Transcript Video Why and How Should We Measure Temperature? < Back to Summit23 Cracks in the Ice Why and How Should We Measure Temperature? Presented by Associate Professor Katia Donadello Thank Christian. Um I think it's already 10 years have been the first TT M course. Uh It's always a pleasure to see so many people being there. Uh I hope we will have a very nice discussion about very interesting topics about temperature management in critical patients. I have the pleasure to uh co-chair uh the event with some friends. Uh It's a kind of Italian connection because I have in the first line, CIA Donado who is associate professor in the University of Verona Katia has been in Brussels working, we work together a few years ago and now she's back as professor in Italy and she has a lot of activities within the European Society of intensive care, actually also responsible for the TT M part. And also Thomas Pis who is working actually in Pordenone, also a lot of experience and a lot of research, experimental and clinic in US first in Europe. Thereafter, being caught the TT M one trial and still uh very keen and involved to spreading knowledge and learning about TT M. So as a chair, I have just to remind our speakers that the most important part will be the discussion So you've seen the program and I ask really to all the speakers to stick maximum to 20 minutes and no more. And then we will have the panel discussion at the end. So now is the time to do the first speaker, a lot of pressure on you, Katia. So Katia Donna Delo is the first speaker who will talk about wine and how should we measure temperature, Katia, please? Yes, I'm pressed. Of course. So um we'll start and uh for French experts uh after lunch, we should drink champagne and uh as an item, we should drink it at the precise temperature. And experts believe that the perfect temperature for champagne is between eight and 10 °C. So one item, one temperature and in indeed differently from polo, the animals that are cold blooded and hemic animals that are warm, cold blooded, we or better we and them are warm blooded. And this normothermia is essential for our vital function and metabolic processes. And despite despite external and internal influences, the core temperature is kept constant and this thermo regulation is indeed maintained. Thanks to heat exchange and heat production, there are active systems that are activated and modifiers like sex, age and comorbidities that might modify the temperature of us human beings. Some parts of our brain are in charge of maintaining this core temperature constant. So, activating regulatory mechanism capable of zeroing the discrepancy between the measured value of temperature and the set value of temperature. But this is feasible depending on the condition of the person in code. So in physiological conditions, we might get cooler than we get hot. This means that when temperature gets higher, there are some of our proteins that like it, they feel as if it is a sort of toasty environment where they are coiled structure is get looser. And this enables them to react better in their physiological situation in their cellular interactions. Nevertheless, when the temperature gets higher than 40 °C, these favorable events get lost and the structures, the critical structures of the cells get destroyed and it is not possible to enable physiological mechanism. And as you can see, there are less than 10 degrees difference between our maximum number of temperature and what is considered very bad temperature. On the other hand, when the temperature gets lower, there are some parts of our body like the immune system that likes it because it boost this boost. The environment enables a better activity of the immune system. And during the lowering of temperature, the interactions between cells gets lower. So as the consumption of oxygen and glucose consumption, so metabolism in general gets lower and this is what happens before organ transplant. And during low temperature management. And when animals go to hibernation, when the temperature is not too cold, this is a favorable situation because the cerebral metabolism rate slows exito toity decreases, the production of free radicals decreases. But when the temperature gets too cold, deleterious effects within the brain and within the body might happen. And it is the same on the opposite way around when the temperature get too hot. So like in fever or in uh high hyperthermia, where we have an increase in blood brain barrier permeability, an increase in glutamate production, an increase in calcium influx and a decrease in caesar threshold. And for instance, recently, a paper on nature reported a relationship between survival, neurological outcome and not only the degree of temperature but the length of hyperthermia exposure. And indeed, the mortality of heat stroke is higher than 40 60%. And the mechanism of hyperthermia, cerebral damage might be cellular local or systemic with the activation. For instance of caspase, the activation of apoptosis process, the activation of heat shock protein and the hyperthermia is related to brain damage. Fever is often present after neurological acute brain injury and not only hyperthermia affects the brain. So by the increasing increasing of brain blood barrier permeability, so the increasing of edema formation, but also increasing oxygen and glucose consumption, but also increasing gastrointestinal permeability. So increasing the risk of endotoxemia. So any episodes of uncontrolled hypothermia may affect a patient's clinical evolution. And it is true also for any episode of uncontrolled fever which may affect the patient's clinical evolution. So, temperature should be kept just right. But how can we do that? So, for instance, recently, last year we published with the different International society survey about the management of a post cardiac arrest patients within Europe. And as you can see, temperature management is applied in non shock rhythm, up to 75% of respondents and up to 60% in non shock rhythm. But there is no note about the method, the quality of the temperature management which is performed. So as we know, we can improve only what we measure because if we measure, we can analyze and we can improve. So I ask, I might say a friend of mine, but he is not to help me to build with you and for you the perfect recipe for temperature management. So I love cooking. And uh as you might know, Gordon Ramsey is a great cooker, a great chef. So just uh taking into account the practical approach to temperature management that was published by Annon and Tacon a few years ago, uh we'll try to depict the perfect recipe for the perfect meal. So if I want to prepare the beef Wellington, as you can see inside it is perfectly red. I am not a chef. So I might be in the need of a meat thermometer. Nevertheless, if I put it in, I put it now and I'm not sure that in the few minutes that will pass thereafter, the meat will not cook over. And indeed, when we talk about the temperature management on temperature control, Fabio Tacon nicely depicted the difference of having temperature management of high quality, using different methods and different attitude, the different actions. So we need first of all to choose the perfect site. So the perfect site might be the tip of his Van Gang's catheter. But we know that we do not use it so often. So we need to have the blood temperature. So to measure it either in the esophageal, in the esophagus, either in the bladder and we need to measure it continuously because you might not desire to answer to your partner. What I usually say to my husband when my car has a problem, this is not my fault. This is a car engine and it is not necessary to have a Ferrari Portofino. This is its cockpit to have a continuous measurement, a continuous monitoring of both oil and water temperature. And indeed the temperature is one of our vital signs. So usually in all your critical ill patients, you monitor heart rate, blood pressure, respiratory rate, saturation continuously. So why not measuring also temperature continuously? And with alarms in order to know what is happening punctually, and we need to have device of quality and acting. So actions of quality. So we need device with the temperature feedback control. So as to fast to to reach fastly fast uh the target temperature and to reduce as much as possible the variability of patient temperature. And we need a recipe. So we need a protocol because uh we need to create a homogeneous application of temperature management independently on the temperature which is decided within the the unit. And we need every member of the unit to be aware of the different steps of the protocol. And what is of importance. So we might decide to have a proactive approach or a reactive approach. And this is a Nemo dynamic vision. This is an old paper by John Louis Vincent dividing the two different way of treating the patients both in the or and in the IC U. But we might apply the proactive approach. So act to avoid something or a reactive approach to so act if something happened also with temperature. So we need sorry a written and parted protocol, an internal sop to update regularly according to the literature, according to the evidence, in order to have the old group aware of what should be done regularly. So body temperature is tightly regulated, tightly controlled in healthy individual. But as you will listen during these two days meeting today meeting, it is often altered after acute brain injury, fever is often experienced after neurological disarrangement, regardless the the type of brain disease and the site of measurement and accidental hypothermia may also be detrimental. And unfortunately, unfortunately, still in 2023 temperature control is still a question on his effectiveness and implementation. So let's prepare the perfect meal. So we need a recipe, we need our own protocol. We need to know doses and intervals. The ingredients and the duration of the meal of the, the the recipe. We need our cooking utensils, so our device and we need the preparation, the good preparation, so inaccurate and adequate control. So the measurement to keep a patient's temperature continuously just right. Thank you. Created by
