Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-16T05:20:50.549Z Has data issue: false hasContentIssue false
  • English
  • Français

Core and skin surface temperature course after normothermic and hypothermic cardiopulmonary bypass and its impact on extubation time

Published online by Cambridge University Press:  24 May 2006

T. Pezawas ,
A. Rajek  and
W. Plöchl
T. Pezawas
Affiliation:
Medical University of Vienna, Department of Cardiology, Vienna, Austria
A. Rajek
Affiliation:
Medical University of Vienna, Department of Cardiothoracic and Vascular Anaesthesiology and Intensive Care, Vienna, Austria
W. Plöchl
Affiliation:
Medical University of Vienna, Department of General Anaesthesiology and Intensive Care, Vienna, Austria
Get access

Extract

Summary

Background and objective: Cardiopulmonary bypass is associated with temperature pertubations that influence extubation time. Common extubation criteria demand a minimum value of core temperature only. The aim of this prospective study was to test the hypothesis that changes in core and skin surface temperature are related to extubation time in patients following normothermic and hypothermic cardiopulmonary bypass. Methods: Forty patients undergoing cardiac surgery were studied; 28 patients had normothermic cardiopulmonary bypass (nasopharyngeal temperature >35.5°C) and 12 had hypothermic cardiopulmonary bypass (28–34°C). In the intensive care unit, urinary bladder temperature and skin surface temperature gradient (forearm temperature minus fingertip temperature: >0°C =vasoconstriction, ≤0°C =vasodilatation) were measured at 30-min intervals for 10 h postoperatively. At the same intervals, the patients were evaluated for extubation according to common extubation criteria. Results: On arrival in the intensive care unit the mean urinary bladder temperature was 36.8 ± 0.5°C in the normothermic group and 36.4±0.3°C in the hypothermic group ( P = 0.014). The skin surface temperature gradient indicated severe vasoconstriction in the both groups. The shift from vasoconstriction to vasodilatation was faster in normothermic cardiopulmonary bypass patients (138±65 min) than in patients after hypothermic cardiopulmonary bypass (186±61 min, P = 0.034). There was a linear relation between the time to reach a skin surface temperature gradient = 0°C and extubation time (r2 = 0.56, normothermic group; r2 = 0.82, hypothermic group). Conclusions: The transition from peripheral vasoconstriction to vasodilatation is related to extubation time in patients following cardiac surgery under normothermic as well as hypothermic cardiopulmonary bypass.

Keywords

CARDIOPULMONARY BYPASSCARDIAC SURGICAL PROCEDURESCRITICAL CAREPOSTOPERATIVE PERIODBODY TEMPERATURE
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 1 , January 2007 , pp. 20 - 25
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Leslie K, Sessler DI. The implications of hypothermia for early trachel extubation following cardiac surgery. J Cardiothorac Vasc Anesth 1998; 12: 30–34.Google Scholar
Sessler DI. Perioperative heat balance. Anesthesiology 2000; 92: 578–596.Google Scholar
Rajek A, Lenhardt R, Sessler DI et al. Tissue heat content and distribution during and after cardiopulmonary bypass at 31°C and 27°C. Anesthesiology 1998; 88: 1511–1518.Google Scholar
The Warm Heat Investigators. Randomized trial of normothermic vs. hypothermic coronary bypass surgery. Lancet 1994; 343: 559–563.
Butler J, Rocker GM, Westaby S. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1993; 55: 552–559.Google Scholar
Boulant JA. Role of preoptic-anterior hypothalamus in thermoregulation and fever. Clin Infect Dis 2000; 31: S157–S161.Google Scholar
Boulant JA. Thermoregulation. In: Mackowiak PA, ed. Fever: Basic Mechanisms and Management. New York: Lippincott-Raven, 1997: 35–58.
Rubinstein EH, Sessler DI. Skin-surface temperature gradients correlate with fingertip blood flow in humans. Anesthesiology 1990; 73: 541–545.Google Scholar
House JR, Tipton MJ. Using skin temperature gradients or skin heat flux measurements to determine thresholds of vasoconstriction and vasodilation. Eur J Appl Physiol 2002; 88: 141–145.Google Scholar
Ozaki M, Sessler DI, Lopez M, Walter K. Pulse oximeter-based flow index correlates well with fingertip volume plethysmography. Anesthesiology 1993; 79 (3A): 542.Google Scholar
Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med 2002; 30: 1210–1213.Google Scholar
Mort TC, Rintel TD, Altman F. The effects of forced-air warming on post bypass central and skin temperatures and shivering activity. J Clin Anesth 1996; 8: 361–370.Google Scholar
Ovrum E, Tangen G, Schiott C, Dragsund S. Rapid recovery protocol applied to 5658 consecutive ‘on-pump’ coronary bypass patients. Ann Thorac Surg 2000; 70: 2008–2012.Google Scholar
Cheng DC. Pro: Early extubation after cardiac surgery decreases intensive care unit stay and cost. J Cardiothorac Vasc Anesth 1995; 9: 460–464.Google Scholar
Cheng DC, Karski J, Peniston C et al. Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: a prospective randomized controlled trial. J Thorac Cardiovasc Surg 1996; 112: 755–764.Google Scholar
Pezawas T, Rajek A, Skolka M, Schneider B, Plöchl W. Perspectives for core and skin surface temperature guided extubation in cardiac surgical patients after normothermic CPB. Intens Care Med 2004; 30: 1676–1680.Google Scholar
Johnson RI, Fox MA, Grayson A, Jackson M, Fabri BM. Should we rely on nasopharyngeal temperature during cardiopulmonary bypass? Perfusion 2002; 17: 145–151.Google Scholar
Wong DT, Cheng DC, Kustra R et al. Risk factors of delayed extubation, prolonged length of stay in the intensive care unit, and mortality in patients undergoing coronary artery bypass graft with fast-track cardiac anesthesia. Anesthesiology 1999; 91: 936–944.Google Scholar
Thong WY, Strickler AG, Li S et al. Hyperthermia in the forty-eight hours after cardiopulmonary bypass. Anesth Analg 2002; 95: 1489–1495.Google Scholar
Grocott HP, Mackensen GB, Grigore AM et al. Postoperative Hyperthermia is associated with cognitive dysfunction after coronary artery bypass graft surgery. Stroke 2002; 33: 537–541.Google Scholar
De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. Anesthesiology 2002; 96: 467–484.Google Scholar
Frank SM, Kluger MJ, Kunkel SL. Elevated thermostatic setpoint in postoperative patients. Anesthesiology; 2000; 93: 1426–1431.CrossRefGoogle Scholar
Reis J, Mota JC, Ponce P, Costa-Pereira A, Guerreiro M. Early extubation does not increase complication rates after coronary artery bypass graft surgery with cardiopulmonary bypass. Eur J Cardiothorac Surg 2002; 21: 1026–1030.Google Scholar