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212 P R I N C I P L E S A N D P R A C T I C E O F C R I T I C A L C A R E

Research vignette
Schey BM, Williams DY, Bucknall T. Skin temperature as a noninva- Results
sive marker of haemodynamic and perfusion status in adult cardiac Cardiac output was a significant predictor for objectively measured
surgical patients: an observational study. Intensive and Critical Care skin temperature and CPTG (P = 0.001 and P = 0.004, respectively).
Nursing 2009; 25(1): 31–7. Subjective assessment of skin temperature was significantly related
Abstract to cardiac output, systemic vascular resistance, and serum lactate
Objective (P < 0.001, respectively).
Foot temperature has long been advocated as a reliable noninva- Conclusions
sive measure of cardiac output despite equivocal evidence. The These results support the utilisation of skin temperature as a non-
aim of this pilot study was to investigate the relationship between invasive marker of cardiac output and perfusion. The use of CPTG
noninvasively measured skin temperature and the more invasive was shown to be unnecessary, given the parallels in results with
core-peripheral temperature gradients (CPTGs), against cardiac the less invasive skin temperature parameters. A larger study is
output, systemic vascular resistance, serum lactate and base however required to validate these findings.
deficit.
Critique
Research methodology This interesting pilot study brings attention to the potential value
The study was of a prospective, observational and correlational of simple non-continuous monitoring and subjective clinical
design. Seventy-six measurements were recorded on ten adults assessment in guiding management of patients following cardiac
post-cardiac surgery. Haemodynamic assessments were made via surgery. The use of noninvasive skin and core temperature gradi-
bolus thermodilution. Skin temperature was measured objec- ents as an indicator of systemic vascular resistance (SVR) and
tively via adhesive probes, and subjectively using a three-point cardiac output (CO) is far from a new technique, although prior
scale.
work, mostly dated, has demonstrated equivocal findings related
Setting to its value. Additionally, the value of subjective clinical assessment
The study was conducted within a tertiary level intensive care is often undervalued in today’s more invasive intensive care
unit. nursing and medical practices.

Learning activities

Learning activities 1–4 relate to the case study. of central line insertion and what strategies can you implement
1. Consider the case study and discuss why haemodynamic mon- to reduce the likelihood of those complications?
itoring is important for this patient’s management. Include 3. What are the key points to remember when interpreting hae-
consideration of the aspects of haemodynamic monitoring modynamic monitoring results in a patient receiving mechani-
that provide particular benefit in this specific case. cal ventilation?
2. Describe the rationale of inserting a central line when the 4. Consider the indications for PAP monitoring, and explain why
patient was first admitted to ICU. What are the complications PAP monitoring was beneficial for this patient’s management.

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