Hypothermia In Surgical Patients Research Articles

Perioperative Hypothermia in Surgical Patients: A Retrospective Cohort Analysis at a Busy District General Hospital

Perioperative Hypothermia in Surgical Patients: A Retrospective Cohort Analysis at a Busy District General Hospital

The effectiveness of pre-warm intravenous fluids on prevention of intraoperative hypothermia in surgical patients

The effectiveness of pre-warm intravenous fluids on prevention of intraoperative hypothermia in surgical patients

CiteSpace-based visual analysis of hypothermia studies in surgical patients.

This study was conducted to understand the research hotspots, research trends and research frontiers for hypothermia in surgical patients and provide a reference for developing effective measures to reduce the incidence of hypothermia in these patients. Using CiteSpace software, a visual analysis of 1288 included articles related to hypothermia in surgical patients was performed. CiteSpace software is a Java application that supports knowledge research, data visualization and analysis of literature databases. The following data were retrieved: title, abstract, year, keywords, author, academic institution, journal and citations. The included literature was analysed using CiteSpace visualization software, knowledge mapping, collaborative network analysis, cluster analysis and highlighting keywords for visualization. A total of 1288 articles related to hypothermia in surgical patients were included, with the largest number of articles published in the United States (448), followed by in Germany (104) and China (102). The top three institutions, journals and authors were from the United States. The most common keywords were perioperative 'hypothermia', 'risk factors' and 'anesthesia'.

Full title: The prevalence of and predictors for perioperative hypothermia in postanaesthesia care unit.

Hypothermia is a common clinical issue during the perioperative period. The patients with perioperative inadvertent hypothermia are associated with higher risk of postoperative complications and higher hospitalisation costs. The aim of this study is to explore the prevalence of and predictors for hypothermia in patients entering postanaesthesia care unit. Retrospective cohort study. A rigorous retrospective cohort study was conducted according to the STROBE reporting checklist. A total of 7216 patients were enrolled in this study. The perioperative variables potentially related to hypothermia were collected. Univariate analysis and multivariate logistic regression analysis were performed to investigate the contributing factors. The overall prevalence of inadvertent hypothermia in postanaesthesia care unit was 21.3% (n=1505). The multivariate logistic regression analysis showed that age >65 (OR=1.561, 95% CI 1.371-1.778, p<.001), non-supine position [lateral decubitus position (OR=1.341, 95% CI 1.133-1.586, p=.001), lithotomy position (OR=1.639, 95% CI 1.295-2.075, p<.001)], non-superficial surgery (OR=2.195, 95% CI 1.566-3.077, p<.001), non-open surgery [laparoscopic surgery (OR=1.205, 95% CI 1.020-1.423, p=.029), endoscopic surgery (OR=1.430, 95%CI 1.084-1.887, p=.011)], the volume of intravenous infusion fluid >1000ml (OR=1.814, 95% CI 1.500-2.194, p<.001), blood transfusion (OR=1.552, 95% CI 1.159-2.078, p=.003), operation performed in the summer or fall (OR=1.874, 95%CI 1.656-2.122, p<.001) and use of dexmedetomidine (OR=1.147, 95%CI 1.015-1.296, p=.028) were associated with increased risk of hypothermia. In contrast, our finding showed that body mass index ≥25kg/m2 (OR=0.556, 95%CI 0.491-0.630, p<.001), higher baseline body temperature (OR=0.641, 95%CI 0.541-0.761, p<.001) and duration of fasting ≥18h (OR=0.487, 95%CI 0.345-0.689, p<.001) were associated with decreased risk of hypothermia. Compared with non-hypothermic patients, patients with hypothermia were associated with prolonged length of hospital days (5 vs. 4days, p<.001). For patients admitted to postanaesthesia care unit after elective procedures, old age, non-supine position, non-open surgery, non-superficial surgery, large volume of intravenous infusion fluid, dexmedetomidine, blood transfusion and Summer or Fall operative season were associated with increased risk of hypothermia, whereas high body mass index, high baseline body temperature and long fasting duration were associated with decreased risk of hypothermia. The outcomes of this study will raise the concerns of perioperative care team on hypothermia in surgical patients. Measures should be taken to improve perioperative hypothermia and clinical outcome.

Risco de hipotermia perioperatória: revisão integrativa

Objetivo: Identificar a ocorrência e os fatores de risco determinantes para o desenvolvimento do diagnóstico de enfermagem risco de hipotermiaperioperatória. Método: Revisão integrativa, usando o acrônimo PIO (pacientes, intervenção, outcomes/desfecho), em que P=pacientes adultos e idosos;I=cirurgias eletivas; O=fatores de risco associados à hipotermia perioperatória. A revisão foi conduzida e reportada com base no Check-list PreferredReporting Items for Systematic Reviews and Meta-Analyses (PRISMA), seguindo-se as sete etapas propostas pelo método PRISMA. Resultados: A buscagerou 854 artigos, sendo retirados os duplicados e os sem relevância. Após aplicação dos critérios de exclusão, 13 artigos foram submetidos à análise final.Índice de massa corporal baixo, idade avançada e tempo cirúrgico prolongado foram os fatores mais relacionados ao desenvolvimento de hipotermianos pacientes cirúrgicos. O manejo da hipotermia colabora para diminuição dos riscos de eventos adversos cardíacos, complicações infecciosas, sangramentose traz maior conforto para o paciente. Conclusão: O enfermeiro precisa agir antes do quadro hipotérmico se instalar, reconhecendo os fatoresde risco inerentes ao paciente e identificando quais tecnologias do cuidado aplicar.

The Relationship of Postoperative Delirium and Unplanned Perioperative Hypothermia in Surgical Patients

PurposeThe purpose of this study was to investigate associations between postoperative delirium (POD) and unplanned perioperative hypothermia (UPH) among adults undergoing noncardiac surgery. DesignA retrospective, exploratory design was used. MethodsA retrospective, exploratory study was conducted using electronic medical record data abstracted from a purposive convenience sample of adult patients undergoing noncardiac surgery from January 2014 to June 2017. FindingsThe analyzed data set included 22,548 surgeries, of which 9% experienced POD. Logistic regression indicated that American Society of Anesthesiologists (ASA) class was the strongest predictor of POD (χ2 = 1,207.11, df = 4, inclusive of all ASA class terms). A significant relationship between UPH and POD (χ2 = 54.94, df = 4, inclusive of all UPH terms) and a complex relationship among UPH, patient age, ASA class, and POD were also found. ConclusionsResults support a relationship between UPH and POD. Notably, there is also a complex relationship in the noncardiac surgery population among UPH, age, ASA class, and POD. Preliminary understanding of this relationship is based on the pathophysiological response to surgical stress. Further research is indicated.

Postoperative Hypothermia in Surgical Patients at Azadi Teaching Hospital

Introduction: The sensation to cold, shake occurrence and shivering are events that are commonly developed following general anesthesia administration postoperatively. Hypothermia has been considered as the most frequent outcome of surgery underwent by anesthesia. Inadvertent hypothermia has been taken into account as common side effect in the postoperative period immediately and it is related to wide impairments and anomalies of different body organs. Concentration on predictive factors of hypothermia would be important to reduce the incidence rate and correct preventable unnecessary risks for patients in the health settings following surgical operations. The aim of study is to assess the magnitude and associated factors of postoperative hypothermia recovery room in patients underwent general anesthesia. Methods: A hospital based prospective cross-sectional study was conducted on200patients with different age groups of both genders who underwent a scheduled non-cardiac surgery and general anesthesia consecutively during the period between the October 1stand the November1st2016. Results: The study revealed that the overall core hypothermia in the study sample was31%. The study showed that the post-operative temperatures decreased statistically significantly in all study patients and separately in adults, children, males, or females P&lt;0.001. The study also revealed that the operation duration(p=0.045)and pre-operative temperature P&lt;0.001were predictors of post-operative hypothermia in study sample. Conclusions: The incidence of hypothermia among study sample was not so high. A significant reduction in core body temperature of patients between pre and post-operation times was found. Those patients with longer operation duration, lower room temperature, and lower pre-operative temperature were at more risk of post-operative hypothermia.

Nurse Anesthetists' and Operating Theater Nurses' Experiences with Inadvertent Hypothermia in Clinical Perioperative Nursing Care

PurposeTo deepen the understanding of and describe nurse anesthetists' and operating theater nurses' experiences with inadvertent hypothermia in clinical perioperative nursing care. DesignQualitative, explorative, and descriptive study that carries an inductive nature. MethodsFocus group interviews with 16 nurse anesthetists and operating theater nurses from four hospitals in Norway. Gadamer's hermeneutics has guided the study's interpretation. FindingsTaking the temperature and measures against inadvertent hypothermia perioperatively are not always systematically implemented. In the data material, three thematic units emerged: routines and habits, the culture of the perioperative unit, and silent suffering. ConclusionsComplications caused by inadvertent hypothermia in surgical patients can lead to unnecessary suffering and prolong the hospital stay. The surgical team's cooperation and responsibility are linked to routine nursing interventions. These depend on the nurses' knowledge and experience as well as their clinical and subjective assessment of the patient's physical condition and the surgical techniques used.

Hypotermi hos operasjonspasienter ved ankomst til postoperativ avdeling

Hypotermi hos operasjonspasienter ved ankomst til postoperativ avdeling

Hypothermia in surgical patients on admission to a postoperative ICU

Hypothermia in surgical patients on admission to a postoperative ICU

Prospective observational study of the effectiveness of prewarming on perioperative hypothermia in surgical patients submitted to spinal anesthesia

Prewarming has been shown to prevent intraoperative inadvertent hypothermia. Nevertheless, data about optimal prewarming-time from published clinical trials report contradictory results. We conducted this pilot study to evaluate routine clinical practice regarding prewarming and its effect on the prevalence of perioperative hypothermia in patients undergoing transurethral resection (TUR) under spinal anesthesia. This was a prospective, observational, pilot study to examine clinical practice in a tertiary hospital regarding prewarming in 140 consecutive patients. When prewarming (pw) was performed, forced-air warming was provided in the pre-anesthesia room for 15 (pw15), 30 (pw30), or 45 (pw45) min. Tympanic temperature was recorded upon entering the pre-anesthesia room, at the time of initiating surgery, and every 15 min intra-operatively. We also recorded duration of the surgical procedure and length of stay in the Post-Anesthesia Care Unit (PACU). Pw15 was performed in 34 patients, pw30 in 29 patients, and pw45 in 21 patients. Fifty-six patients did not receive pw and 96% of them developed hypothermia at the end of the surgical procedure, compared to 73% of patients in pw15 (p = 0.002), 75% in pw30 (p = 0.006) and 90% in pw45 (p = 0.3). Length of stay in the PACU was markedly shorter in pw15 (131 ± 69 min) and pw30 (123 ± 60 min) than in the non-pw group (197 ± 105 min) (p = 0.015 and p = 0.011, respectively). This difference was not significant in pw45 (129 ± 56 min) compared to non-pw patients. In conclusion, prewarming for 15 or 30 min before TUR under spinal anesthesia prevents development of hypothermia at the end of the surgical procedure.

An Exploration of Postoperative Delirium and Unplanned Perioperative Hypothermia in Surgical Patients

An Exploration of Postoperative Delirium and Unplanned Perioperative Hypothermia in Surgical Patients

Efficiency of the Thermal Jacket on the delivered temperature of prewarmed crystalloid intravenous fluid.

Warming of intravenous fluids can decrease the incidence of hypothermia in surgical patients. A quasi-experimental research design was used to compare the delivered temperature of fluids using a conventional blood warmer and the Thermal Jacket, an insulation device designed for intravenous fluid bags. Fluids were divided into one control and three experimental groups. Fluids were initially either room temperature (22.05 +/- 0.45 degrees C) or prewarmed to 41.45 +/- 1.05 degrees C and infused using no temperature maintenance device, a Thermal Jacket, or a water bath blood warmer. Temperatures were recorded at 10-minute intervals at flow rates ranging from 100 to 1,000 mL/hr. Analysis of variance showed a highly significant difference between the delivered temperatures using the various temperature maintenance devices, as well as varying flow rates. The Thermal Jacket, used with prewarmed intravenous fluids, was as effective as the conventional method of delivering warmed fluids. Also, within the range of flow rates studied, faster flow rates tended to yield higher delivered temperatures.

Meta-analysis: effectiveness of forced-air warming for prevention of perioperative hypothermia in surgical patients.

The aim of this study was to evaluate the effectiveness of forced-air warming for preventing perioperative hypothermia. Perioperative hypothermia commonly occurs in patients receiving anaesthesia during surgeries. However, the effectiveness of warming systems requires verification. Systematic review incorporating meta-analysis. We searched OVID, PubMed, Cochrane Library, Medline, CINAHL, CETD and CEPS databases (2001-2015) for randomized controlled trials published in English and Chinese. Outcome measures of interests were body temperature and thermal comfort. Cochrane methods, Quality of evidence (GRADE) assessments and Jadad Quality Score were used. Twenty-nine trials (1875 patients) met inclusion criteria, including seven trials (502 patients) related to thermal comfort. Results showed that: (1) forced-air warming was more effective than passive insulation and circulating-water mattresses; (2) there was no statistically significant difference among forced-air warming, resistive heating blankets, radiant warming systems and circulating-water garments; and (3) that thermal comfort provided by forced-air warming was superior to that of passive insulation, resistive heating blankets and radiant warming systems, but inferior to that of circulating-water mattresses. Forced-air warming prevents perioperative hypothermia more effectively than passive insulation and circulating-water mattresses, whereas there is no statistically significant difference in its effectiveness compared with circulating-water garments, resistive heating blankets and radiant warming systems.

Efficacy of external warming in attenuation of hypothermia in surgical patients.

Hypothermia in surgical patients can be the consequence of long duration of surgical intervention, general anaesthesia and low temperature in operating room. Postoperative hypothermia contributes to a number of postoperative complications such as arrhythmia, myocardial ischemia, hypertension, bleeding, wound infection, coagulopathy, and prolonged effect of muscle relaxants. External heating procedures are used to prevent this condition. The aim of this study was to evaluate the efficiency of external warming system in alleviation of cold stress and hypothermia in patients who underwent major surgical procedures. The study was conducted in the Military Medical Academy in Belgrade. A total of 30 patients of both genders underwent abdominal surgical procedures, randomly divided into two equal groups: the one was externally warmed using warm air mattress (W), while in the control group (C) surgical procedure was performed in regular conditions, without additional warming. Oesophageal temperature (Te) was used as indicator of changes in core temperature, during surgery and awakening postoperative period, and temperature of control sites on the right hand (Th) and the right foot (Tf) reflected the changes in skin temperatures during surgery. Te and skin temperatures were monitored during the intraoperative period, with continuous measurement of Te during the following 90 minutes of the postoperative period. Heart rates and blood pressures were monitored continuously during the intraoperative and awakening period. In the W group, the average Te, Tf and Th did not change significantly during the intraoperative as well as the postoperative period. In the controls, the average Te significantly decreased during the intraoperative period (from 35.61 ± 0.35 °C at 0 minute to 33.86 ± 0.51°C at 120th minute). Compared to the W group, Te in the C group was significantly lower in all the observed periods. Average values of Tf and Th significantly decreased in the C group (from 30.83 ± 1.85 at 20th minute to 29.0 ± 1.39°C at 120th minute, and from 32.75 ± 0.96 to 31.05 ± 1.09°C, respectively). The obtained results confirm that the external warming using warm air mattress was able to attenuate hypothermia, i.e. substantial decrease in core temperature, compared with the similar exposure to cold stress in the control group.

MicroRNA‐155 potentiates the inflammatory response in hypothermia by suppressing IL‐10 production

Therapeutic hypothermia is commonly used to improve neurological outcomes in patients after cardiac arrest. However, therapeutic hypothermia increases sepsis risk and unintentional hypothermia in surgical patients increases infectious complications. Nonetheless, the molecular mechanisms by which hypothermia dysregulates innate immunity are incompletely understood. We found that exposure of human monocytes to cold (32°C) potentiated LPS-induced production of TNF and IL-6, while blunting IL-10 production. This dysregulation was associated with increased expression of microRNA-155 (miR-155), which potentiates Toll-like receptor (TLR) signaling by negatively regulating Ship1 and Socs1. Indeed, Ship1 and Socs1 were suppressed at 32°C and miR-155 antagomirs increased Ship1 and Socs1 and reversed the alterations in cytokine production in cold-exposed monocytes. In contrast, miR-155 mimics phenocopied the effects of cold exposure, reducing Ship1 and Socs1 and altering TNF and IL-10 production. In a murine model of LPS-induced peritonitis, cold exposure potentiated hypothermia and decreased survival (10 vs. 50%; P < 0.05), effects that were associated with increased miR-155, suppression of Ship1 and Socs1, and alterations in TNF and IL-10. Importantly, miR-155-deficiency reduced hypothermia and improved survival (78 vs. 32%, P < 0.05), which was associated with increased Ship1, Socs1, and IL-10. These results establish a causal role of miR-155 in the dysregulation of the inflammatory response to hypothermia.

Post-operative Hypothermia in Surgical Patients at University of Gondar Hospital, Ethiopia

Background: Hypothermia (i.e., temperature <36°C) is a common incident in the immediate postoperative period. However, it is usually diagnosed and treated infrequently. Maintaining normal body temperature will reduce hospital stay, surgical site infection, postoperative blood transfusions, pressure ulcers, subjective discomfort and mortality. The aim of this study was to identify magnitude and factors associated with postoperative hypothermia. Methods: Hospital based cross sectional study was conducted at University of Gondar Hospital. All consecutive postoperative (N= 384) patients that underwent scheduled or emergency surgery were included. Tympanic membrane temperature was measured before surgery and on arrival at recovery room via clinical nurses. Analysis was done using version 20 SPSS and binary logistic regression was utilized to identify associated factors. Result: The incidence of postoperative hypothermia at Recovery Room was 30.72%. Of these, 30 (27.96%) and 43 (34.44%) were mild and moderate respectively, with no severe hypothermia. Surgical patient operated under general anesthesia was more likely to develop postoperative hypothermia than spinal anesthesia (AOR, 1.84; 95% CI, 1.17; 3.24). Additionally, those with higher ASA physical status were at higher risk of postoperative hypothermia (AOR, 1.99; 95% CI, 1.16; 3.44). Temperature was not routinely taken by health care providers in the preoperative and intraoperative period. Conclusion and recommendation: Incidence of postoperative hypothermia at Recovery Room was high. Patient with high ASA physical status and operated under general anesthesia were significant factors for the development of postoperative hypothermia. Anesthesia providers along with perioperative surgical team should participate to reduce the occurrence of postoperative hypothermia with early prediction and diagnosis, especially in high risk groups.

Patient warming in surgery and the enhanced recovery

Perioperative hypothermia is associated with poor outcomes for patients, yet it is preventable in most cases (National Institute for Health and Clinical Excellence (NICE), 2011a). NICE guideline 65 (2008) provides clear recommendations for avoiding perioperative hypothermia in surgical patients at each stage of their surgical journey, preoperatively, intraoperatively and postoperatively. This article describes the risks for patients at each of the three stages and disseminates the most recent NICE recommendations on how both patients and health professionals can work together to avoid perioperative hypothermia. The Enhanced Recovery after Surgery programme (ERAS) considers patient warming to maintain perioperative normothermia to be a key component in accelerating patient recovery. This article looks at how the NICE guidelines on inadvertent perioperative hypothermia and the ERAS programme complement each other to successfully and significantly improve patient recovery.

Influence of Midazolam and Glycopyrrolate on Intra-operative Body Temperature in Abdominal Surgical Patients

Purpose: influence of benzodiazepine (midazolam)or cholinergic inhibitor (atropine or glycopyrrlate) on intra-operative body temperature remains unclear and controversial. This study compares intra-operative body temperature in 50 abdominal surgical patients under general anesthesia between the administration of midazolam and glycopyrrolate in combination, or glycopyrrolate alone. Methods: Patients who underwent abdominal surgery were recruited from September 2008 through October 2009 at Gachon University Gil hospital in incheon. Core body temperature was measured in the right ear using a tympanic membrane thermometer at induction of general anesthesia and at 1 hr, 2 hr, and 3 hr after induction. Results: There were no differences in core body temperature at any measurement point between either patient group (F=1.08, <TEX>$p$</TEX>=.377). Core body temperature decreased throughout the 3 hr after induction in both groups (F=9.22, <TEX>$p$</TEX> <.001). Specially, core temperatures at induction of general anesthesia (p<.001), 1 hr (p<.001), 2 hr (<TEX>$p$</TEX> <.001), and 3 hr (<TEX>$p$</TEX> <.001) after induction were lower than before administration of midazolam and glycopyrrolate, or glycopyrrolate alone. Conclusion: We conclude that a cholinergic inhibitor (glycopyrrolate, 0.1 mg) therefore seems not to affect intra-operative body temperature of patients given a benzodiazepine (midazolam, 0.04 mg <TEX>$kg^{-1}$</TEX>), and not to increase body temperature in patients not given a benzodiazepine during the 3 hr after the induction of general anesthesia. Intra-operative warming therefore is needed to prevent hypothermia in surgical patients who receive pre-operative administration of midazolam and/or glycopyrrolate.

A systematic review of the effectiveness of cutaneous warming systems to prevent hypothermia

To retrieve and critique recent randomised trials of cutaneous warming systems used to prevent hypothermia in surgical patients during the intraoperative period and to identify gaps in current evidence and make recommendations for future trials. Hypothermia affects up to 70% of anaesthetised surgical patients and is associated with several significant negative health outcomes. Systematic review using integrative methods. We searched CINAHL, EMBASE, Cochrane Register of Controlled Trials and Medline databases (January 2000-April 2007) for recent reports on randomised controlled trials of cutaneous warming systems used with elective patients during the intraoperative period. Inclusion criteria. We included randomised control trials examining the effects of cutaneous warming systems used intraoperatively on patients aged 18 years or older undergoing non-emergency surgery. Studies published in English, Spanish or Portuguese with a comparison group that consisted of either usual care or active cutaneous warming systems without prewarming were reviewed. Of 193 papers initially identified, 14 studies met the inclusion criteria. There was moderate evidence to indicate that carbon-fibre blankets and forced-air warming systems are equally effective and that circulating-water garments are most effective for maintaining normothermia during the intraoperative period. Few trials reported costs. Carbon-fibre blankets and forced-air warming systems are effective and circulating-water garments may be preferable. Future research should measure the direct and indirect costs associated with competing systems. Nurses can use this review to inform their selection of warming interventions in perioperative nursing practice. They can also assess other factors such as nursing workload, staff training and equipment maintenance, which should be incorporated into future research.