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We examined the agreement and temperature tracking ability of zero-heat-flux skin temperature (T\n                      <jats:sub>ZHF<\/jats:sub>\n                      ) compared with T\n                      <jats:sub>NP<\/jats:sub>\n                      in cardiac surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Of 40 patients scheduled to undergo cardiac surgery with CPB, paired T\n                      <jats:sub>ZHF<\/jats:sub>\n                      and T\n                      <jats:sub>NP<\/jats:sub>\n                      measurements were recorded for 33 patients, yielding 8610 measurements across pre-CPB, CPB-cooling, CPB-maintenance, CPB-rewarming, and post-CPB.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the final, trimmed dataset, T\n                      <jats:sub>ZHF<\/jats:sub>\n                      and T\n                      <jats:sub>NP<\/jats:sub>\n                      at 30\u00a0min after CPB weaning, the primary endpoint, showed similar mean values (35.57\u2009\u00b1\u20090.69\u00a0\u00b0C vs. 35.69\u2009\u00b1\u20090.61\u00a0\u00b0C;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.181), with a mean difference of \u20130.12\u00a0\u00b0C (95% Confidence Interval: \u20130.29 to 0.06). Bland\u2013Altman analysis showed a small mean bias between T\n                      <jats:sub>ZHF<\/jats:sub>\n                      and T\n                      <jats:sub>NP<\/jats:sub>\n                      across all intraoperative phases, ranging from\u2009\u2212\u20090.55 to 0.28\u00a0\u00b0C. However, the limits of agreement (LOA) exceeded the clinically acceptable\u2009\u00b1\u20090.5\u00a0\u00b0C during CPB-cooling and CPB-rewarming. Mixed-effects modeling showed considerable between-patient variability in the difference between T\n                      <jats:sub>ZHF<\/jats:sub>\n                      and T\n                      <jats:sub>NP<\/jats:sub>\n                      measurements during periods of rapid temperature change. Consistent with the Bland\u2013Altman results, correlation coefficients between T\n                      <jats:sub>ZHF<\/jats:sub>\n                      and T\n                      <jats:sub>NP<\/jats:sub>\n                      measurements remained high (ranging from 0.798 to 0.958), and their intraclass correlation coefficients were high (ranging from 0.82 to 0.99) across all intraoperative phases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Our results indicate that T\n                      <jats:sub>ZHF<\/jats:sub>\n                      tracked T\n                      <jats:sub>NP<\/jats:sub>\n                      trends, but its large LOA limits its accuracy and reliability. Simultaneous blood temperature monitoring would enhance T\n                      <jats:sub>ZHF<\/jats:sub>\n                      \u2019s effectiveness, as is currently done in cardiac surgery, where both blood temperature and T\n                      <jats:sub>NP<\/jats:sub>\n                      are monitored.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov Identifier: NCT04160845.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12871-026-04068-4","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:53:54Z","timestamp":1784030034000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Zero-heat flux skin temperature tracks nasopharyngeal temperature during cardiac surgery with cardiopulmonary bypass: a prospective observational study"],"prefix":"10.1186","volume":"26","author":[{"given":"Kyoung-Woon","family":"Joung","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Sik","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju-Youn","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suryeon","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Kyu","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0806-8969","authenticated-orcid":false,"given":"Tae-Yop","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In-Cheol","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"issue":"2","key":"4068_CR1","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/j.athoracsur.2008.10.078","volume":"87","author":"M Boodhwani","year":"2009","unstructured":"Boodhwani M, Rubens FD, Wozny D, Nathan HJ. 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