Abstract
Introduction. Burns patients are vulnerable to hyperthermia due to sepsis and SIRS and to hypothermia due to heat loss during excision surgery. Both states are associated with increased morbidity and mortality. We describe the first use of a novel esophageal heat exchange device in combination with a heater/cooler unit to manage perioperative hypothermia and postoperative pyrexia. Material and Methods. The device was used in three patients with full thickness burns of 51%, 49%, and 45% body surface area to reduce perioperative hypothermia during surgeries of >6 h duration and subsequently to control hyperthermia in one of the patients who developed pyrexia of 40°C on the 22nd postoperative day due to E. coli/Candida septicaemia which was unresponsive to conventional cooling strategies. Results. Perioperative core temperature was maintained at 37°C for all three patients, and it was possible to reduce ambient temperature to 26°C to increase comfort levels for the operating team. The core temperature of the pyrexial patient was reduced to 38.5°C within 2.5 h of instituting the device and maintained around this value thereafter. Conclusion. The device was easy to use with no adverse incidents and helped maintain normothermia in all cases.
Highlights
Burns patients are vulnerable to hyperthermia due to sepsis and SIRS and to hypothermia due to heat loss during excision surgery
Burns patients are vulnerable to hyperthermia due to sepsis and the acute inflammatory response (SIRS) to burns and to hypothermia due to heat loss during surgery for excision and grafting
Warming strategies can be considered in three main categories: passive rewarming where the environment is optimised, active external warming, and active core warming
Summary
Burns patients are vulnerable to hyperthermia due to sepsis and the acute inflammatory response (SIRS) to burns and to hypothermia due to heat loss during surgery for excision and grafting. A warm underblanket, and an operating room maintained at 30∘C, a passive warming technique which is very uncomfortable for staff, we and others often observe a gradual fall in patient core temperature during the course of large-area burn excisions [1,2,3]. Sometimes these procedures have to be performed in stages for this reason. We describe here the first use of this device in a series of burned patients, as a warming device during large surface area burn excisions, followed in one instance for active cooling during postoperative fever
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