The big toe in the recovery room: peripheral warm-up patterns in children after open-heart surgery

To evaluate the usefulness of toe temperature warm-up patterns in predicting survival in a group of pediatric patients after cardiac surgery, the condition of 70 children [age 3.9 years + / - 3.8 yr] was evaluated for 24 hours postoperatively by direct and indirect cardiac monitoring, including toe temperature, while in a heat controlled environment. Two groups were identified 60 survivors and 10 nonsurvivors. The volume balance, pH and urine output of all patients were maintained within acceptable values, but nonsurvivors had a persistently lower blood pressure. Systemic vascular resistance separated survivors from nonsurvivors but cardiac index did not. A toe temperature that did not reach 32 degrees C within 4 hours of operation was associated with increased mortality. With peripheral warm-up patterns a nomogram was constructed, its predictive accuracy was identified [99% valid] and the tow temperature trends were correlated with traditional monitoring techniques. The authors conclude that measurement of tow temperature is a useful, inexpensive and noninvasive addition to established methods of monitoring after open-heart operations.