Hyperthermia in the forty-eight hours after cardiopulmonary bypass

Abstract

The adverse consequences of perioperative hypothermia have been emphasized. However, postoperative hyperthermia may be equally hazardous after cardiac surgery, owing to increased oxygen demand and potential exacerbation of neurologic injury. To determine the incidence of hyperthermia (bladder temperature [BT] > or = 38.5 degrees C) after cardiopulmonary bypass, we recorded hourly postoperative BT (n = 305), nasopharyngeal (n = 40), and jugular venous bulb (n = 20) temperatures for up to 48 h after admission to the intensive care unit (ICU). At least 38% of the patients developed postoperative hyperthermia, although all patients did not remain in the ICU for 48 h. The incidence of hyperthermia peaked with a bimodal distribution at 9.1 +/- 4.0 h (26%) and at 27.7 +/- 6.3 h (26%). Of these, 14% of the patients were hyperthermic at both times. For the first 5 postoperative h, jugular venous bulb temperature was 0.4 degrees C higher than the BT (P < 0.05). There was no difference between BT and nasopharyngeal temperature. Higher temperature on ICU entry and age <60 yr were independently associated with hyperthermia (P < 0.05). In summary, postoperative hyperthermia is common, with both early and late occurrences during the first 48 h after cardiac surgery with cardiopulmonary bypass.

Implications: Postoperative hyperthermia is common in cardiac surgery patients, with a bimodal distribution during the first 48 h. Jugular venous bulb temperature is slightly higher than bladder temperature for several hours. Postoperative cerebral hyperthermia may contribute to the severity of cerebral injury after cardiopulmonary bypass.