Letter to the Director
Limitations on the temperature measurement of the awake polytraumatic patient
Limitaciones de la medición de temperatura en el paciente politraumático despierto
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"apellidos" => "Correa Barrera" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935621000153" "doi" => "10.1016/j.redar.2020.11.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935621000153?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192922000269?idApp=UINPBA00004N" "url" => "/23411929/0000006900000002/v1_202203120614/S2341192922000269/v1_202203120614/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "Limitations on the temperature measurement of the awake polytraumatic patient" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "119" "paginaFinal" => "120" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Blasco Mariño, I. Soteras Martínez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Blasco Mariño" "email" => array:1 [ 0 => "roblasc.rb@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Soteras Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Anestesiología, Hospital Universitario Vall d’Hebron, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina, Universidad de Gerona, Gerona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Limitaciones de la medición de temperatura en el paciente politraumático despierto" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the article published by González et al. titled <span class="elsevierStyleItalic">Damage Control Resuscitation in the Traumatic Patient</span> (<a href="https://doi.org/10.1016/j.redar.2019.03.009">https://doi.org/10.1016/j.redar.2019.03.009</a>), in which the authors draw attention to hypothermia as an aggravating cause of poor prognosis in polytrauma patients. An understanding of accidental hypothermia in polytrauma patients is mandatory, since single changes induced by hypothermia can lead to errors in diagnosis and treatment. The presence of hypothermia should be suspected and treated early, even in predominantly warm regions, and standard operating procedures together with in-service training courses are essential for all healthcare workers involved in the resuscitation of these patients. Accurate temperature measurement is crucial, given the impact of triage and early resuscitation on prognosis. Measuring temperature in a controlled environment with the patient under conscious sedation is relatively simple. An oesophageal probe placed in the lower third of the oesophagus is the method of choice<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>, provided it is not contraindicated (suspected oesophageal rupture, open chest, etc.). However, we would like to make some observations on the choice of non-invasive methods to measure core temperature in awake patients, a matter of considerable interest.</p><p id="par0010" class="elsevierStylePara elsevierViewall">There are currently many different methods of measuring temperature<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. A urinary catheter with a temperature probe is a valid and inexpensive option, except when it is contraindicated (blood meatus, perineum injury, etc.). However, the measurements obtained are affected by the presence of cold urine (falsely low temperature), the patient needs to be undressed and/or moved, and the probe is slow in correlating core temperature with bladder temperature. This method, however, can allow clinicians to monitor urinary output, and the same catheter can be used in the in-hospital and outpatient setting. A rectal probe must be inserted to a depth of at least 15 cm to obtain reliable measurements. The readings obtained correlate poorly with changes in core temperature, and may be altered by the presence of stool and cold or frozen blood in the rectal venous plexus, and as the patient must be moved to insert the probe, it is of little use in polytrauma patients. Furthermore, false high measurements may be obtained when rewarming involves peritoneal lavage. Skin temperature, on the other hand, does not accurately reflect core temperature, and is highly dependent on vascular changes and skin integrity. Data from studies on the 3M™ SpotOn™ skin sensor, a device that has been validated in different surgeries and correlates acceptably with core temperature, have emerged in recent years<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. However, its use in polytrauma patients has not been validated and is likely to present some limitations. Firstly, most studies published so far have been performed in a controlled room environment, not in natural settings where considerable temperature variations can increase the gradient between the shell and core thermal compartments, thus affecting measurement accuracy and the time required to collect data. Secondly, there are scant data on the use of the SpotOn™ in temperatures below 32 °C; moderate hypothermia is relatively common in the context of winter and severe polytrauma. Thirdly, good tissue perfusion is a pre-requisite for creating the isothermal tunnel in which temperature is measured; however, traumatic injuries are a leading cause of tissue hypoperfusion. In fact, this skin sensor performs poorly with respect to the oesophageal probe or pulmonary artery catheter when rapid changes in core temperature occur. Finally, epitympanic temperature can be measured in 2 ways: by means of an infrared thermometer (temperature changes in the presence of cerumen, water, snow, blood or tympanic integrity) or by means of a thermistor probe that isolates the auditory canal from the external environment, thereby providing a more reliable measurement of the internal carotid artery. Infrared epitympanic measurement is performed intermittently, and is unreliable when environmental and/or body temperatures are low. The more severe the hypothermia, the worse the correlation with core temperature. Epitympanic probe measurements correlate well with core temperature, and provide continuous data<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>. However, the probe cannot be used in patients with injuries to the auricle, auditory canal or suspicion of temporal bone injury. It is affordable, easy to place and does not require moving the patient. Epitympanic measurement methods cannot be used in the event of cardiorespiratory arrest.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Given the possibility of bias, determination of temperatures <28 °C should be correlated with symptoms and the possibility of measuring the temperature at other sites. If suspicion of temperature <28 °C is confirmed, the patient should be transferred to a hospital with ECMO technology<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>. The findings of studies performed so far are inconsistent when different measurement sites are compared. Under controlled environmental conditions, bladder temperature correlates well with core temperature, followed by rectal and epitympanic temperature using a thermistor probe<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>. In light of the limited amount of evidence available, and given the reliability, clinical context, consistent measurements over a wide range of temperatures in adverse environmental conditions, and ease of use, we recommend using an epitympanic probe to measure temperature in non-intubated trauma patients<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Blasco Mariño R, Soteras Martínez I. Limitaciones de la medición de temperatura en el paciente politraumático despierto. 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