Determinants of core temperature at the time of admission to intensive care following cardiac surgery.

OBJECTIVE: To determine the predictors of core temperature on arrival in the intensive care unit (ICU) after cardiac surgery. DESIGN: Prospective, randomized trial. SETTING: Tertiary care medical center, operating rooms (ORs), and ICU. PATIENTS: 72 patients presenting for coronary artery bypass surgery. INTERVENTIONS: Randomized assignment for ambient OR temperature (16-18 degrees C vs. 21-23 degrees C) and rewarming endpoint on cardiopulmonary bypass (CPB; nasopharyngeal and urinary bladder temperatures >/=36.5 degrees C and 34.0 degrees C, respectively, vs. nasopharyngeal and urinary bladder temperatures >/=37.5 degrees C and 36.0 degrees C, respectively) at the time of separation from bypass. MEASUREMENTS AND MAIN RESULTS: The best (and only significant) predictor of core temperature on arrival in the ICU was rewarming endpoint at the time of separation from CPB (p = 0.004). Patient weight, height, body habitus, and nitroprusside administration did not significantly predict core temperature. Ambient temperature affected only body temperature when the duration of time in the OR after separation from bypass was prolonged (>90 min). A weighted average body temperature was a better predictor of complete rewarming than was any single monitoring site. CONCLUSIONS: To reduce the incidence of hypothermia after cardiac surgery, the most important variable is rewarming endpoint achieved before separation from bypass. A warm ambient temperature (>21 degrees C) may be beneficial if the duration of time in the OR after bypass is prolonged (>90 min).

Relative contribution of core and cutaneous temperatures to thermal comfort and autonomic responses in humans.

Subjective thermal comfort plays a critical role in body temperature regulation since this represents the primary stimulus for behavioral thermoregulation. Although both core (Tc) and skin-surface (Tsk) temperatures are known afferent inputs to the thermoregulatory system, the relative contributions of Tc and Tsk to thermal comfort are unknown. We independently altered Tc and Tsk in human subjects while measuring thermal comfort, vasomotor changes, metabolic heat production, and systemic catecholaminergic responses. Multiple linear regression was used to determine the relative Tc/Tsk contribution to thermal comfort and the autonomic thermoregulatory responses, by using the ratio of regression coefficients for Tc and Tsk. The Tc/Tsk contribution ratio was relatively lower for thermal comfort (1:1) than for vasomotor changes (3:1; P = 0.008), metabolic heat production (3.6:1; P = 0.001), norepinephrine (1.8:1; P = 0.03), and epinephrine (3:1; P = 0.006) responses. Thus Tc and Tsk contribute about equally toward thermal comfort, whereas Tc predominates in regulation of the autonomic and metabolic responses.