Shivering influence on urinary bladder and pulmonary artery temperature ratio after cardiac surgery

2.50
Hdl Handle:
http://hdl.handle.net/10755/151794
Type:
Presentation
Title:
Shivering influence on urinary bladder and pulmonary artery temperature ratio after cardiac surgery
Abstract:
Shivering influence on urinary bladder and pulmonary artery temperature ratio after cardiac surgery
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:June, 2001
Author:Earp, Jaibun
P.I. Institution Name:Florida A & M University
Objective: Shivering is a normal defensive mechanism to produce heat in response to cold. Shivering after hypothermic cardiac surgery, however, has been a major obstacle in achieving early extubation of the endotrachial tube, speedy recovery, and early hospital discharge, for it increases oxygen consumption up to 500 % and adds high metabolic demands. With the use of less hypothermic cardiopulmonary bypass (CPB), incidence and indicators of shivering have not been examined. The purpose of this study was to replicate Earp & Finlayson’s(1992) research, investigating after drop, incidence of shivering, and core and skin surface temperature gradients in cardiac surgical patients. Design: A prospective descriptive design. Population, Sample, Setting, Years: A convenience sample of 20 patients (12 males; 8 females), aged 51 to 84 (X=65.78, SD: 8.92), who were scheduled for an elective coronary artery bypass surgery (CABG) in a medium size teaching hospital, located in Northern Florida were included in this study with data collection taking place from November 1999 to March 2000. Variables studied: Heart rate, Blood pressure, Pulmonary artery (Tpa) and bladder (Tub) temperatures, forearm (FA) and finger tip (FT) temperatures, and shivering measured by electromyography (EMG) of masseter and pectoral muscles. Methods: Patients who underwent CABG with hypothermic cardiopulmonary bypass (CPB) (30o C) were observed for five hours immediately following admission to the intensive care unit (ICU) for the variables under study. Intraoperative data including CPB time, cross-clamping time, type of cardioplegia, and temperature at the end of CPB were obtained in the operating room. All data were computerized with 15-minute interval collection. Findings: Afterdrop occurred with mean temperature drop of 1.14oC to 1.98oC. Six (30%) patients shivered ranging from 15 to 45 minutes. Pearson correlation between Tub and Tpa ranged from 0.82 to 0.94(p<.05) with Tub higher than Tpa most of the time. With shivering, Tub/Tpa ratio tended to be less than one, reversing the normal trend. Conclusions: Admission temperature to ICU is hypothermic and afterdrop continues for 15 to 30 minutes. Bladder temperature indicates accurate core temperature. Shivering continues to be prevalent even though patients undergo less hypothermic surgery. Heat produced by shivering may reverse Tub/Tpa temperature patterns, overcoming normally lower Tpa temperature expected from maintenance fluid infusion. Tub/Tpa ratio less than one may likely be suggestive of shivering. Implications: Tub/Tpa temperature ratio could be used to detect shivering during the rewarming period in cardiac surgical patients. Clinicians should maximize patient data available by technology for early detection of shivering in order to economize ICU and recovery time. Background/Significance: Shivering is a normal defensive mechanism to produce heat in response to cold. Shivering after hypothermic cardiac surgery, however, has been a major obstacle in achieving early extubation of the endotrachial tube, speedy recovery, and early hospital discharge, for it increases oxygen consumption up to 500 % and adds high metabolic demands. With the use of less hypothermic cardiopulmonary bypass (CPB), incidence and indicators of shivering have not been examined. Purpose: This study, a replication of Earp& Finlayson’s(1992) research, investigated after drop, incidence of shivering and core and skin surface temperature gradients in cardiac surgical patients. Methods: In a prospective descriptive design, a convenience sample of 20 patients (12 males; 8 females), aged 51 to 84 (X=65.78, SD: 8.92), who underwent hypothermic CPB (30o C) were observed for five hours immediately following admission to the intensive care unit (ICU) for the following: HR, BP, pulmonary artery (Tpa) and bladder (Tub) temperatures, forearm (FA) and finger tip (FT) temperatures, electromyography (EMG) of masseter and pectoral muscles. All data were computerized with 15-minute interval collection. Results: After drop occurred with mean temperature drop of 1.14oC to 1.98oC. Six (30%) patients shivered ranging from 15 to 45 minutes. Pearson correlation between Tub and Tpa ranged from 0.82 to 0.94(p<.05) with Tub higher than Tpa most of the time. With shivering, Tub/Tpa ratio tended to be less than one, reversing the normal trend. Conclusions: Admission temperature to ICU is hypothermic and after drop continues for 15 to 30 minutes. Bladder temperature indicates accurate core temperature. Shivering continues to be prevalent even though patients undergo less hypothermic surgery. Heat produced by shivering may reverse Tub/Tpa temperature patterns, overcoming normally lower Tpa temperature expected from maintenance fluid infusion. Tub/Tpa ratio less than one may likely be suggestive of shivering. Implications: Heat produced by shivering may reverse Tub/Tpa temperature patterns, overcoming normally lower Tpa temperature expected from maintenance fluid infusion. Tub/Tpa ratio less than one may likely be suggestive of shivering. Further study with inclusion of more women, particularly minority women, should be conducted.
Repository Posting Date:
26-Oct-2011
Date of Publication:
Jun-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleShivering influence on urinary bladder and pulmonary artery temperature ratio after cardiac surgeryen_GB
dc.identifier.urihttp://hdl.handle.net/10755/151794-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Shivering influence on urinary bladder and pulmonary artery temperature ratio after cardiac surgery</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">June, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Earp, Jaibun</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Florida A &amp; M University</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jearp@angelfire.com</td></tr><tr><td colspan="2" class="item-abstract">Objective: Shivering is a normal defensive mechanism to produce heat in response to cold. Shivering after hypothermic cardiac surgery, however, has been a major obstacle in achieving early extubation of the endotrachial tube, speedy recovery, and early hospital discharge, for it increases oxygen consumption up to 500 % and adds high metabolic demands. With the use of less hypothermic cardiopulmonary bypass (CPB), incidence and indicators of shivering have not been examined. The purpose of this study was to replicate Earp &amp; Finlayson&rsquo;s(1992) research, investigating after drop, incidence of shivering, and core and skin surface temperature gradients in cardiac surgical patients. Design: A prospective descriptive design. Population, Sample, Setting, Years: A convenience sample of 20 patients (12 males; 8 females), aged 51 to 84 (X=65.78, SD: 8.92), who were scheduled for an elective coronary artery bypass surgery (CABG) in a medium size teaching hospital, located in Northern Florida were included in this study with data collection taking place from November 1999 to March 2000. Variables studied: Heart rate, Blood pressure, Pulmonary artery (Tpa) and bladder (Tub) temperatures, forearm (FA) and finger tip (FT) temperatures, and shivering measured by electromyography (EMG) of masseter and pectoral muscles. Methods: Patients who underwent CABG with hypothermic cardiopulmonary bypass (CPB) (30o C) were observed for five hours immediately following admission to the intensive care unit (ICU) for the variables under study. Intraoperative data including CPB time, cross-clamping time, type of cardioplegia, and temperature at the end of CPB were obtained in the operating room. All data were computerized with 15-minute interval collection. Findings: Afterdrop occurred with mean temperature drop of 1.14oC to 1.98oC. Six (30%) patients shivered ranging from 15 to 45 minutes. Pearson correlation between Tub and Tpa ranged from 0.82 to 0.94(p&lt;.05) with Tub higher than Tpa most of the time. With shivering, Tub/Tpa ratio tended to be less than one, reversing the normal trend. Conclusions: Admission temperature to ICU is hypothermic and afterdrop continues for 15 to 30 minutes. Bladder temperature indicates accurate core temperature. Shivering continues to be prevalent even though patients undergo less hypothermic surgery. Heat produced by shivering may reverse Tub/Tpa temperature patterns, overcoming normally lower Tpa temperature expected from maintenance fluid infusion. Tub/Tpa ratio less than one may likely be suggestive of shivering. Implications: Tub/Tpa temperature ratio could be used to detect shivering during the rewarming period in cardiac surgical patients. Clinicians should maximize patient data available by technology for early detection of shivering in order to economize ICU and recovery time. Background/Significance: Shivering is a normal defensive mechanism to produce heat in response to cold. Shivering after hypothermic cardiac surgery, however, has been a major obstacle in achieving early extubation of the endotrachial tube, speedy recovery, and early hospital discharge, for it increases oxygen consumption up to 500 % and adds high metabolic demands. With the use of less hypothermic cardiopulmonary bypass (CPB), incidence and indicators of shivering have not been examined. Purpose: This study, a replication of Earp&amp; Finlayson&rsquo;s(1992) research, investigated after drop, incidence of shivering and core and skin surface temperature gradients in cardiac surgical patients. Methods: In a prospective descriptive design, a convenience sample of 20 patients (12 males; 8 females), aged 51 to 84 (X=65.78, SD: 8.92), who underwent hypothermic CPB (30o C) were observed for five hours immediately following admission to the intensive care unit (ICU) for the following: HR, BP, pulmonary artery (Tpa) and bladder (Tub) temperatures, forearm (FA) and finger tip (FT) temperatures, electromyography (EMG) of masseter and pectoral muscles. All data were computerized with 15-minute interval collection. Results: After drop occurred with mean temperature drop of 1.14oC to 1.98oC. Six (30%) patients shivered ranging from 15 to 45 minutes. Pearson correlation between Tub and Tpa ranged from 0.82 to 0.94(p&lt;.05) with Tub higher than Tpa most of the time. With shivering, Tub/Tpa ratio tended to be less than one, reversing the normal trend. Conclusions: Admission temperature to ICU is hypothermic and after drop continues for 15 to 30 minutes. Bladder temperature indicates accurate core temperature. Shivering continues to be prevalent even though patients undergo less hypothermic surgery. Heat produced by shivering may reverse Tub/Tpa temperature patterns, overcoming normally lower Tpa temperature expected from maintenance fluid infusion. Tub/Tpa ratio less than one may likely be suggestive of shivering. Implications: Heat produced by shivering may reverse Tub/Tpa temperature patterns, overcoming normally lower Tpa temperature expected from maintenance fluid infusion. Tub/Tpa ratio less than one may likely be suggestive of shivering. Further study with inclusion of more women, particularly minority women, should be conducted.</td></tr></table>en_GB
dc.date.available2011-10-26T11:13:54Z-
dc.date.issued2001-06en_GB
dc.date.accessioned2011-10-26T11:13:54Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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