Skin temperature and core-peripheral temperature gradient as markers of hemodynamic status in critically ill patients: a review.

OBJECTIVE: To examine the evidential basis underpinning the monitoring of skin temperature and core-peripheral temperature gradient as elements of hemodynamic assessment in critically ill and adult cardiac surgical patients. METHODS: Twenty-six studies examining the efficacy of skin temperature or temperature gradient as markers of hemodynamic status were selected as part of an integrative review. RESULTS: Evidence pertaining to the efficacy of these parameters as markers of cardiac function is equivocal and has not been well appraised in the adult cardiac surgical population. Skin temperature and systemic vascular resistance are also affected by factors other than cardiac output. CONCLUSIONS: Skin temperature and core-peripheral temperature gradient should not be considered in isolation from other hemodynamic parameters when assessing cardiac status until they are validated by further large-scale prospective studies.

Influence of temporary chondroitinase ABC-induced glycosaminoglycan suppression on maturation of tissue-engineered cartilage.

OBJECTIVE: A fundamental challenge of cartilage tissue engineering has been the inability to promote collagen synthesis up to native levels. In contrast, recent protocols have demonstrated that glycosaminoglycans (GAG) can be synthesized to native levels in 4-6 weeks of in vitro culture. We hypothesize that rapid GAG synthesis may be an impediment to collagen synthesis, possibly by altering transport pathways of nutrients or synthesis products. In this study, this hypothesis is tested by inducing enzymatic GAG loss in the early culture period of cartilage tissue constructs, and monitoring collagen content at various time points after cessation of enzymatic treatment. METHODS: In Study 1, to induce breakdown of proteoglycans, chondroitinase ABC (CABC, 0.002U/mL) was continuously added into the culture media for the initial 4 weeks of culture or for 2 weeks starting on day 14 of culture. In Study 2, multiple transient CABC treatments (0.15U/mL, for 2 days) were applied to the matured tissue-engineered constructs. RESULTS: Continuous and transient CABC treatments significantly increased the collagen concentration of the constructs, improving their tensile properties. The GAG content of the treated constructs recovered quickly to the pretreatment level after 2-3 weeks. CONCLUSIONS: This study demonstrates that tissue-engineered cartilage constructs with improved tensile properties can be achieved by temporarily suppressing the GAG content enzymatically.

Influence of chondroitin sulfate on the biochemical, mechanical and frictional properties of cartilage explants in long-term culture.

A recent study [Basalo et al., 2007. Chondroitin sulfate reduces the friction coefficient of articular cartilage. J. Biomech. 40(8), 1847-1854] has shown that the friction coefficient of bovine articular cartilage is reduced significantly by the supplementation of chondroitin sulfate (CS) at a concentration of 100mg/ml. This result suggests that intra-articular injection of CS may be used as a prophylactic treatment against the progression of osteoarthritis. The objective of this study was to test the hypothesis that long-term culture of cartilage explants in CS produces no adverse mechanical, biochemical, or cytotoxic effects, while reducing the friction coefficient relative to the control group. Long-term cultures of live bovine articular cartilage explants were performed with incubation in media containing CS of three different concentrations (0, 10 and 100mg/ml). Frictional tests (cartilage-on-glass) were performed under constant stress (0.5MPa) for 3600s and the time-dependent friction coefficient was measured. Samples incubated in a 100mg/ml of CS solution exhibited a significantly lower equilibrium friction coefficient than the control (0.05+/-0.01 vs. 0.18+/-0.02 on Day 0, 0.04+/-0.01 vs. 0.14+/-0.04 on Day 7 and 0.04+/-0.01 vs. 0.15+/-0.06 on Day 14). Samples incubated in 10mg/ml of CS did not exhibit any significant decrease in the friction coefficient. Cell viability and DNA content were maintained in all groups. However, after 28 days of culture, the Young's modulus and glycosaminoglycan content of explants incubated in 100mg/ml of CS decreased to 5% and 40% of their initial levels, respectively. Based on this adverse outcome the hypothesis of this study is rejected, dampening our enthusiasm for the use of intra-articular CS injections as a prophylactic treatment in osteoarthritis.

Skin temperature as a noninvasive marker of haemodynamic and perfusion status in adult cardiac surgical patients: an observational study.

OBJECTIVE: Foot temperature has long been advocated as a reliable noninvasive measure of cardiac output despite equivocal evidence. The aim of this pilot study was to investigate the relationship between noninvasively measured skin temperature and the more invasive core-peripheral temperature gradients (CPTGs), against cardiac output, systemic vascular resistance, serum lactate, and base deficit. RESEARCH METHODOLOGY: The study was of a prospective, observational and correlational design. Seventy-six measurements were recorded on 10 adults postcardiac surgery. Haemodynamic assessments were made via bolus thermodilution. Skin temperature was measured objectively via adhesive probes, and subjectively using a three-point scale. SETTING: The study was conducted within a tertiary level intensive care unit. RESULTS: Cardiac output was a significant predictor for objectively measured skin temperature and CPTG (p=.001 and p=.004, respectively). Subjective assessment of skin temperature was significantly related to cardiac output, systemic vascular resistance, and serum lactate (p<.001, respectively). CONCLUSIONS: These results support the utilisation of skin temperature as a noninvasive marker of cardiac output and perfusion. The use of CPTG was shown to be unnecessary, given the parallels in results with the less invasive skin temperature parameters. A larger study is however required to validate these findings.