Brachial arterial temperature as an indicator of core temperature: proof of concept and potential applications

Abstract

There is potential for heat loss and hypothermia during anesthesia and also for hyperthermia if heat conservation and active warming measures are not accurately titrated. Accurate temperature monitoring is particularly important in procedures in which the patient is actively cooled and then rewarmed such as during cardiopulmonary bypass surgery (CPB). We simultaneously measured core, nasopharyngeal, and brachial artery temperatures to investigate the last named as a potential peripheral temperature monitoring site. Ten patients undergoing hypothermic CPB were instrumented for simultaneous monitoring of temperatures in the pulmonary artery (PA), aortic arterial inflow (AI), nasopharynx (NP), and brachial artery (BA). Core temperature was defined as PA temperature before and after CPB and the AI temperature during CPB. Mean deviations of BA and NP temperatures from core temperature were calculated for three steady-state periods (before, during, and after CPB). Mean deviation of BA and NP temperatures from AI temperature was also calculated during active rewarming. A total of 1862 measurements were obtained and logged from eight patients. Mean BA and NP deviations from core temperature across the steady-state periods (before, during, and after CBP) were, respectively: .23 +/- .25, -.26 +/- .3, and -.09 +/- .05 degrees C (BA), and .11 +/- .19, -.1 +/- .47, and -.04 +/- .3 degrees C (NP). During steady-state periods, there was no evidence of a difference between the mean BA and NP deviation. During active rewarming, the mean difference between the BA and AI temperatures was .14 +/- .36 degrees C. During this period, NP temperature lagged behind AI and BA temperatures by up to 41 minutes and was up to 5.3 degres C lower than BA (mean difference between BA and NP temperatures was 1.22 +/- .58 degrees C). The BA temperature is an adequate surrogate for core temperature. It also accurately tracks the changing AI temperature during rewarming and is therefore potentially useful in detecting a hyperthermic perfusate, which might cause cerebral hyperthermia.

Figure 1.

Recorded brachial artery (BA), nasopharynx (NP), arterial inflow (AI), and pulmonary artery (PA) temperatures for a representative patient. Vertical gray lines indicate the boundaries used to delineate the prebypass, bypass, and postbypass periods (over which the average deviation from “core” temperature was calculated); vertical red lines indicate the rewarming period boundaries.

Figure 2.

Average deviation from the core temperature for the brachial (BA) and nasopharyngeal (NP) sites for each patient (i.e., core – BA and core – NP) during steady-state temperature periods. Core temperature was considered to be the aortic inflow temperature during cardiopulmonary bypass and the pulmonary arterial temperature preand postbypass. Measurements on the same patient are linked by gray lines.

Figure 3.

Temperature at three sites (aortic inflow [AI], nasopharynx [NP], and brachial artery [BA]) during rewarming in a representative patient. Vertical gray lines show the time period within which sites were compared (i.e., from the onset of active warming until the nasopharynx temperature reaches a plateau).

Figure 4.

The time series measurements of the brachial artery (BA), nasopharynx (NP), arterial inflow (AI), and pulmonary artery (PA) temperatures from the eight patients within the study are shown using separate panels.