Comparison of a Continuous Noninvasive Temperature to Monitor Core Temperature Measures During Targeted Temperature Management
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AbstractBackground: Temperature modulating devices (TMD) currently utilize core temperature measurements during targeted temperature management (TTM) that are currently limited to esophageal (Et), bladder (Bt), or rectal (Rt) temperatures. We assessed the ability of a continuous noninvasive temperature monitor to accurately approximate core temperature during TTM. Methods: All patients undergoing TTM using a gel pad surface TMD and an existing core temperature monitoring device were eligible for this study. Core and continuous noninvasive temperature monitoring values were simultaneously recorded for up to 72 h of TTM. The two sets of temperature data were downloaded from a clinical data acquisition storage system at 1-min intervals. The Bland–Altman method assessed agreement between the core and continuous noninvasive temperature monitor values, by measuring the mean difference (± 2 SD) between these values. Results: There were 20 subjects that underwent study between January 2018 and March 2018 (55% women, age: 57 ± 14 years old, BMI: 28.9 + 9.8 kg/m2, 100% mechanically ventilated). The comparison patient temperature source was predominantly esophageal (n = 10) followed by bladder (n = 5) or rectal (n = 5). There were a total of 999 h of paired patient temperature data from esophageal (50%), bladder (25%), and rectal (25%) temperatures. Bland–Altman analysis demonstrated good agreement with the superficial temperature monitor and core temperature measures in all patients overall, with a difference mean of 0.06 ± 0.39 C (P = 0.99) and no proportional bias noted (β =0.002, P = 0.917). Conclusions: Continuous noninvasive temperature monitoring is a suitable alternative method for assessing core temperature during TTM. Future studies should focus on developing connectivity with a continuous noninvasive temperature monitor to approximate core temperature during TTM.
KeywordContinuous noninvasive temperature monitoring
Targeted temperature management
Identifier to cite or link to this itemhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85087611884&doi=10.1007%2fs12028-020-01036-9&partnerID=40&md5=783cd4a4bf028d5390b8e5cdd7594ce8; http://hdl.handle.net/10713/13379
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Temperature, Humidity, and Latitude Analysis to Estimate Potential Spread and Seasonality of Coronavirus Disease 2019 (COVID-19)Sajadi, M.M.; Habibzadeh, P.; Amoroso, A. (American Medical Association, 2020)Importance: Coronavirus disease 2019 (COVID-19) infection has resulted in a global crisis. Investigating the potential association of climate and seasonality with the spread of this infection could aid in preventive and surveillance strategies. Objective: To examine the association of climate with the spread of COVID-19 infection. Design, Setting, and Participants: This cohort study examined climate data from 50 cities worldwide with and without substantial community spread of COVID-19. Eight cities with substantial spread of COVID-19 (Wuhan, China; Tokyo, Japan; Daegu, South Korea; Qom, Iran; Milan, Italy; Paris, France; Seattle, US; and Madrid, Spain) were compared with 42 cities that have not been affected or did not have substantial community spread. Data were collected from January to March 10, 2020. Main Outcomes and Measures: Substantial community transmission was defined as at least 10 reported deaths in a country as of March 10, 2020. Climate data (latitude, mean 2-m temperature, mean specific humidity, and mean relative humidity) were obtained from ERA-5 reanalysis. Results: The 8 cities with substantial community spread as of March 10, 2020, were located on a narrow band, roughly on the 30° N to 50° N corridor. They had consistently similar weather patterns, consisting of mean temperatures of between 5 and 11 °C, combined with low specific humidity (3-6 g/kg) and low absolute humidity (4-7 g/m3). There was a lack of substantial community establishment in expected locations based on proximity. For example, while Wuhan, China (30.8° N) had 3136 deaths and 80 757 cases, Moscow, Russia (56.0° N), had 0 deaths and 10 cases and Hanoi, Vietnam (21.2° N), had 0 deaths and 31 cases. Conclusions and Relevance: In this study, the distribution of substantial community outbreaks of COVID-19 along restricted latitude, temperature, and humidity measurements was consistent with the behavior of a seasonal respiratory virus. Using weather modeling, it may be possible to estimate the regions most likely to be at a higher risk of substantial community spread of COVID-19 in the upcoming weeks, allowing for concentration of public health efforts on surveillance and containment.
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Effects of Physiological Temperature Changes On Micro RNA Expression and Their Functional ConsequencesPotla, Ratnakar; Hasday, Jeffrey D.; 0000-0001-5712-271X (2015)Physiological changes in human core body temperature have important biological consequences for host response to infection, inflammation and survival. Work from our lab and others have shown that changes in temperature within clinically relevant range modify the expression of many chemokines, cytokines and other signaling molecules. Previous studies have focused on transcriptional regulation of temperature-dependent gene expression. In our present studies, we analyzed the mechanisms of temperature-dependent post transcriptional gene regulation by small non coding RNAs called micro RNAs (miRNAs). We found that exposure to clinically relevant hypothermia (32°C) within physiological range increased the expression of a surprisingly limited subset of miRNAs with some unusual characteristics. These miRNAs represent the passenger strands of miRNA duplex that are usually less abundant at 37°C. The same miRNAs tended to decrease at 39.5°C. Three of these miRNA targeted protein kinase C alpha (PKCα), a key player in cell cycle regulation. PKCα protein levels decreased with temperature and were rescued by miRNA inhibition at 32°C. The PKCα-dependent block of G1-S cell cycle transition was reversed at 32°C, and the effects of 32°C abrogated by miRNA inhibition. We further studied the effects of physiological temperature change on wnt signaling pathway, which contains several predicted targets of temperature-sensitive miRNAs. Exposure to 32°C reduced and exposure to 39.5°C increased wnt signaling as measured by wnt-dependent gene expression and a wnt-dependent reporter plasmid. Hypothermia reduced cell levels of the wnt-dependent transcription factor, TCF7 and this was reversed by miRNA inhibitors. The potential impact of these temperature changes on lung injury, repair, and fibrosis was evaluated by analyzing expression of genes involved in epithelial mesenchymal transition, which were reduced at 32°C and increased at 39.5°C. These genes, including collagen-1, TWIST1, N-cadherin, and MMP7 have all been shown to markers of human lung fibrosing diseases. These studies suggest that fever may worsen and hypothermia mitigate lung fibrosis and identifies a set of temperature-sensitive miRNAs as one potential mechanism.