Mind the Gap! Core-Peripheral Temperature Gradient and Its Relationship to Mortality in Major Burns

Area of Science:

• Critical Care Medicine
• Burn Injury Research
• Thermoregulation

Background:

• Hypothermia is linked to adverse outcomes in severe burn patients.
• The core-peripheral temperature gradient's role in severe burns remains understudied.
• Current guidelines aim to prevent hypothermia and maintain normothermia (37.5–39.5 °C) with a core-peripheral gap ≤2 °C.

Purpose of the Study:

• To investigate the association between the core-peripheral temperature gradient and outcomes in severe burn patients.
• To evaluate the significance of the core-peripheral temperature gap in predicting mortality.
• To challenge existing expert consensus on optimal temperature management in burn care.

Main Methods:

• Analysis of data from 61 severe burn patients admitted to the ICU between 2016 and 2022.
• Assessment of core body temperature and core-peripheral temperature gap at 48 hours post-admission.
• Statistical analysis to determine the relationship between temperature parameters and mortality.

Main Results:

• Higher core temperature at 48 hours, absence of hypothermia, and a core-peripheral temperature gap >2 °C were associated with decreased mortality.
• The mean core body temperature and core-peripheral temperature gap increased over the first 48 hours (r=0.5, p<0.001).
• Non-survivors exhibited a core-peripheral gap <2 °C at 48 hours, while survivors had a higher mean gap (1.6 °C vs. 0.8 °C, p=0.04).

Conclusions:

• Avoiding hypothermia and achieving higher target temperatures correlate with reduced mortality in severe burn patients.
• A core-peripheral temperature gap >2 °C at 48 hours may indicate better outcomes, challenging previous expert opinion.
• Further research with larger cohorts is needed to confirm the predictive value of a larger core-peripheral temperature gap in critically ill burn patients.