多通道温度测量仪的外文及翻译.docx

多通道温度测量仪的外文及翻译.docx

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多通道温度测量仪的外文及翻译

MeasuringTemperatureofNICUPatients-AComparisonofThreeDevices

HelenMarieRosenthal,AndrewLeslie

Abstract

Background:

Theprovisionofathermoneutralenvironmentisacorner-toneofneonatalcare.Anaccuratemethodoftemperaturemeasurementisrequiredinorderthatneonatalnursescanprovidethiscare.Glassmercurythermometers,nowrarelyusedinthedevelopedworldwereoncethegoldstandard.Theyhavemainlybeenreplacedbymanydifferenttypesofmodernthermometers.

Methods:

Thisstudyaimstocomparetheaccuracyanduser-acceptabilityofoneelectronicandoneinfraredthermometer（LightouchNeonate,ExergenCorp,USA;Suretemp678,WelchAllyn,Beaverton,USA）withtraditionalglassmercurythermometryforintermittenttemperaturemeasurementontheNICU,usingtheaxillaasthemeasuringsite.

Results:

Theresultsdemonstrateagenerallypositiveperformanceofthetwode-vicestested.Themean（SD）differencebetweenthereadingsfromtheSuretempthermometerandtheglassmercurythermometerwas0.1（±0.25）℃.ThemeandifferencebetweenthereadingsfromtheLightouchthermometerandtheglassmercurythermometeris0.07℃.

Introduction

Maintainingthethermoneutralenvironmentforsickandprematurenewborninfantsisakeypartofthenurse'sroleontheNICU,asabnormaltemperatureisstronglyassociatedwithadverseoutcome（BaileyandRose,2000;CESDI,2003;Silvermanetal.,1958;WHO,1997）.Obtainingaccuratemeasurementoftemperatureisanobligatorystepinprovidingthermoneutrality.TemperatureofNICUpatientsmaybemeasuredinavarietyofsites,includingrectumandaxilla,andusinganumberofdifferenttools,includingglassmercurythermometersandelectronicdevices,whichmayinturnchecktemperaturecontinuously,orasone-offreadings.

Mercurythermometryisnowusedrarelyinthedevelopedworld,exceptasacomparisonforevaluatingnewdevices,asinthisstudy.Thisislargelyduetoconcernsaboutthehazardsassociatedwithmercury.Mercuryemitsatoxicvapourthatcanbeinhaledorabsorbeddirectlythroughtheskin.Thisvapourmaypersistformonthsoryears（Blumenthal,1992）.Veryprematureneonateswiththeirincreasedskinpermeabilityareahigh-riskgroupforabsorbingmercuryvapour,especiallyasthewarmenvironmentrequiredfortheircarefacilitatesmercuryvapourisation（DoH,1985）.Whilemercurythermometershavebeenregardedasthegoldstandardformeasurementofbodytemperature（Blumenthal,1992;Pontiousetal.,1994;Sheeran,1996）,numerousstudiesidentifytheirinaccuracies（Abbeyetal.,1978;Blumenthal,1992;Leick-RudeandBloom,1998）.JohnstonandShorten（1991）tested48mercurythermometersagainstacalibratedwaterbath,findingonlyfiverecordingthesametemperature.Theremainingthermometersvariedbyasmuchas0.8℃.

Inplaceofmercurythermometry,aprofusionofdevicesforspot-checkmeasurementhavebecomeavailable.Theseutiliseelectronic,infraredorchemicaltechnology,foruseinthetympanicmembrane,axillaorrectum.Inadditiontoprovidingspot-checkmeasurements,somethermometersmaybeusedineithermonitoringorpredictivemodes.Monitoringmodegivesacontinuousreadout,whilepredictivemodeusesanalgorithmtopredicttemperaturebasedonrateofriseafterprobeintroduction.

Anumberofthesedeviceshavebeenstudiedpreviously（Davis,1993;Greenalletal.,1997;Johnsonetal.,1991;Leick-RudeandBloom,1998;Ogren,1990;Pontiousetal.,1994;Rogersetal.,1991）.WeissandRichards（1994）studied142pretermandterminfants.Usingasingleinstrument（IVAC2080）theymeasuredtemperatureusingdifferentmodesandindifferentsitesinthesamebaby.Theyfoundstatisticallysignificantdifferencesbetweenmeasurementsobtainedintheaxillainpredictiveandmonitoringmodes,butconcludedthatthedifferencesseen（0.1-0.2℃）werenotclinicallysignificant.SeguinandTerry（1999）comparedaxillarytemperaturesobtainedin28termandpreterminfantsusingtheLightouchdevice（ExergenCorp,USA）inpredictivemodewithrectaltemperature.Theyfoundpreterminfantsinincubatorshadtheleastdifferencebetweenthetworeadings,mean（SD）0.09（0.16）℃.Theyconcludedthiswasclinicallyacceptable.

Therectumisnowrarelyusedasatemperaturemeasuringsite.Theutilityoftheaxillaasthemeasuringsite,comparedtotherectum,wasassessedbyJirapaetandJirapaet（2000）.Theymeasuredthetemperatureof109pretermandterminfantssimultaneouslyusingfourdifferentmethods.Whentheycomparedrectalandaxillary

temperaturemeasuredusingmercurythermometrytheyfoundamean（95%CI）differenceof0.06（0.03-0.09）℃andconcludedthataxillarytemperaturecanbeasaccurateasrectal.

Thisstudycomparestheaccuracyanduser-acceptabilityofoneelectronicandoneinfraredthermometer（LightouchNeonate,ExergenCorp,USA;Suretemp678,WelchAllyn,Beaverton,USA）withtraditionalglassmercurythermometryforintermittenttemperaturemeasurementontheNICU,usingtheaxillaasthemeasuringsite.

TheLightouchthermometerusesanopticaldevicewithacupshapedprobe,whichdetectsinfraredemissionsfromthesurfaceoftheskin.Asthereisnotemperaturedevicetoheatup,ittakeslessthan1stoproduceareading.TheSuretemp678isanelectronicthermistorthermometer,whichtakes10stodisplayafinalreadinginpredictivemode.

ThetrialaimwastodeterminewhethertheLightouchNeonateinfraredthermometerortheSuretempelectronicthermometersettopredictivemode,wouldbeaccuratealternativeswhencomparedtoglassmercurythermometers.

Methods

AconveniencesampleconsistingofthepopulationresidentonalargeregionalNICU,duringathree-weektrialperiod,wasusedtoobtainthetwoseparatedatasets.Theseincludedbabiesrequiringintensivecare,highdependencycareandlowdependencycare.Thepatientpopulationconsistedoftermandpreterminfantswithavarietyofmedicalandsurgicalconditions.

Readingswereobtainedatthesametime,usingglassmercurythermometryandoneofthetwotrialdevices.TemperaturereadingsweretakenasclinicallyindicatedandallinfantspresentonanyareaoftheNICUwereeligibleforinclusion.Guidelinesweredevelopedsothatthesamemethodoftemperaturemeasurementwouldbeundertakenbyindividualnurses,ensuringcomparablesetsofdatawouldbeproduced,whichdifferedonlybywhichtrialthermometerwasused.

Themercurythermometerwasheldinplaceforfiveminutes,asrecommendedbyBliss-Holtz（1995）.TheSuretempthermometerwassettothepredictivemode.EithertheSuretemportheLightouchwasplacedontheinfantuntilareadingwasobtained.Thetworeadingswerethenrecordedonatrialdatasheet.

StatisticalanalyseswereproducedusingtheSPSSstatisticalprogram.TheBlandandAltman（1986）approachforcomparingtwomeasurementdeviceswasutilisedforindividualcomparisonofeachofthetrialthermometerswiththeglassmercurythermometer.Thismethodofstatisticalanalysisallowscomparisonofnewmeasurementtechniqueswithestablishedonestoseewhethertheyagreesufficientlyforthenewtoreplacetheold.

Comparisonofthereadingsfromeachtrialthermometerwiththeirrespectivepairedglassmercuryaxillaryreadingswasaccomplishedbycalculatinglimitsofagreement,withinwhich95%±2standarddeviations（SD）ofindividualdifferenceswouldfall.Scatterplotswereusedtodisplaydifferencesinreadingsforeachthermometer.Glassmercuryreadingsminustrialthermometerreadingwereplottedonthey-axisandtheaverageofthetworeadingsonthex-axis.Alineindicatingthelevelofthemeandifferencebetweenthereadingsassistsvisualisationofthedifferencesbetweenindividualreadingsaroundthemean.Additionallinesindicate±2SDaboveandbelowthemean（seeFigs.1and2）.Ifthedifferencesarenormallydistributed,95%ofthedifferencesshouldliebetween_±2SDofthemeandifference（BlandandAltman,1986;Leick-RudeandBloom,1998）.

Leick-RudeandBloom（1998）identifythat95%limitsofagreementcanrepresentalargerangeofdifferencesforsomeinstruments.Clinically,thiscouldhavemarkedimplications,astemperatureisoftenacriterionfordecidingwhetheraninfant'sthermalenvironmentneedsadjusting,orwhethertheyrequireasepticscreen.Thusthepercentageofreadingsforeachinstrumentthatwaswithin±0.2℃,±0.5℃and±1℃oftheglassmercuryreadingwasalsocalculated,asinthestudybyLeick-RudeandBloom（1998）.ThePearsonproductmomentcorrelationco-efficientwasalsocalculated.Thismeasuresthestrengthofarelationbetween2variables.Avalueof1showsperfectpositivecorrelation（BlandandAltman,1986）.

Figure1Suretempthermometervs.glassmercurythermometer.Bland-Altmanplot.Alineindicatingthelevelofthemeandifferencebetweenthereadingsallowsvisualisationofscatteraroundthemean.Additionallinesindicate_2SDaboveandbelowthemean.

Figure2Lightouchthermometervs.glassmercurythermometer.Bland-Altmanplot.Alineindicatingthelevelofthemeandifferencebetweenthereadingsallowsvisualisationofscatteraroundthemean.Additionallinesindicate_±2SDaboveandbelowthemean.

Results

Thirty-fourinfantsprovided102pairedreadingsbetweentheinfant’sownglassmercurythermometerandtheSuretempelectronicthermometer.Ninety-sevensetsofdatawereusedduringthestatisticalanalysis.Fivesetsofdatacouldnotbeusedeitherbecausetheywereincompleteorbecausethecorrectlengthoftimehadnotbeenusedfortemperaturemeasurementwiththeglassmercurythermometer.

Thirty-nineinfantsprovided101pairedreadingsbetweentheLightouchinfraredthermometerandglassmercurythermometer.Ninet