Danger of using core/peripheral temperature gradient as a guide to therapy in shock

Skin temperature and core-peripheral temperature gradient as markers of hemodynamic status in critically ill patients: A review

“…(p. 852). 15 An explanation for the disagreement between these results and those of earlier work may lie in the lower cardiac output states experienced by patients within the samples of the key protagonists. 11,12 However, more recently CPTG has been shown in pediatric patients to correlate poorly with hemodynamic variables within cardiac surgical subsets 10,70 and is ineffective as a predictor of major adverse events, such as cardiac arrest and multiple-system organ failure.…”

“…22,23,[24][25][26] Normal skin temperature of the toe, measured objectively using a skin temperature probe, lies between 33 C and 34 C, whereas core temperature typically ranges between 36.5 C and 37.5 C. Peripheral circulation is reported to be normal only if the temperature difference between the skin and core is <3 C to 4 C. 24,25,27,28 Cold skin and CPTGs >5 C have thus been associated with poor peripheral perfusion and impaired cardiac function. 11,13,15 The presence of cool skin on its own, however, is nonspecific and may have other, less sinister causes. Blood flow to the skin is also influenced by skin temperature by way of modulation of local vasoconstrictor tone as part of the skin's thermoregulatory function.…”

“…The notion that the skin potentially makes only a minor contribution to the overall measurement of vascular resistance may help to explain the results of several influential studies unsupportive of the use of CPTG as a guide to circulatory status. Weak or absent correlation was found between CPTGs, cardiac output, and SVR in pediatric cardiac surgical patients 9,14 and in adult shock patients of mixed etiology, 15 thus inspiring the description of CPTG monitoring as ''. .…”

“…The belief that the temperature of the feet is a reliable indicator of circulatory adequacy has guided therapy in critically ill patients despite equivocal evidence. [9][10][11][12][13][14][15] A significant deficit in our understanding is in the adult cardiac surgical patient. This paper will present an analysis of the published research evidence surrounding the monitoring of skin temperature and core-peripheral temperature gradient (CPTG) as elements of hemodynamic assessment in critically ill and adult cardiac surgical patients.…”

Bed side prognostic markers for dengue fever: serum lactate, base excess and central peripheral temperature gradient

“…Its usefulness in adult patients has been disputed. [26][27][28] As most have some form of invasive monitoring of volume status, its use could be regarded as outdated and irrelevant, in children the usefulness of central peripheral temperature gradient has been proven in many studies. Also, as invasive monitoring to volume status is seldom available in resource poor settings, use of temp gradient in this section is practical, cheap, less time consuming and efficient.…”