The Rise and Fall of Thermoregulation

Each of us possesses a complex system of thermoregulation mechanisms that helps maintain a normal core body temperature. However, keeping temperature in check is easier said than done, especially for children in the pediatric intensive care unit.

“Critical care nurses encounter pediatric patients with potential temperature disturbances on a daily basis, as patient diagnoses and/or surgical procedures can affect normal thermoregulation,” says Mary Frances Pate, associate professor, WellStar School of Nursing at Kennesaw State University in Kennesaw, Georgia. “In these patients, heat production and heat loss are out of balance. For example, if a patient is hyperthermic, O2 consumption can increase 2% to 4% for every degree of temperature elevation. Conversely, if a patient is hypothermic, the kidneys are affected, and the patient may begin to diurese.”

In addition, pediatric patients may present with infections or perhaps brain lesions that disrupt normal temperature regulation. Environmental factors during a major cardiothoracic surgery in which the entire chest is exposed can leave a child cooler than normal, thus requiring heating devices to increase body temperature.

During this morning’s session, “Running Hot and Cold: Thermoregulation in the Pediatric ICU,” from 10-11:15 a.m., in room W203A, Pate and co-presenter Serena Kelly, acute care PNP at Oregon Health & Science University’s Doernbecher Children’s Hospital in Portland, will review the pathophysiology of thermoregulation in pediatric patients, while also discussing potential guidelines developed from valid temperature measurement methodologies.

According to Pate, temperature measurement is just as important as all other vital signs, but many times our attention is focused on respiratory values, blood pressure and heart rate. “We need to be smart about the methods we use to measure temperature, but we also must remember that children are not little adults,” Pate says. “A child’s immature organ system can make them extremely susceptible to disturbances in thermoregulation because an infant, for example, can’t regulate his or her core temperature as well as adults can.”

Therefore, temperature-management guidelines targeted to specific diagnoses would be helpful and, if developed well, would incorporate the latest evidence-based practices for nurses to use at the bedside.