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