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The big toe in the recovery room: peripheral warm-up patterns in children after open-heart surgery
Insights
Toe temperature monitoring after pediatric cardiac surgery can predict survival. A toe temperature below 32°C within 4 hours indicates higher mortality risk, offering a simple, noninvasive tool.
Area of Science:
- Cardiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Postoperative monitoring is crucial for pediatric cardiac surgery patients.
- Traditional monitoring methods may not always capture subtle changes predicting outcomes.
- Early identification of at-risk patients can improve survival rates.
Purpose of the Study:
- To assess the predictive value of toe temperature warm-up patterns for survival in pediatric cardiac surgery patients.
- To determine if toe temperature trends correlate with traditional monitoring techniques.
- To establish a nomogram for predicting mortality based on toe temperature.
Main Methods:
- Evaluated 70 pediatric patients (3.9 ± 3.8 years) for 24 hours post-cardiac surgery.
- Monitored toe temperature in a controlled environment alongside cardiac monitoring.
- Compared physiological parameters between survivors (n=60) and nonsurvivors (n=10).
Main Results:
- Nonsurvivors exhibited persistently lower blood pressure compared to survivors.
- Systemic vascular resistance differentiated survivors from nonsurvivors; cardiac index did not.
- A toe temperature failing to reach 32°C within 4 hours post-operation was linked to increased mortality.
Conclusions:
- Toe temperature measurement is a valuable, cost-effective, and noninvasive addition to standard monitoring after open-heart surgery.
- Peripheral warm-up patterns, specifically toe temperature, can predict survival in pediatric cardiac surgery patients.
- A nomogram based on toe temperature trends demonstrated 99% predictive accuracy.
Abstract:
To evaluate the usefulness of toe temperature warm-up patterns in predicting survival in a group of pediatric patients after cardiac surgery, the condition of 70 children [age 3.9 years + / - 3.8 yr] was evaluated for 24 hours postoperatively by direct and indirect cardiac monitoring, including toe temperature, while in a heat controlled environment. Two groups were identified 60 survivors and 10 nonsurvivors. The volume balance, pH and urine output of all patients were maintained within acceptable values, but nonsurvivors had a persistently lower blood pressure. Systemic vascular resistance separated survivors from nonsurvivors but cardiac index did not. A toe temperature that did not reach 32 degrees C within 4 hours of operation was associated with increased mortality. With peripheral warm-up patterns a nomogram was constructed, its predictive accuracy was identified [99% valid] and the tow temperature trends were correlated with traditional monitoring techniques. The authors conclude that measurement of tow temperature is a useful, inexpensive and noninvasive addition to established methods of monitoring after open-heart operations.