Language：English   Publisher：Journal of Anesthesia  

Purpose: Careful perioperative temperature management is important because it influences clinical outcomes. In pediatric patients, the esophageal temperature is the most accurate indicator of core temperature. However, it requires probe insertion into the body cavity, which is mildly invasive. Therefore, a non-invasive easily and continuously temperature monitor system is ideal. This study aimed to assess the accuracy of Temple Touch Pro™ (TTP), a non-invasive temperature monitoring using the heat flux technique, compared with esophageal (Tesoph) and rectal (Trect) temperature measurements in pediatric patients, especially in infants and toddlers. Methods: This single-center prospective observational study included 40 pediatric patients (< 3 years old) who underwent elective non-cardiac surgery. The accuracy of TTP was analyzed using Bland–Altman analysis and compared with Tesoph or Trect temperature measurements. The error was within ± 0.5 °C and was considered clinically acceptable. Results: The bias ± precision between TTP and Tesoph was 0.09 ± 0.28 °C, and 95% limits of agreement were – 0.48 to 0.65 °C (error within ± 0.5 °C: 94.0%). The bias ± precision between TTP and Trect was 0.41 ± 0.38 °C and 95% limits of agreement were – 0.35 to 1.17 °C (error within ± 0.5 °C: 68.5%). In infants, bias ± precision with 95% limits of agreement were 0.10 ± 0.30 °C with – 0.50 to 0.69 °C (TTP vs. Tesoph) and 0.35 ± 0.29 °C with – 0.23 to 0.92 °C (TTP vs. Trect). Conclusion: Core temperature measurements using TTP in infants and toddlers were more accurate with Tesoph than with Trect. In the future, non-invasive TTP temperature monitoring will help perioperative temperature management in pediatric patients.

DOI： 10.1007/s00540-024-03404-7

Web of Science

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PubMed

Language：English   Publisher：Anesthesia and Analgesia  

BACKGROUND: The estimated continuous cardiac output (esCCO) system is a hemodynamic monitor that uses electrocardiograms and pulse oximeter waves to noninvasively estimate cardiac output. The coefficients for esCCO measurement have been established for adult patients, but the appropriate coefficients for pediatric patients are unclear. Therefore, this study determined esCCO coefficients for pediatric patients and validated the accuracy and tracking ability of a modified esCCO system. METHODS: An initial study compared cardiac output measurements using transthoracic echocardiography and esCCO in 60 pediatric patients aged <15 years who underwent elective noncardiac surgery. Consequently, the coefficients for the esCCO measurements were redefined for pediatric patients. The main study compared cardiac output measurements between transthoracic echocardiography and modified esCCO in 80 pediatric patients. Measurements were performed pre- and postoperatively, and the accuracy and trending ability of the cardiac output measurements were evaluated using Bland-Altman analysis and a polar plot. RESULTS: The correlation coefficients between the modified esCCO and transthoracic echocardiography were 0.96 and 0.98 in the pre- and postoperative measurements, respectively. In Bland-Altman analysis, the bias (standard deviation [SD]), 95% limits of agreement, and percentage error were 0.03 (0.28), -0.53 to 0.60, and 18% in the preoperative measurement, and -0.04 (0.19), -0.42 to 0.35, and 15% in the postoperative measurement, respectively. The polar plot showed that the cardiac output changes were well tracked, with an angular bias (SD) of 2.9° (6.0°) and radial 95% limits of agreement ranging from -9.2° to 14.9°. CONCLUSIONS: Cardiac output measurement by esCCO with modified coefficients for pediatric patients showed high accuracy and tracking ability compared with cardiac output measurement by transthoracic echocardiography. This noninvasive cardiac output measurement could benefit perioperative hemodynamic monitoring in children.

DOI： 10.1213/ANE.0000000000007144

Scopus

PubMed

Language：English   Publisher：Medicine (United States)  

Intraoperative hypotension (IOH) or highly invasive surgery adversely affects postoperative clinical outcomes. It is, however, unclear whether IOH affects postoperative acute kidney injury (AKI) depending on the invasiveness of abdominal surgery. We speculated that IOH in highly invasive abdominal surgery is a significant risk factor for postoperative AKI. We retrospectively reviewed the data of 448 patients who underwent abdominal surgery. Patients were divided into 3 groups: highly (such as pancreaticoduodenectomy and hepatectomy), moderately (open abdominal surgery), and minimally (laparoscopic surgery) invasive surgeries. The association between the time-weighted average (TWA) of mean arterial pressure (MAP) values (≤60 and ≤ 55 mm Hg) and AKI occurrences in each group was assessed. Postoperative AKI occurred after highly, moderately, and minimally invasive surgeries in 33 of 222 (14.9%), 14 of 110 (12.7%), and 12 of 116 (10.3%) cases, respectively (P = .526). The median [interquartile range] of TWA-MAP ≤ 60 mm Hg, as an IOH parameter, was 0.94 [0.33-2.08] mm Hg in highly, 0.54 [0.16-1.46] mm Hg in moderately, and 0.14 [0.03-0.57] mm Hg in minimally invasive surgeries (P < 0001). In addition, there was a significant association between TWA-MAP and AKI in highly invasive surgery, unlike in moderately and minimally invasive surgery, with adjusted odds ratios (95% confidence interval) for TWA-MAP ≤ 60 and ≤ 55 mm Hg associated with AKI of 1.23 [1.00-1.52] (P = .049) and 1.55 [1.02-2.36] (P = .041), respectively. Intraoperative MAP ≤ 60 mm Hg in highly invasive abdominal surgery is associated with postoperative AKI, compared to moderately and minimally invasive surgeries. Additionally, low MAP thresholds in highly invasive surgery increase postoperative AKI risk.

DOI： 10.1097/MD.0000000000036465

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PubMed

Authorship：Lead author   Language：English   Publisher：Journal of Anesthesia  

Purpose: The estimated continuous cardiac output (esCCO) system was recently developed as a noninvasive hemodynamic monitoring alternative to the thermodilution cardiac output (TDCO). However, the accuracy of continuous cardiac output measurements by the esCCO system compared to TDCO under different respiratory conditions remains unclear. This prospective study aimed to assess the clinical accuracy of the esCCO system by continuously measuring the esCCO and TDCO. Methods: Forty patients who had undergone cardiac surgery with a pulmonary artery catheter were enrolled. We compared the esCCO with TDCO from mechanical ventilation to spontaneous respiration through extubation. Patients undergoing cardiac pacing during esCCO measurement, those receiving treatment with an intra-aortic balloon pump, and those with measurement errors or missing data were excluded. In total, 23 patients were included. Agreement between the esCCO and TDCO measurements was evaluated using Bland–Altman analysis with a 20 min moving average of the esCCO. Results: The paired esCCO and TDCO measurements (939 points before extubation and 1112 points after extubation) were compared. The respective bias and standard deviation (SD) values were 0.13 L/min and 0.60 L/min before extubation, and − 0.48 L/min and 0.78 L/min after extubation. There was a significant difference in bias before and after extubation (P < 0.001); the SD before and after extubation was not significant (P = 0.315). The percentage errors were 25.1% before extubation and 29.6% after extubation, which is the criterion for acceptance of a new technique. Conclusion: The accuracy of the esCCO system is clinically acceptable to that of TDCO under mechanical ventilation and spontaneous respiration.

DOI： 10.1007/s00540-023-03176-6

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PubMed

Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：The Japanese Society of Intensive Care Medicine  

DOI： 10.3918/jsicm.30_32

CiNii Research

Publisher：Radiology Case Reports  

DOI： 10.1016/j.radcr.2020.07.023

Scopus

PubMed