaient en corrélation identique avec la température oesophagienne; distale, le coefficient de corrélation (r2) étant 0,7 dans chaque cas. La température différentielle (la température oesophagienne moins celle du site étudié) était beaucoup plus importante pour la température oesophagienne (0,7°C) que pour les autres sites (0,2°C). Cependant, à chacun des sites, la précision n’était que de 0,3°C.
Conclusion
Nos données suggèrent que la température tracheale pourrait ne pas être un substitut valable pour le monitorage des sites conventionnels de la température centrale. Par contre, l’exactitude et la précision du monitorage tissulaire profond au niveau du front et du sternum sont suffisants pour l’usage clinique.
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Supported by NIH Grant GM49670, the Joseph Drown Foundation (Los Angeles, CA), and the Anaesthesia Patient Safety Foundation (Ermire, PA). Mallinckrodt Anaesthesiology Products, Inc. (St. Louis, MO) donated the thermocouples we used. Terumo Medical, Inc. (Tokyo, Japan) loaned the authors a Coretemp® “deep body” thermometer and provided endotracheal tubes.
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Matsukawa, T., Sessler, D.I., Ozaki, M. et al. Comparison of distal oesophageal temperature with “deep” and tracheal temperatures. Can J Anaesth 44, 433–438 (1997). https://doi.org/10.1007/BF03014466
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DOI: https://doi.org/10.1007/BF03014466