Abstract and Introduction
Background: A predictive model that uses the rhythmicity of core body temperature (CBT) could be an easily accessible clinical tool to ultimately improve outcomes among critically ill patients.
Objectives: To assess the relation between the 24-hour CBT profile (CBT-24) before intensive care unit (ICU) discharge and clinical events in the step-down unit within 7 days of ICU discharge.
Methods: This retrospective cohort study in a tertiary ICU at a single center included adult patients requiring acute invasive ventilation for more than 48 hours and assessed major clinical adverse events (MCAEs) and rapid response system activations (RRSAs) within 7 days of ICU discharge (MCAE-7 and RRSA-7, respectively).
Results: The 291 enrolled patients had a median mechanical ventilation duration of 139 hours (IQR, 50–862 hours) and at admission had a median Acute Physiology and Chronic Health Evaluation II score of 22 (IQR, 7–42). At least 1 MCAE or RRSA occurred in 64% and 22% of patients, respectively. Independent predictors of an MCAE-7 were absence of CBT-24 rhythmicity (odds ratio, 1.78 [95% CI, 1.07–2.98]; P = .03), Sequential Organ Failure Assessment score at ICU discharge (1.10 [1.00–1.21]; P = .05), male sex (1.72 [1.04–2.86]; P = .04), age (1.02 [1.00–1.04]; P = .02), and Charlson Comorbidity Index (0.87 [0.76–0.99]; P = .03). Age (1.03 [1.01–1.05]; P = .006), sepsis at ICU admission (2.02 [1.13–3.63]; P = .02), and Charlson Comorbidity Index (1.18 [1.02–1.36]; P = .02) were independent predictors of an RRSA-7.
Conclusions: Use of CBT-24 rhythmicity can assist in stratifying a patient's risk of subsequent deterioration during general care within 7 days of ICU discharge.
Organ system physiology and behaviors—for example, body temperature, brain wave activity, cardiac and respiratory function, blood coagulation, immune function, and drug metabolism—often follow rhythmic circadian patterns.[1,2] Disturbances in the timing of biological processes, or circadian rhythm disruption (CRD), are common in critically ill patients, and various factors contribute, such as ambient light and noise, acute and chronic disease, sleep disruption, and the timing of therapy regimens.[3–8] Core body temperature (CBT) is a reliable and stable indicator of circadian timing in health, and it is a routine clinical measure for determining whole-body homeostasis or characterizing hypothermia or fever.
Patients commonly deteriorate clinically after discharge from an intensive care unit (ICU); this deterioration results in ICU readmissions,[12–14] higher mortality,[12,15] prolonged hospital stay, and higher overall health care costs. The presence of CRD may mark the persistence or development of a disease process, putting the patient at risk for clinical deterioration or a new clinical event. The proportion of patients who have CRD at ICU discharge and the relation between CRD and adverse effects during general care after an ICU stay are not known. The Temperature Profile and Adverse Outcomes Post ICU Discharge (TAOPID) study aimed to assess CBT profile during the 24 hours of ICU admission before discharge (CBT-24) as a predictor for rapid response system activation (RRSA) or a major clinical adverse event (MCAE) within 7 days after ICU discharge.
Am J Crit Care. 2022;31(1):e1-e9. © 2022 American Association of Critical-Care Nurses