During surgery for congenital heart disease (CHD) temperature management is crucial. Vesical (Tves) and nasopharyngeal (TNPH) temperature are usually measured. Whereas Tves slowly responds to temperature changes, TNPH carries the risk of bleeding. The zero-heat-flux (ZHF) temperature monitoring systems SpotOn™ (TSpotOn), and Tcore™ (Tcore) measure temperature non-invasively. We evaluated accuracy and precision of the non-invasive devices, and of Tves compared to TNPH for estimating temperature. In this prospective observational study in pediatric and adult patients accuracy and precision of TSpotOn, Tcore, and Tves were analyzed using the Bland-Altman method. Proportion of differences (PoD) and Lin´s concordance correlation coefficient (LCC) were calculated. Data of 47 patients resulted in sets of matched measurements: 1073 for TSpotOn vs. TNPH, 874 for Tcore vs. TNPH, and 1102 for Tves vs. TNPH. Accuracy was - 0.39 °C for TSpotOn, -0.09 °C for Tcore, and 0.07 °C for Tves. Precisison was between - 1.12 and 0.35 °C for TSpotOn, -0.88 to 0.71 °C for Tcore, and - 1.90 to 2.05 °C for Tves. PoD ≤ 0.5 °C were 71% for TSpotOn, 71% for Tcore, and 60% for Tves. LCC was 0.9455 for TSpotOn, 0.9510 for Tcore, and 0.9322 for Tves. Temperatures below 25.2 °C (TSpotOn) or 27.1 (Tcore) could not be recorded non-invasively, but only with Tves. Trial registration German Clinical Trials Register, DRKS00010720.

UNASSIGNED: In the event of a severe occupational heat-related illness, paramedic assistance may not be immediately available. A worker\'s survival may depend on their co-workers access to efficacious field-based cooling modalities. One cooling method that has been claimed to be practical in field-based settings is the ice towel method.
UNASSIGNED: This case study assessed the practicality of the ice towel method in an industrial setting, where criteria for use include cost effectiveness, portability, scalability, and implementation by a single worker under the stress of an emergency.
UNASSIGNED: This case study describes the emergency application of the ice towel method while awaiting paramedics, for a worker suffering suspected exertional heat stroke on a remote job site.
UNASSIGNED: Ice towels were able to be transported to a remote field site and applied successfully by a single worker under the stress of a potentially life-threatening emergency.
UNASSIGNED: The ice towel method was cost effective, scalable, transportable, and rapidly applied in a field-based emergency. This case study demonstrates the importance of organizations assessing their heat-related risks, and determining controls based upon their efficacy and practicality for their unique setting.

OBJECTIVE: This study aimed to determine the effect of a forced-air warming blanket placed on different body parts on the core temperature of patients undergoing elective open abdominal surgery.
METHODS: Prospective, single-center, randomized, controlled, single-blind trial.
METHODS: A total of 537 patients who underwent open abdominal surgery were randomized into groups A, B, and C and provided with different forced-air warming blankets. Group A was given an upper body blanket, group B a lower body blanket, and group C an underbody blanket. The incidence of intraoperative hypothermia, the time maintaining the core temperature over 36 ℃ before hypothermia, the duration of hypothermia, the rewarming rate, and relevant complications were compared among three groups.
RESULTS: Intraoperative hypothermia occurred in 51.4% of patients in group B, 37.6% of patients in group A, and 34.1% of patients in group C (P = .002). Maintaining the core temperature above 36 ℃ was longer before hypothermia in groups A and C (log-rank P = .006). In groups A and C, the duration of hypothermia was shorter, the rewarming rate was higher, and the incidence of shivering and postoperative nausea and vomiting were lower, compared to group B.
CONCLUSIONS: In patients undergoing elective open abdominal surgery, a forced-air warming blanket on the upper body part or underbody area decreased intraoperative hypothermia, prolonged the time to maintain the core temperature above 36 ℃ before hypothermia, and could better prevent further hypothermia when the core temperature had decreased below 36 ℃. In addition, it was significantly superior in reducing shivering and postoperative nausea and vomiting in the postanesthesia care unit.

Temperature monitoring in the perioperative setting often represents a compromise between accuracy, invasiveness of probe placement, and patient comfort. Transcutaneous sensors using the Zero-Heat-Flux (ZHF) and Double-Sensor (DS) technology have been developed and evaluated in a variety of clinical settings. The present study is the first to compare the performance of both sensors simultaneously with temperature measured by a Swan-Ganz catheter (PAC) in patients admitted to the intensive care unit (ICU) after cardiac surgery.
In this monocentric prospective observational study patients were postoperatively transferred to the ICU and both sensors were placed on the patients\' foreheads. Core body temperature measured by intraoperatively placed PAC served as gold standard. Measurements were recorded at 5-minute intervals and up to 40 data sets per patient were recorded. Bland and Altman\'s method for repeated measurements was used to analyse agreement. Subgroup analyses for gender, body-mass-index, core temperature, airway status and different time intervals were performed. Lin\'s concordance correlation coefficient (LCCC) was calculated, as well as sensitivity and specificity for detecting hyperthermia (≥ 38 °C) and hypothermia (< 36 °C).
Over a period of six month, we collected 1600 sets of DS, ZHF, and PAC measurements, from a total of 40 patients. Bland-Altman analysis revealed a mean bias of -0.82 ± 1.27 °C (average ± 95% Limits-of-Agreement (LoA)) and - 0.54 ± 1.14 °C for DS and ZHF, respectively. The LCCC was 0.5 (DS) and 0.63 (ZHF). Mean bias was significantly higher in hyperthermic and hypothermic patients. Sensitivity and specificity were 0.12 / 0.99 (DS) and 0.35 / 1.0 (ZHF) for hyperthermia and 0.95 / 0.72 (DS) and 1.0 / 0.85 (ZHF) for hypothermia.
Core temperature was generally underestimated by the non-invasive approaches. In our study, ZHF outperformed DS. In terms of agreement, results for both sensors were outside the range that is considered clinically acceptable. Nevertheless, both sensors might be adequate to detect postoperative hypothermia reliably when more invasive methods are not available or appropriate.
German Register of Clinical Trials (DRKS-ID: DRKS00027003), retrospectively registered 10/28/2021.

Exercise represents a viable non-pharmacological intervention to help treating insomnia but the interaction mechanisms between sleep and physical activity still remain poorly understood. The aim of this study was to investigate the effect of a aerobic exercise training intervention on sleep and core temperature.
Twenty-four adult women suffering from insomnia participated in this study. They were randomized into an exercise group and a control group. Aerobic exercise training consisted in moderate to vigorous aerobic exercise training for 12 weeks. Outcome measures included both subjective (Insomnia Severity Index, ISI) and objective (actigraphy recordings) sleep quality assessments, and core body temperature continuously recorded for a minimum 24 h.
The exercise group showed a decrease in ISI (p < 0.001) and in various objective sleep parameters. The core temperature batyphase value was lowered (p = 0.037) whereas its amplitude was larger (p = 0.002). We also found a tight correlation between the evolution of insomnia and the evolution of mean night-time core temperature and batyphase values.
A moderate to vigorous aerobic exercise program appears to be an effective non-drug therapy for improving sleep in women with insomnia. In addition, exercise programs should aim to increase core body temperature during practice to induce sleep-promoting adaptations and rebound.

The aim of this study was to compare precooling durations before aerobic performance in a heat/ wet stress environment. Seven heat-acclimated and trained male cyclists completed 1-hour time trials in a hot and humid environment. Before each trial, the cyclists drank (1) a neutral beverage at 23°C during the 1-hour pre-exercise resting period (Neutral), (2) an ice-slush/menthol beverage at -1°C during the last 30 min of the resting period (Pre-30), or (3) an ice-slush/menthol beverage at -1°C during the 1-hour pre-exercise resting period (Pre-60). In each condition, the cyclists drank cold water/menthol at 3°C during the exercise. Performance was significantly higher in Pre-60 than in Pre-30 and Neutral conditions (condition effect: F(2,12)=9.50, p=0.003, ηp2=0.61), with no difference between Pre-30 and Neutral. During the resting period, rectal temperature was significantly lower in Pre-60 than in Pre-30 and Neutral (condition effect: F(2,12)=4.48, p=0.035, ηp2=0.43). Thermal comfort and rating of perceived exertion were not affected by conditions, but thermal sensation was positively affected in Pre-60 during the resting period (Friedman condition effect at 40, 45 and 60 minutes: χ2=6.74; df=2; p=0.035; χ2=8.00; df=2; p=0.018; χ2=4.90; df=2; p=0.086, respectively) and exercise (Friedman condition effect at 5 and 60 minutes: χ2=6.62; df=2; p=0.037; χ2=6.50; df=2; p=0.039, respectively). This study shows that 1 hour of precooling with an ice-slush and menthol beverage (1) improved performance in a 1-hour time trial, (2) had a cumulative effect with a cold water/menthol beverage during this exercise, and (3) decreased rectal temperature during the resting period. This precooling method enhances cycling performance in a heat/wet stress environment.

OBJECTIVE: This study examined physiological and perceptual parameters related to cold-induced vasodilation (CIVD) in the fingers and toes of people with paraplegia and compared them with responses observed in able-bodied individuals.
METHODS: Seven participants with paraplegia and seven able-bodied individuals participated in a randomized matched-controlled study involving left-hand and -foot immersion in cold water (8 ± 1 °C) for 40 min during exposure to cool (16 ± 1 °C), thermoneutral (23 ± 1 °C), and hot (34 ± 1 °C) ambient conditions.
RESULTS: Similar CIVD occurrence was observed in the fingers in the two groups. In toes, three of the seven participants with paraplegia revealed CIVDs: one in cool, two in thermoneutral, and three in hot conditions. No able-bodied participants revealed CIVDs in cool and thermoneutral conditions, while four revealed CIVDs in hot conditions. The toe CIVDs of paraplegic participants were counterintuitive in several respects: they were more frequent in cool and thermoneutral conditions (compared to the able-bodied participants), emerged in these conditions despite lower core and skin temperatures of these participants, and were evident only in cases of thoracic level lesions (instead of lesions at lower spinal levels).
CONCLUSIONS: Our findings demonstrated considerable inter-individual variability in CIVD responses in both the paraplegic and able-bodied groups. While we observed vasodilatory responses in the toes of participants with paraplegia that technically fulfilled the criteria for CIVD, it is unlikely that they reflect the CIVD phenomenon observed in able-bodied individuals. Taken together, our findings favor the contribution of central over peripheral factors in relation to the origin and/or control of CIVD.

UNASSIGNED: Thoracic paravertebral block (TPVB) may be highly beneficial for thoracoscopic lobectomy patients, but it may increase the risk of hypothermia. Apart from its anesthetic-reducing effects, this randomized controlled trial aimed to investigate the hypothermic effect of TPVB, and thus optimize its clinical use.
UNASSIGNED: Adult patients were randomly allocated to two groups: TPVB + general anesthesia (GA) group or GA group. In the TPVB+GA group, the block was performed after GA induction by an experienced but unrelated anesthesiologist. Both the lower esophageal and axillary temperature were recorded at the beginning of surgery (T0) and every 15 min thereafter (T1-T8), and the end of surgery (Tp). The primary outcome was the lower esophageal temperature at Tp. The secondary outcomes included lower esophageal temperature from T0-T8 and axillary temperature from T0-Tp. The total propofol, analgesics, and norepinephrine consumption and the incidence of adverse events were also recorded.
UNASSIGNED: Forty-eight patients were randomly allocated to the TPVB+GA (n=24) and GA (n=24) groups. The core temperature at the end of the surgery was lower in the TPVB+GA group than the GA group (35.90±0.30°C vs 36.35±0.33°C, P<0.001), with a significant difference from 45 min after the surgery began until the end of the surgery (P<0.05). In contrast, the peripheral temperature showed a significant difference at 60 min after the surgery began till the end (P<0.05). TPVB+GA exhibited excellent analgesic and sedative-sparing effects compared to GA alone (P<0.001), though it increased norepinephrine consumption due to hypotension (P<0.001).
UNASSIGNED: Although thorough warming strategies were used, TPVB combined with GA remarkably reduced the body temperature, which is an easily neglected side effect. Further studies on the most effective precautions are needed to optimize the clinical use of TPVB.

BACKGROUND: Cold-induced vasodilation (CIVD) is a phenomenon that refers to a paradoxical increase in finger temperature that sometimes occurs during cold exposure. The aim of this study was to compare CIVD responses between women and men, during exposure to different environmental conditions.
METHODS: Seven men and seven women participated in a matched controlled study consisting of a familiarization protocol followed by three experimental sessions (cool (10.8 °C WBGT), thermoneutral (17.2 °C WBGT), and hot (27.2 °C WBGT)). In each session, participants were asked to immerse their left hand and foot in warm water (35 ± 1 °C) for five minutes. Thereafter, the left hand and foot were immersed in cold water (8 ± 1 °C) for 40 min. After that, the left hand and foot were removed from the water and participants remained seated for five minutes.
RESULTS: For a matched thermal stress, women experienced an elevated cardiovascular strain (heart rate and in some cases mean arterial pressure) and higher frequency of CIVD reactions (men: 31 vs. women: 60) in comparison to their male counterparts.
CONCLUSIONS: The present study demonstrated that women experienced elevated cardiovascular strain and higher frequency of CIVD reactions, particularly in the toes, compared to their male counterparts during cold-water immersion.

The practice of physical activity in a variable climate during the same competition is becoming more and more common due to climate change and increasingly frequent climate disturbances. The main aim of this pilot study was to understand the impact of cold ambient temperature on performance factors during a professional cycling race. Six professional athletes (age = 27 ± 2.7 years; height = 180.86 ± 5.81 cm; weight = 74.09 ± 9.11 kg; % fat mass = 8.01 ± 2.47%; maximum aerobic power (MAP) = 473 ± 26.28 W, undertook ~20 h training each week at the time of the study) participated in the Tour de la Provence under cold environmental conditions (the ambient temperature was 15.6 ± 1.4 °C with a relative humidity of 41 ± 8.5% and the normalized ambient temperature (Tawc) was 7.77 ± 2.04 °C). Body core temperature (Tco) was measured with an ingestible capsule. Heart rate (HR), power, speed, cadence and the elevation gradient were read from the cyclists\' onboard performance monitors. The interaction (multivariate analysis of variance) of the Tawc and the elevation gradient has a significant impact (F(1.5) = 32.2; p < 0.001) on the variables (cadence, power, velocity, core temperature, heart rate) and on each individual. Thus, this pilot study shows that in cold environmental conditions, the athlete\'s performance was limited by weather parameters (ambient temperature associated with air velocity) and race characteristics. The interaction of Tawc and elevation gradient significantly influences thermal (Tco), physiological (HR) and performance (power, speed and cadence) factors. Therefore, it is advisable to develop warm-up, hydration and clothing strategies for competitive cycling under cold ambient conditions and to acclimatize to the cold by training in the same conditions to those that may be encountered in competition.