Maintaining intraoperative normothermia reduces blood loss in patients undergoing major operations: a pilot randomized controlled clinical trial

Jie Yi,Hao Liang,Ruiyue Song,Yuguang Huang,Hailu Xia

doi:10.1186/s12871-018-0582-9

Abstract

BackgroundInadvertent intraoperative hypothermia (core temperature < 36 °C) is a common but preventable adverse event. This study aimed to determine whether active intraoperative warming reduced bleeding in patients undergoing major operations: open thoracic surgery and hip replacement surgery.Methods/DesignThe study was a pilot, prospective, parallel two-arm randomized controlled trial. Eligible patients were randomly allocated to two groups: passive warming (PW), with application of a cotton blanket (thermal insulation), or active warming (AW), with a forced-air warming system. The primary endpoint was intraoperative blood loss, and secondary endpoints were surgical-site infection, cardiovascular events, and length of stay in the post-anesthesia care unit, intensive care unit, and hospital.ResultsSixty-two patients were enrolled. Forced-air active warming maintained intraoperative normothermia in all AW subjects, whereas intraoperative hypothermia occurred in 21/32 (71.8%) of PW patients (p = 0.000). The volume of blood loss was more in the PW group (682 ± 426 ml) than in the AW group (464 ± 324 ml) (p < 0.021), and the perioperative hemoglobin value declined more in the PW group (28.6 ± 17.5 g/L) than in the AW group (21.0 ± 9.9 g/L) (p = 0.045). However, there were no difference in other clinical outcomes between two groups.ConclusionIntraoperative active warming is associated with less blood loss than passive warming in open thoracic and hip replacement operations in this pilot study.Trial registrationThis trial was registered with Clinicaltrials.gov (Identifier: NCT02214524) on 27 August 2014.

Highlights

IntroductionInadvertent intraoperative hypothermia (core temperature < 36 °C) is a common but preventable adverse event
Inadvertent intraoperative hypothermia is a common but preventable adverse event
The volume of blood loss was more in the passive warming (PW) group (682 ± 426 ml) than in the active warming (AW) group (464 ± 324 ml) (p < 0.021), and the perioperative hemoglobin value declined more in the PW group (28.6 ± 17.5 g/L) than in the AW group (21.0 ± 9.9 g/L) (p = 0.045)

Summary

Introduction

Inadvertent intraoperative hypothermia (core temperature < 36 °C) is a common but preventable adverse event. Core body temperature declines by as much as 1.6 °C within the first hour after the induction of anesthesia, which increases the risks of inadvertent hypothermia [2], mortality, blood. Schmid et al [4] evaluated blood loss and transfusion requirements in 60 patients undergoing primary total hip arthroplasties, who were randomly assigned to normothermia or mild hypothermia; intra- and post-operative blood loss were found significantly more in the hypothermic patients than in the normothermic patients, and a typical decrease in core temperature resulted in about 500 mL blood loss [4]. 36.5 °C compared to core temperature of 36.0 °C in patients receiving the conventional warming; they found that intraoperative blood loss was significantly more in the latter group. The above-cited authors have concluded that maintaining perioperative normothermia reduces blood loss and transfusion requirements [13] other data are not supportive [14, 15]

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