Central peripheral temperature gradient: Its value and limitations in the management of critically III surgical patients

doi:10.1016/0002-9610(80)90041-0

The American Journal of Surgery

Volume 140, Issue 5, November 1980, Pages 609-612

https://doi.org/10.1016/0002-9610(80)90041-0 Get rights and content

Abstract

Monitoring the central peripheral temperature gradient in critically ill surgical patients is a simple, sensitive, noninvasive and inexpensive method that can accurately reflect the state of peripheral circulation. It serves as an early warning sign, and its return to normal is a good measure of the efficacy of therapy. Recognition of the cause of an abnormal gradient is essential to successful management since it can result from pain as well as hypovolemia. Warm-up patterns vary, and every patient should be treated individually. Forcing vasodilatation is usually unnecessary and may be dangerous in hypothermic patients and in patients with hypovolemia if blood volume is not corrected simultaneously. Peripheral vascular disease, central hypothermia and the use of vasoactive drugs limit the usefulness of this method.

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Skin temperature and core-peripheral temperature gradient as markers of hemodynamic status in critically ill patients: A Review
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Citation Excerpt :
Changes in temperature gradient may be temporally associated with a decrease in cardiac output. The value of measuring CPTG may then lie in its ability to predict change in cardiac output; thus, serial measurements may be required to elicit a more accurate assessment of hemodynamic status.10,28,55 The conclusions of the most quoted opponents of this practice14,15 were based on isolated measurements of CPTG, cardiac output, and SVR.
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.
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.
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.
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.
Skin temperature as a noninvasive marker of haemodynamic and perfusion status in adult cardiac surgical patients: An observational study
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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.
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.
The study was conducted within a tertiary level intensive care unit.
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¹: From the Department of Surgery, Hahnemann Medical College and Hospital, Philadelphia, Pennsylvania.

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Scientific paperCentral peripheral temperature gradient: Its value and limitations in the management of critically III surgical patients

Abstract

J Appl Physiol

Relationship in the toe of skin surface temperature to mean blood flow measured with a plethysmograph

Clin Sci

Treatment of shock with vasodilators measuring temperature of the big toe: ten years experience in 150 cases

Dis Chest

Observations on peripheral and central temperature with particular reference to the occurrence on vasoconstriction

Br J Surg

Peripheral vasoconstriction after open-heart surgery

Thorax

Observation on central and peripheral temperatures in understanding and management of shock

Br J Surg

Scientific paper
Central peripheral temperature gradient: Its value and limitations in the management of critically III surgical patients