Highest core temperature during cardiopulmonary bypass and rate of mediastinitis.
Temperature control during cardiopulmonary bypass (CPB) may be related to rates of bacterial infection. We assessed the relationship between highest core temperature during CPB and rates of mediastinitis in 6955 consecutive isolated coronary artery bypass graft (CABG) procedures in northern New England. The overall rate of mediastinitis was 1.1%. The association between highest core temperature and mediastinitis was different for diabetics than for nondiabetics. A multivariate model showed that there was a significant interaction between diabetes and temperature in their association with mediastinitis (p=0.015). Diabetic patients showed higher rates of mediastinitis as highest core temperature increased, from 0.7% in the < or = 37 degrees C group to 3.3% in the > or = 38 degrees C group (p(trend) = 0.002). Adjusted rates were similar. Nondiabetic patients did not show this trend (p(trend) = 0.998). Among diabetic patients, a peak core body temperature > 37.9 degrees C during CPB is a significant risk factor for development of mediastinitis. Avoidance of higher temperatures during CPB may lower the risk of mediastinitis for diabetic patients undergoing CABG surgery.
Groom
Robert C
RC
Maine Medical Center, Portland, ME 04102, USA. GROOMR@mmc.org
Rassias
Athos J
AJ
Cormack
John E
JE
DeFoe
Gordon R
GR
DioDato
Christian
C
Krumholz
Charles K
CK
Forest
Richard J
RJ
Pieroni
John W
JW
O'Connor
Brian
B
Warren
Craig S
CS
Olmstead
Elaine M
EM
Ross
Cathy S
CS
O'Connor
Gerald T
GT
D000368:Aged; D001831:Body Temperature; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D005334:Fever; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000209:etiology*; D016491:Peripheral Vascular Diseases / Q000628:therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors