Effects Of Active Warming Research Articles

Effect of active warming on perioperative cardiovascular outcomes: a systematic review and meta-analysis of randomized controlled trials

PurposeThe objective of this study was to provide an updated review on the active warming effects on major adverse cardiac events, 30-day all-cause mortality, and myocardial injury after noncardiac surgery.MethodWe systematically searched MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, Web of Science, and Chinese BioMedical Literature Database. We included randomized controlled trials of adult population undergoing noncardiac surgeries that concentrate on the comparison of active warming methods and passive thermal management. Cochrane Collaboration’s tool was applied for risk-of-bias assessment. We used trial sequential analysis to evaluate the possibility of false positive or negative results.ResultsA total of 13,316 unique records were identified, of which only 19 with reported perioperative cardiovascular outcomes were included in the systematic review and nine of them were included in final meta-analysis. No statistically significant difference between active warming methods and routine care was found in major adverse cardiac events (RR 0.56, 95% confidence interval (CI) 0.14–2.21, I2 = 71%, number of events 59 vs. 70), 30-day all-cause mortality (RR 0.81, 95% CI 0.43–1.54, I2 = 0%, number of events 17 vs. 21), and myocardial injury after noncardiac surgery (RR 0.61, 95% CI 0.17–2.22, I2 = 79%, number of events 236 vs. 234). Trial sequential analysis suggests that current trials did not reach the minimum information size regarding the major cardiovascular events.ConclusionsCompared to routine perioperative care, we found that active warming methods are not necessary for cardiovascular prevention in patients undergoing noncardiac surgery.

Effect of active and passive warming on preventing hypothermia and shivering during cesarean delivery: a systematic review and meta-analysis of randomized controlled trials

BackgroundPerioperative hypothermia and shivering commonly occur in pregnant women undergoing cesarean section. The warming method is usually used to prevent hypothermia and shivering. However, the effect of active warming (AW) prior to passive warming (PW) on the perioperative outcomes of pregnant women and their offspring remains controversial.MethodsThis study aimed to investigate the effects of AW and PW on maternal and newborn perioperative outcomes during cesarean delivery. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PubMed, Embase, Scopus, and the Cochrane Library were used to search for randomized controlled trials (RCTs) up to August 7, 2022. The Cochrane risk of bias assessment tool was used to assess articles selected for the systematic review. Continuous data were analyzed using weighted mean differences (WMDs) with 95% confidence intervals (CIs), and categorical data were analyzed by the random-effects model.ResultsA total of 1241 participants from twelve RCTs were selected for the final meta-analysis. AW was associated with a lower risk of maternal hypothermia (RR: 0.77, 95% CI: 0.63–0.93, P = 0.007) and shivering (RR: 0.56, 95% CI: 0.37–0.85; P = 0.007). AW was associated with high maternal temperature (WMD: 0.27, 95%CI: 0.14 to 0.40, P < 0.001). No significant difference was observed between AW and PW in terms of hypothermia (RR: 0.60, 95% CI: 0.24–1.51, P = 0.278), temperature (WMD: 0.31, 95% CI: − 0.00 to 0.62; P = 0.050), and umbilical vein PH in newborns (WMD: -0.00; 95% CI: − 0.02 to 0.02, P = 0.710).ConclusionsThese findings suggested that AW can better prevent maternal hypothermia and shivering than PW. In contrast, no significant effect was observed in newborns. Overall, the quality of the included studies is high due to RCTs, low risk of bias, consistency, and precision. We identified the quality of the overall evidence from the survey to be GRADE I.

Effect of active warming during general anaesthesia on post-operative body temperature, shivering, thermal comfort, pain, nausea and vomiting in adult patients: a randomized clinical trials protocol

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;This study aims to investigate the effects of individual and combined use of intraoperative forced-air warming and warmed intravenous and irrigation fluids on post-operative body temperature, shivering, thermal comfort, pain, nausea and vomiting in adult patients receiving general anaesthesia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a randomised controlled clinical trial. A 2x2 factorial design will used in the experiment. Eligible patients will be randomly assigned to one of four groups. We attempt to report this randomized controlled trial to comply with the spirit. The study population will consist of 120 adult patients receiving general anaesthesia at university hospitals in Turkey. After the induction of anaesthesia, the first group (n=30) will be warmed with only forced-air warming device, the second group (n=30) will receive only warmed intravenous and irrigation fluids, forced-air warming as well as warmed intravenous (IV) and irrigation fluids will be applied to the third group (n=30), the fourth group (n=30) will consist of the control group without any intervention. Blood and blood products to be applied intraoperatively to all groups will be heated to 37°C.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The primary outcome measures are post-operative body temperature, shivering, thermal comfort, pain, nausea and vomiting. The primary results will be subjected to a one-way analysis of variance for covariant such as amount of bleeding and volume of intraoperative fluids.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;The trial has been registered in clinical trials: https://clinicaltrials.gov/. Registration number: NCT04907617).&lt;/p&gt;

The effects of active warming on perioperative inadvertent hypothermia in patients undergoing vitreoretinal surgery under local anesthesia.

Purpose:Perioperative inadvertent hypothermia (PIH) is the decrease in core temperature below 36°C. We aimed to assess whether PIH develops in patients operated under local anesthesia (ULA) for vitreoretinal surgery in the operating room and investigate active warming efficacy.Methods:Seventy-two patients were divided into two groups: Group 1 contained unwarmed patients (n = 36), and Group 2, warmed patients (n = 36). The core temperatures, heart rate (HR), and mean arterial pressure (MAP) of the patients were measured at the beginning of surgery, after 20 min, 40 min, 1 h, at the end of the operation, and during the postoperative period.Results:PIH incidence was 44.6% in Group 1, whereas no hypothermia was observed in Group 2. Patient temperatures at 20 min (P = 0.001), 40 min (P < 0.001), 1 h (P < 0.001), the end of the operation (P < 0.001), and the postoperative period (P < 0.001) were significantly higher in Group 2 than in Group 1. Patient HRs at the end of the operation and during the postoperative period were significantly lower in Group 2 (P = 0.005) than in Group 1 (P < 0.001). The intraoperative 40th (P = 0.044) and 60th (P < 0.001) minutes, end of operation (P < 0.001), and postoperative MAP (P < 0.001) values of Group 1 were significantly higher than those of Group 2.Conclusion:PIH may develop in patients operated ULA, especially with a low ambient temperature. Actively warming may help prevent the harmful effects of PIH.

Effect of Active Warming on Surgical Site Infections

Effect of Active Warming on Surgical Site Infections

Active Warming Study

We're impressed by the original research studies published in AJN because of their rigor, relevance, and readability. We were especially interested in “The Effects of Active Warming on Patient Temperature and Pain After Total Knee Arthroplasty” (May) because of the nurse's key role in maintaining postoperative normothermia and because of our own recent study in this area1 and our study (in process) about optimal blanket-warming cabinet temperatures. The authors state that the temperature of the blanket-warming cupboard wasn't monitored. We wonder, however, at what temperature the cupboard was set. Low cupboard settings (<150°F) produce lukewarm blankets and lower skin temperatures and lower ratings of thermal comfort compared with higher cupboard settings.2-3 We are pleased that the authors measured “thermal comfort,” because little research has been done on this important variable, and agree with the belief that thermal comfort is “integral to a patient's perception of well-being,” as stated in the article. Based on our own recent study of perioperative hypothermia,1 we caution against using the patient's thermal comfort rating as predictive of core temperature. In our study, we asked patients on arrival to the postanesthesia care unit whether they felt “too hot,” “too cold,” or “just right.” We found that the patient's thermal comfort response did not accurately reflect hypothermia as measured by core (bladder) temperature. Elizabeth H. Winslow, PhD, RN, FAAN Patricia A. Kelly, DNP, APRN, CNS, AOCN Dallas Authors Ember E. Benson, Diana E. McMillan, and Bill Ong respond: The readers are correct in noting that the warming cupboard temperature wasn't monitored. We don't know at what temperature the cupboards were set, because various models within the research facility were used, some of which didn't have an indicator displaying the set temperature or the actual temperature. Temperature variations were likely to occur because of real clinical factors, such as the addition of room-temperature blankets, the door opening, and the length of time before the blanket was applied to the patient. We weren't attempting to predict patients' core temperature using their response to thermal comfort. Rather, we assessed for hypothermia using oral temperature readings, and we measured how satisfied patients were with the thermal comfort provided by the warming methods during the perioperative period and whether this affected their pain. A previous study found that the application of warmth (via forced air blankets) provides patients with a positive feeling of comfort and reduced anxiety.1 Furthermore, some research suggests a link between anxiety and pain2; providing “anxiety reducing strategies,”3 such as warmth, may ultimately affect postoperative pain. We are encouraged that perioperative hypothermia is garnering greater interest, as we believe the subject is of critical importance and worthy of more study.

The effect of active warming in prehospital trauma care during road and air ambulance transportation - a clinical randomized trial

BackgroundPrevention and treatment of hypothermia by active warming in prehospital trauma care is recommended but scientifical evidence of its effectiveness in a clinical setting is scarce. The objective of this study was to evaluate the effect of additional active warming during road or air ambulance transportation of trauma patients.MethodsPatients were assigned to either passive warming with blankets or passive warming with blankets with the addition of an active warming intervention using a large chemical heat pad applied to the upper torso. Ear canal temperature, subjective sensation of cold discomfort and vital signs were monitored.ResultsMean core temperatures increased from 35.1°C (95% CI; 34.7-35.5°C) to 36.0°C (95% CI; 35.7-36.3°C) (p < 0.05) in patients assigned to passive warming only (n = 22) and from 35.6°C (95% CI; 35.2-36.0°C) to 36.4°C (95% CI; 36.1-36.7°C) (p < 0.05) in patients assigned to additional active warming (n = 26) with no significant differences between the groups. Cold discomfort decreased in 2/3 of patients assigned to passive warming only and in all patients assigned to additional active warming, the difference in cold discomfort change being statistically significant (p < 0.05). Patients assigned to additional active warming also presented a statistically significant decrease in heart rate and respiratory frequency (p < 0.05).ConclusionsIn mildly hypothermic trauma patients, with preserved shivering capacity, adequate passive warming is an effective treatment to establish a slow rewarming rate and to reduce cold discomfort during prehospital transportation. However, the addition of active warming using a chemical heat pad applied to the torso will significantly improve thermal comfort even further and might also reduce the cold induced stress response.Trial RegistrationClinicalTrials.gov: NCT01400152

Effect of active warming on shivering during spinal anesthesia.

Hypothermia is considered one of the reasons for intraoperative shivering. The purpose of this study is to assess whether active warming can prevent hypothermia and shivering in young adults under spinal anesthesia. Fifty male patients scheduled for an elective operation on lower extremity under spinal anesthesia were randomly assigned into the warming group (n = 25) and the control group (n = 25). The active warming was performed using a forced air-warming device, a warmed blanket and warmed fluid. Axillary and tympanic temperatures, shivering degree, thermal discomfort, and anesthetic level were checked every 10 minutes after intrathecal injection of local anesthetics. Patients' characteristics and anesthetic levels were comparable between the groups. Axillary and tympanic temperatures were maintained higher in the warming group than the control group 10 minutes and 20 minutes after intrathecal injection respectively. The lowest temperature in operating room was higher in the warming group (36.3 +/- 0.5degrees C) compared with the control group (35.7 +/- 0.5degrees C) (P < 0.05). Incidences of intraoperative shivering and thermal discomfort were lower in the warming group. We conclude that intraoperative active warming can prevent hypothermia and shivering during spinal anesthesia.