Abstract
BackgroundHypothermia in burns is common and increases morbidity and mortality. Several methods are available to reach and maintain normal core body temperature, but have not yet been evaluated in critical care for burned patients. Our unit's ordinary technique for controlling body temperature (Bair Hugger®+ radiator ceiling + bed warmer + Hotline®) has many drawbacks e.g.; slow and the working environment is hampered.The aim of this study was to compare our ordinary heating technique with newly-developed methods: the Allon™2001 Thermowrap (a temperature regulating water-mattress), and Warmcloud (a temperature regulating air-mattress).MethodsTen consecutive burned patients (> 20% total burned surface area and a core temperature < 36.0°C) were included in this prospective, randomised, comparative study. Patients were randomly exposed to 3 heating methods. Each treatment/measuring-cycle lasted for 6 hours. Each heating method was assessed for 2 hours according to a randomised timetable. Core temperature was measured using an indwelling (bladder) thermistor. Paired t-tests were used to assess the significance of differences between the treatments within the patients. ANOVA was used to assess the differences in temperature from the first to the last measurement among all treatments. Three-way ANOVA with the Tukey HSD post hoc test and a repeated measures ANOVA was used in the same manner, but included information about patients and treatment/measuring-cycles to control for potential confounding. Data are presented as mean (SD) and (range). Probabilities of less than 0.05 were accepted as significant.ResultsThe mean increase, 1.4 (SD 0.6°C; range 0.6-2.6°C) in core temperature/treatment/measuring-cycle highly significantly favoured the Allon™2001 Thermowrap in contrast to the conventional method 0.2 (0.6)°C (range -1.2 to 1.5°C) and the Warmcloud 0.3 (0.4)°C (range -0.4 to 0.9°C). The procedures for using the Allon™2001 Thermowrap were experienced to be more comfortable and straightforward than the conventional method or the Warmcloud.ConclusionsThe Allon™2001 Thermowrap was more effective than the Warmcloud or the conventional method in controlling patients' temperatures.
Highlights
Hypothermia in burns is common and increases morbidity and mortality
All patients risk a decrease in body temperature between the scene of trauma and admission to the burn unit
At the burn unit repeated procedures under anaesthesia mean that the risk of hypothermia is not reduced for a long part of the patient’s stay
Summary
Several methods are available to reach and maintain normal core body temperature, but have not yet been evaluated in critical care for burned patients. All patients risk a decrease in body temperature between the scene of trauma and admission to the burn unit. In our burn unit the typical approach to combat hypothermia would be increased ambient room temperature, resuscitation with warm fluids, warm blankets, radiators in the ceilings, and hot air. These techniques are often available and technically less demanding but often not effective enough and slow working as well as influencing the staff’s work environment. For hypothermic trauma patients a number of rewarming modalities have been described and can be divided in three main strategies; passive rewarming (optimizing the environment allowing endogenous heat production), active external rewarming (adding heat to body surfaces), and active core rewarming (adding heat to internal body surfaces) [1]
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