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Non-Axillary Chest Skin Temperature Underestimates Core Temperature During Redistribution Hypothermia Following
Bo-Hyun Sang1,2, Soojeong Oh1, Lime Kim1
1Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, Seongnam-si, South Korea.
Therapeutic Hypothermia and Temperature Management
|July 9, 2026
Summary
Chest skin temperature is unreliable for monitoring core body temperature during spinal anesthesia, unlike zero-heat-flux (ZHF) thermometry, which shows good agreement with tympanic measurements for detecting hypothermia.
Area of Science:
- Anesthesiology
- Physiology
- Medical Instrumentation
Background:
- Accurate perioperative core temperature monitoring is crucial for detecting hypothermia during spinal anesthesia.
- Rapid body heat redistribution under spinal anesthesia complicates temperature assessment.
- The reliability of noninvasive thermometry, specifically chest skin temperature, requires investigation.
Purpose of the Study:
- To evaluate the reliability of non-axillary chest skin temperature monitoring compared to zero-heat-flux (ZHF) thermometry and tympanic thermometry during spinal anesthesia.
- To determine if chest skin temperature can serve as a surrogate for core temperature in this clinical setting.
Main Methods:
- Prospective observational study involving 99 patients undergoing orthopedic surgery under spinal anesthesia.
- Temperature measurements recorded every 5 minutes using forehead ZHF sensor, infrared tympanic thermometer, and chest skin probe.
- Agreement assessed via Bland-Altman analysis, proportion within ±0.5°C, and Lin's concordance correlation coefficient.
Main Results:
- Zero-heat-flux (ZHF) and tympanic temperatures demonstrated good agreement (mean difference 0.04 ± 0.35°C; 89% within ±0.5°C).
- Chest skin temperature showed poor agreement with both ZHF (mean difference 0.99 ± 1.11°C) and tympanic measurements.
- Chest skin temperature measurements did not meet the predefined threshold for reliable core temperature estimation.
Conclusions:
- Non-axillary chest skin temperature is an unreliable indicator of core temperature during spinal anesthesia-induced redistribution hypothermia.
- Zero-heat-flux (ZHF) thermometry offers a more reliable noninvasive alternative for perioperative temperature monitoring compared to chest skin temperature.
- ZHF thermometry shows substantial agreement with tympanic thermometry, supporting its potential use in clinical practice.
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01:14Temperature Measurement Sites
A thermometer measures body temperature. The common sites for measuring body temperature are the oral cavity, axillary region, temporal artery, and skin surface, such as the forehead, abdomen, and axilla. True core body temperature is assessed in the rectum, tympanic membrane, pulmonary artery, esophagus, and urinary bladder.
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01:29Decreased Body Temperature
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Step 1: Perform hand hygiene and don a fresh pair of gloves to prevent cross-infection and ensure patient safety.
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Step 3: Assess the patient's forehead...
Step 1: Perform hand hygiene and don a fresh pair of gloves to prevent cross-infection and ensure patient safety.
Step 2: Explain the procedure to the patient to establish trust. Clear communication establishes trust with the patient, ensures they understand what to expect, promotes cooperation, and enhances comfort during the procedure.
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