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J Thorac Cardiovasc Surg 2006;131:614-620
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Intracardiac temperature monitoring in infants after cardiac surgery

^a Department of Pediatrics, Division of Cardiology, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa
^b Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa
^c Biostatistics and Data Management Core, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa
^d Department of Surgery, Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa

Received for publication March 11, 2005; revisions received September 8, 2005; accepted for publication September 8, 2005.

^_* Address for reprints: Sarah Tabbutt, MD, PhD, Cardiac Intensive Care Unit, The Cardiac Center, The Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia PA 19104 (Email: tabbutt{at}email.chop.edu).

BACKGROUND: Hyperthermia after cerebral ischemia is associated with worse neurologic outcome. Our goals were 3-fold: (1) to describe the postoperative temperature course in infants after cardiac surgery, (2) to compare intracardiac temperature monitoring with traditional monitoring in infants, and (3) to determine variables that influence the patients' temperatures.

METHODS: Longitudinal temperature data were collected for 100 infants undergoing cardiac surgery. Intra-atrial, nasopharyngeal, esophageal, rectal, and axillary temperatures were recorded in all patients.

RESULTS: The mean age at the time of operation was 128 ± 166 days, and the mean weight was 5.1 ± 2.4 kg. Circulatory arrest was used for 54 patients. In the operating room, the maximum intra-atrial temperature (37.5°C ± 0.6°C) was significantly greater than both the simultaneous esophageal temperature (36.9°C ± 1.9°C, P = .03) and nasopharyngeal temperature (36.3°C ± 2.5°C, P < .001). In the cardiac intensive care unit, intra-atrial temperature was significantly greater than both axillary and rectal temperatures. During the first 24 postoperative hours, intra-atrial temperature was greater than 38°C in 48 (48%) patients, rectal temperature was greater than 38°C in 36 (36%) patients, and axillary temperature was greater than 38°C in 7 (7%) patients.

CONCLUSIONS: In patients less than 2 years of age undergoing cardiac surgery requiring cardiopulmonary bypass, intra-atrial temperature peaked 4 to 6 hours after leaving the operating room. Traditional methods of temperature monitoring significantly underestimate core temperature after cardiac surgery in infants. Use of intracardiac temperature monitoring might result in avoidance of cerebral hyperthermia.

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