Heart & Lung: The Journal of Acute and Critical Care
Volume 39, Issue 1 , Pages 27-40 , January 2010

Skin temperature and core-peripheral temperature gradient as markers of hemodynamic status in critically ill patients: A review

  • Bernadette M. Schey, RN, MNC (Crit. Care)

      Affiliations

    • Intensive Care Unit, St. Vincent's & Mercy Private Hospital, Melbourne
    • Corresponding Author InformationCorresponding author: Bernadette Schey, RN, MNC (Crit. Care), Grad. Dip. Midwifery, Crit. Care Cert., c/o Intensive Care Unit, St. Vincent's & Mercy Private Hospital, 59-61 Victoria Parade Fitzroy, Victoria, Australia, 3065.
  • ,
  • David Y. Williams, MBBS, FANZCA, FJFICM

      Affiliations

    • Intensive Care Unit, St. Vincent's & Mercy Private Hospital, Melbourne
    • St. Vincent's Public Hospital, Melbourne
  • ,
  • Tracey Bucknall, RN, PhD

      Affiliations

    • Cabrini-Deakin Center for Nursing Research, Cabrini Institute, Deakin University, Melbourne, Australia

References 

  1. Connors AF, Speroff T, Dawson N, Thomas C, Harrell FE, Wagner D, et al. The effectiveness of right heart catheterisation in the initial care of critically ill patients. JAMA. 1996;276:889–897
  2. ESCAPE Trial Investigators and ESCAPE Study Coordinators. Evaluation of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE Trial. JAMA. 2005;294:1625–1633
  3. Shah MR, Hasselblad V, Stevenson LW, Binanay C, O'Connor CM, Sopko G, et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA. 2005;294:1664–1670
  4. Elliott C, Zimmerman G, Clemmer T. Complications of pulmonary artery catheterization in the care of critically ill patients: a prospective study. Chest. 1979;76:647–652
  5. Boyd K, Thomas S, Gold J. A prospective study of complications of pulmonary artery catheterizations in 500 consecutive patients. Chest. 1983;84:245–249
  6. Mattay M, Chatterjee K. Bedside catheterisation of the pulmonary artery: risks compared with benefits. Ann Intern Med. 1988;109:826–834
  7. Harvey S, Young D, Brampton W, Cooper A, Doig G, Sibbald W, et al. Pulmonary artery catheters for adult patients in intensive care. Cochrane Database Syst Rev. 2006 Jul 19;3:CD003408
  8. In:  Adams F editors. The genuine works of Hippocrates. London, UK: Sydenham Society; 1849;
  9. Butt W, Shann F. Core-peripheral temperature gradient does not predict cardiac output or systemic vascular resistance in children. Anaesth Intensive Care. 1991;19:84–87
  10. Murdoch IA, Qureshi SA, Mitchell A, Huggon IC. Core-peripheral temperature gradient in children: does it reflect clinically important changes in circulatory haemodynamics?. Acta Paediatr. 1993;82:773–776
  11. Joly HR, Weil MH. Temperature of the great toe as an indication of the severity of shock. Circulation. 1969;39:131–138
  12. Alexi-Meskhishvili V, Popov SA, Nikoljuk AP. Evaluation of hemodynamics in infants and small babies after open heart surgery. Thorac Cardiovasc Surg. 1984;32:4–9
  13. Henning RJ, Weiner F, Valdes MD, Weil MH. Measurement of toe temperature for assessing the severity of acute circulatory failure. Surg Gynaecol Obstet. 1979;149:1–7
  14. Ryan CA, Soder CM. Relation between core/peripheral temperature gradient and central haemodynamics in children after open heart surgery. Crit Care Med. 1989;17:638–640
  15. Woods I, Wilkins RG, Edwards D, Martin P, Faragher B. Danger of using core/peripheral temperature gradient as a guide to therapy in shock. Crit Care Med. 1987;15:850–852
  16. Felder D, Russ E, Montgomery H, Horwitz O. Relation in the toe of skin surface temperature to mean blood flow measured with a plethysmograph. Clin Sci. 1954;13:251–252
  17. Lima A, Bakker J. Noninvasive monitoring of peripheral perfusion. Intensive Care Med. 2005;31:1316–1326
  18. Darovic GO. Hemodynamic monitoring: invasive and noninvasive clinical application. 2nd ed.. Philadelphia, PA: W.B. Saunders; 1995;
  19. Jones KM, Shock BL, Shock . In:  Bucher L,  Melander S editor. Critical care nursing. Philadelphia, PA: W.B. Saunders; 1999;p. 1016–6
  20. McLuckie A. Shock: An overview. In:  Bersten AD,  Soni N editor. Oh's intensive care manual. 5th ed. Sydney, Australia: Butterman Heinemann; 2003;p. 71–77
  21. Peters J, Mack GW, Lister G. The importance of the peripheral circulation in critical illness. Intensive Care Med. 2001;27:1446–1458
  22. Matthews HR, Meade JB, Evans CC. Significance of prolonged peripheral vasoconstriction after open-heart surgery. Thorax. 1974;29:343–348
  23. Dietzman R, Feemster J, Idezuki Y, Bloch J, Lillehei R. Peripheral resistance changes during shock in man. Angiology. 1968;19:268–276
  24. Ibsen B. Treatment of shock with vasodilators measuring skin temperature on the big toe. Dis Chest. 1967;52:425–428
  25. Aynsley-Green A, Pickering D. Use of central and peripheral temperature-measurements in care of critically ill child. Arch Dis Child. 1974;49:477–481
  26. Ledingham IM, Ramsay G. Hypovolaemic shock. Br J Anaesth. 1986;58:169–189
  27. Smith RE. Circadian variation in human thermoregulatory responses. J Appl Physiol. 1969;26:554–556
  28. Kholoussy AM, Sufian S, Pavlides C, Matsumoto T. Central peripheral temperature-gradient - its value and limitations in the management of critically ill surgical patients. Am J Surg. 1980;140:609–612
  29. Earp JK. Thermal gradients and shivering following open heart surgery. Dimens Crit Care Nurs. 1989;8:266–273
  30. Matsukawa T, Cheng C, Sessler DI, Ozaki M, Kurz A, Merrifield B, et al. Increasing mean skin temperature linearly reduces the core-temperature thresholds for vasoconstriction and shivering in humans. Anesthesiology. 1995;82:1160–1168
  31. Wyss C, Brengelmann GL, Johnson J, Rowell L, Niederberger M. Control of skin blood flow, sweating, and heart rate: role of skin vs. core temperature. J Appl Physiol. 1974;36:726–733
  32. Astiz ME, Rackow EC. Assessing perfusion failure during circulatory shock. Crit Care Clin. 1993;9:299–312
  33. Sommers MS, Stevenson JS, Ivey TD. Skin temperature and limb blood flow as predictors of cardiac output. Clin Nurs Res. 1995;4:22–37
  34. Menon V, Slater JN, White HD, Sleeper LA, Cocke T, Hochman JS. Acute myocardial infarction complicated by systemic hypoperfusion without hypotension: Report of the SHOCK Trial Registry. Am J Med. 2000;108:374–380
  35. Knight RW, Opie JC. The big toe in the recovery room: peripheral warm up patterns in children after open-heart surgery. Can J Surg. 1981;24:239–242
  36. Guyton AC, Hall JE. Textbook of medical physiology. 10th ed.. Philadelphia, PA: W.B. Saunders; 2000;
  37. Chulay M, Burns S. AACN Essentials of critical care nursing. New York, NY: McGraw-Hill; 2006;
  38. Woodrow P. Intensive care nursing: a framework for practice. 2nd ed.. London, UK: Routledge; 2006;
  39. Schell H, Puntillo K. Critical care nursing secrets. 2nd ed.. St. Louis, MO: Mosby Elselvier; 2006;
  40. Elliott D, Aitken LM, Chaboyer W. ACCCN's critical care nursing. Sydney, Australia: Mosby-Elselvier; 2007;
  41. Weil MH. Defining haemodynamic instability. In:  Pinsky MR,  Payen D editor. Functional hemodynamic monitoring. Berlin, Germany: Springer-Verlag; 2005;p. 10–14
  42. Hillman K, Bishop G, Flabouris A. Patient examination in the intensive care unit. In:  Vincent JL editors. Intensive care medicine: annual update 2002. Berlin, Germany: Springer-Verlag; 2002;
  43. Curley F, Smyrnios N. Routine monitoring of critically ill patients. In:  Irwin R,  Cerra F,  Rippe J editor. Intensive care medicine. New York, NY: Williams & Wilkins; 2003;p. 250–270
  44. Zipes D, Libby P, Bonow R, Braunwald E. Braunwald's heart disease: a textbook of cardiovascular medicine. 7th ed.. Philadelphia, PA: Elsevier Saunders; 2005;
  45. Fagan MJ. Relation between nurses' assessments of perfusion and toe temperature in pediatric patients with cardiovascular disease. Heart Lung. 1988;17:157–165
  46. Vincent J-L, Weil MH. Fluid challenge revisited. Crit Care Med. 2006;34:1333–1337
  47. Clarke SFJ, Parriss RJ, Reynard K. Core-peripheral temperature gradient as a diagnostic test in dyspnoea. Emerg Med J. 2005;22:633–635
  48. Pezawas T, Rajek A, Plochl W. Core and skin temperature course after normothermic and hypothermic cardiopulmonary bypass and its impact on intubation time. Eur J Anaesthesiol. 2007;24:20–25
  49. Pezawas T, Rajek A, Skolka M, Schneider B, Plochl W. Perspectives for core and skin surface temperature guided extubation in patients after normothermic cardiopulmonary bypass. Intensive Care Med. 2004;30:1676–1680
  50. Kaplan LJ, Frangos S. Clinical review: acid-base abnormalities in the intensive care unit. Crit Care. 2005;9:198–202
  51. Lambert HJ, Baylis PH, Coulthard MG. Central-peripheral temperature difference, blood pressure, and arginine vasopressin in preterm neonates undergoing volume expansion. Arch Dis Child. 1998;78:F43–F45
  52. Dietzman R, Ersek R, Lillehei C, Castaneda A, Lillehei R. Low output syndrome: recognition and treatment. J Thorac Cardiovasc Surg. 1969;57:138–149
  53. Ross BA, Lord Brock, Aynsley-Green A. Observations of central and peripheral temperatures in the understanding and management of shock. Br J Surg. 1969;56:877–882
  54. Ruiz CE, Weil MH, Carlson RW. Treatment of circulatory shock with dopamine: studies on survival. JAMA. 1979;242:165–168
  55. Vincent J-L, Moraine J-J, van der Linden P. Toe temperature versus transcutaneous oxygen tension monitoring during acute circulatory failure. Intensive Care Med. 1988;14:64–68
  56. Cowan BN, Burns HJG, Boyle P, Ledingham IM. The relative prognostic value of lactate and haemodynamic measurements in early shock. Anaesthesia. 1984;39:750–755
  57. Kirklin JK, Blackstone EH, Kirklin JW, McKay R, Pacifico AD, Bargeron LM. Intracardiac surgery in infants under age 3 months: predictors of postoperative in-hospital death. Am J Cardiol. 1981;48:507–512
  58. Kaplan LJ, McPartland K, Santora TA, Trooskin SZ. Start with a subjective assessment of skin temperature to identify hypoperfusion in intensive care unit patients. J Trauma. 2001;50:620–628
  59. Linton R, Linton N, Kelly F. Is clinical assessment of the circulation reliable in postoperative cardiac surgical patients?. J Cardiothorac Vasc Anesth. 2002;16:4–7
  60. Millner R, Treasure T. Explaining cardiac surgery: patient assessment and care. London, UK: BMJ Publishing Group; 1995;
  61. Niinikoski J, Kuttila K. Adequacy of tissue oxygenation in cardiac surgery: regional measurements. Crit Care Med. 1993;21(suppl):S77–S83
  62. Seki S, Fujii H, Itano T, Murakami T, Teramoto S, Sunada T. Regional changes of skin temperature in the leg after open-heart surgery. J Thorac Cardiovasc Surg. 1974;68:411–418
  63. Spackman TN, Abenstein JP. Continuous cardiac output may be more accurate than bolus thermodilution output during the use of an upper-body warming blanket. Anesthesiology. 1993;79:A463
  64. Salenger R, Gammie JS, Vander Salm TJ. Postoperative care of cardiac surgical patients. In:  Cohn LH,  Edmunds LH editor. Cardiac surgery in the adult. 2nd ed. New York, NY: McGraw-Hill; 2003;p. 439–469
  65. Johnson MR. Low vascular resistance after cardiopulmonary bypass: are we any closer to understanding the enigma?. Crit Care Med. 1999;27:1048–1050
  66. Kristof A, Magder S. Low systemic vascular resistance state in patients undergoing cardiopulmonary bypass. Crit Care Med. 1999;27:1121–1127
  67. Kuttila K, Niinikoski J. Peripheral perfusion after cardiac surgery. Crit Care Med. 1989;17:217–220
  68. Bailey JM, Levy JH, Kopel MA, Tobia V, Grabenkort WR. Relation between clinical evaluation of peripheral perfusion and global hemodynamics in adults after cardiac surgery. Crit Care Med. 1990;18:1353–1356
  69. Schey BM, Williams DY, Bucknall T. Skin temperature as a noninvasive marker of haemodynamic and perfusion status in adult cardiac surgical patients: an observational study. Intens Crit Care Nurs. 2009;25:31–37
  70. Tibby SM, Hatherill M, Murdoch IA. Capillary refill and core-peripheral temperature gap as indicators of haemodynamic status in paediatric intensive care patients. Arch Dis Child. 1999;77:516–518
  71. Duke T, Butt W, South M, Karl TR. Early markers of major adverse events in children after cardiac operations. J Thorac Cardiovasc Surg. 1997;114:1042–1052
  72. Pate MFD. Thermal regulation. In:  Curley MAQ,  Moloney-Harmon PA editor. Critical care nursing of infants and children. 2nd ed. Philadelphia, PA: W.B. Saunders; 2001;p. 447–449
  73. Duncan AW. The critically ill child. In:  Bersten AD,  Soni N editor. Oh's intensive care manual. 5th ed. Sydney, Australia: Butterworth Heinemann; 2003;p. 997–1005
  74. Curley MAQ, Moloney-Harmon PA. Critical care nursing of infants and children. 2nd ed.. Philadelphia, PA: W.B. Saunders; 2001;
  75. National Institute of Standards and Technology: Traceability—NIST Policy and supplementary materials. Available at: http://www.nist.gov/thermometry. Accessed March 2, 2005.
  76. Boutros AR, Lee C. Value of continuous monitoring of mixed venous blood oxygen saturation in the management of critically ill patients. Crit Care Med. 1986;14:132–134
  77. National Health and Medical Research Council. How to use the evidence: assessment and application of scientific evidence. Handbook series on preparing clinical practice guidelines. 2000. Available at: http://www.nhmrc.gov.au/publications/synopses/_files/cp69.pdf. Accessed February 11, 2008.

PII: S0147-9563(09)00094-6

doi: 10.1016/j.hrtlng.2009.04.002

Heart & Lung: The Journal of Acute and Critical Care
Volume 39, Issue 1 , Pages 27-40 , January 2010