Intraoperative Core Temperature Research Articles

Construction and validation of a postoperative hypothermia prediction model in elderly patients undergoing colorectal surgery

BackgroundPostoperative hypothermia (POH) is a common issue in colorectal surgery patients, leading to complications. This study aimed to develop and validate a predictive model for identifying POH in colorectal surgery patients. MethodsA retrospective analysis of 1,316 patients who underwent colorectal surgery between June 2020 and September 2022 was conducted using institutional medical records. Intraoperative core temperatures and potential influencing factors were collected, and regression analysis was used to identify risk factors for POH and create a model. The model's performance was evaluated using the receiver operating characteristic curve analysis. ResultsIntraoperative hypothermia occurred in 51.5 % of patients. Significant predictors of POH included gender, alcohol consumption, surgery duration, platelet count, and age. The constructed model included factors like fluid intake, platelets, cigarette use, alcohol consumption, surgery type, muscle relaxants, age, ABSI, and gender. The model showed good predictive performance with an area under the ROC curve of 0.981 and a Hosmer-Lemeshow test p-value of 0.676. The Youden index, sensitivity, specificity, and practical application rate were 0.602, 0.790, 0.812, and 98.81 %, respectively. ConclusionThis study developed a predictive model for POH in colorectal surgery patients, considering individual factors and exploring underlying causes. Understanding risk factors and consequences of POH is crucial for nurses and perioperative professionals in clinical practice.

Intraoperative Patient Warming Instead of Gas on the Management of Postoperative Pain in Laparoscopic Colectomy and Cholecystectomy: A Randomized Controlled Trial.

Blurred lines remain in details of the association between patient warming with postoperative pain and a proper analgesic requirement. Therefore, the present study proposes to observe the effects of intraoperative patient warming and carbon dioxide insufflation duration in laparoscopic colectomy (LCol) andlaparoscopic cholecystectomy (LChol) procedures on postoperative pain, analgesic requirements, and hemodynamics. The present study involved 80 cases aged 18-80 years with the American Society of Anesthesiologists I-III classification, possessing two initial groups primarily, one for LCol and one for LChol. Subsequently, each was divided into two through randomization for intraoperative warming. Postoperatively, pain perception, per se, was evaluated using the visual analog scale (VAS) score at the 30 minutes, 1st, 6th, 12th, and 24th hours, along with the impact of pain on hemodynamic parameters and side effects such as nausea/vomiting and the dosage of analgesics used. Groups actively heated with warm air-blowing devices detected significantly higher intraoperative core and skin temperature measurements, and postoperative early pain perception was significantly lower in the warmed ones. Furthermore, a significant decrease in the VAS scores and the analgesic at the 12th and 24th hours compared to the first six hours was recognized between them. Consequently, herewith, we postulate that so-called patient warming positively affects the VAS scores.

Comparison of prewarming plus intraoperative warming with intraoperative warming alone in patients undergoing minimally invasive thoracic or abdominal surgery: A systematic review and meta-analysis.

Prewarming has been recommended to reduce intraoperative hypothermia. However, the evidence is unclear. This review examined if prewarming can prevent intraoperative hypothermia in patients undergoing thoracoscopic and laparoscopic surgeries. PubMed, CENTRAL, Web of Science, and Embase databases were searched for randomized controlled trials (RCTs) up to 15th January 2024. The primary outcome of interest was the difference in intraoperative core temperature. The secondary outcomes were intraoperative hypothermia (<36°) and postoperative shivering. Seven RCTs were eligible. Meta-analysis showed that intraoperative core temperature was significantly higher at the start or within 30mins of the start of the surgery (MD: 0.32 95% CI: 0.15, 0.50 I2 = 94% p = 0.0003), 60 mins after the start of the surgery (MD: 0.37 95% CI: 0.24, 0.50 I2 = 81% p<0.00001), 120 mins after the start of the surgery (MD: 0.34 95% CI: 0.12, 0.56 I2 = 88% p = 0.003), and at the end of the surgery (MD: 0.35 95% CI: 0.25, 0.45 I2 = 61% p<0.00001). The incidence of shivering was also significantly lower in the prewarming group (OR: 0.18 95% CI: 0.08, 0.43 I2 = 0%). Prewarming was also associated with a significant reduction in the risk of hypothermia (OR: 0.20 95% CI: 0.10, 0.41 I2 = 0% p<0.0001). The certainty of the evidence assessed by GRADE was "moderate" for intraoperative core temperatures at all time points and "low" for minimal intraoperative core temperature, shivering, and hypothermia. Moderate to low-quality evidence shows that prewarming combined with intraoperative warming, as compared to intraoperative warming alone, can improve intraoperative temperature control and reduce the risk of hypothermia and shivering in patients undergoing thoracoscopic and laparoscopic procedures.

SP9.8 An Audit of Intraoperative Hypothermia Rates in Adults Undergoing Emergency Surgery in a Tertiary General Surgical Unit and Evaluation of the Efficacy of Preoperative and Intraoperative Forced-Air Warming on Achieving Intraoperative Normothermia

Abstract Aims Surgical site infections (SSIs) inflict significant economic burden on the NHS. Preoperative and intraoperative hypothermia are risk factors for SSIs. Evidence shows that maintenance of intraoperative normothermia significantly reduces SSI rates. Perioperative SSI bundles addressing factors including hair removal, antibiotic prophylaxis, skin preparation, drape positioning, and hypothermia are critical to improving SSI rates. We aim to audit rates of intraoperative hypothermia in our surgical caseload and evaluate the efficacy of preoperative and intraoperative forced-air warming through bespoke gowns in achieving intraoperative normothermia. Methods We conducted a retrospective audit of the intraoperative core temperatures of all adult patients undergoing surgical procedures on the emergency theatre list of a general surgery department and who had a temperature at knife-to-skin recorded (n=88). We then ran a prospective trial, outfitting patients listed for surgery (n=15) with forced-air warming gowns. Patients underwent forced-air warming with the gowns for 45 minutes on the surgical ward, throughout anaesthetic induction, and intraoperatively. Patient core temperature was measured at baseline, upon arrival at the anaesthetic room, and at knife-to-skin. Results Baseline audit data showed over 18% of patients were hypothermic at knife-to-skin. Contrastingly, 100% of patients wearing forced-air warming gowns were normothermic at knife-to-skin. The mean core temperature at knife-to-skin was significantly higher in patients wearing warming gowns (p=0.012). Conclusions Forced-air warming gowns are superior to traditional hospital gowns, blankets and surgical access forced-air warming devices in achieving intraoperative normothermia. They are an effective, sustainable, and cost-neutral, ‘all-in-one’ alternative to current perioperative protocol and will reduce SSI rates.

Aggressive intraoperative warming and postoperative pulmonary complications in elderly patients recovering from esophageal cancer surgery: sub-analysis of a randomized trial.

Elderly patients having esophagectomies often become hypothermic which may promote complications. We tested the hypothesis that aggressive warming to a core temperature of 37°C reduces postoperative pulmonary complications (PPCs) in elderly patients having esophageal cancer resections. This study was a pre-defined sub-study of a multi-center, parallel group, superiority trial (PROTECT). Patients aged >65 years and having elective radical resection of esophageal cancer in a single center were randomly allocated into either aggressive warming group (target intraoperative core temperatures of 37°C) or routine thermal management group (target intraoperative core temperatures of 35.5°C). The primary endpoint was the incidence of PPCs. Secondary endpoints included duration of chest tube drainage and other postoperative complications. A total of 300 patients were included in the primary analysis. PPCs occurred in 27 (18%) of 150 patients in the aggressive warming group and 31 (21%) of 150 patients in the routine thermal management group. The relative risk (RR) of aggressive versus routine thermal management was 0.9 (95% CI: 0.5, 1.4; p = 0.56). The duration of chest drainage in patients assigned to aggressive warming was shorter than that assigned to routine thermal management: 4 (3, 5) days vs. 5 (4, 7) days; hazard ratio (HR) 1.4 [95% CI: 1.1, 1.7]; p = 0.001. Fewer aggressively warmed patients needed chest drainage for more than 5 days: 30/150 (20%) vs. 51/150 (34%); RR:0.6 (95% CI: 0.4, 0.9; p = 0.03). The incidence of other postoperative complications were similar between the two groups. Aggressive warming does not reduce the incidence of PPCs in elderly patients receiving esophagectomy. The duration of chest drainage was reduced by aggressive warming. But as a secondary analysis of a planned sub-group study, these results should be considered exploratory. https://www.chictr.org.cn/showproj.aspx?proj=37099, ChiCTR1900022257.

Comparative effects of warming systems applied to different parts of the body on hypothermia in adults undergoing abdominal surgery: A systematic review and network meta-analysis of randomized controlled trials

Study objectiveThe prevention of perioperative hypothermia after anesthesia induction is a critical concern in patients undergoing abdominal surgery. The effectiveness of various warming systems for preventing hypothermia and shivering when applied to specific areas of the body remains undetermined. DesignSystematic review and network meta-analysis. SettingOperating room. InterventionFive electronic databases were searched, including only randomized control trials (RCTs) reporting the effects of warming systems applied to specific body sites on the intraoperative core temperature and postoperative risk of shivering in adults undergoing abdominal surgery. A multivariate random-effects network meta-analysis with a frequentist framework was implemented for data analysis. MeasurementsThe primary outcome was the core body temperature 60 and 120 min after anesthesia induction for abdominal surgery. The secondary outcome was the incidence of postoperative shivering. ResultsThis review comprised a total of 24 RCTs including 1119 patients. At 60 and 120 min after anesthesia induction, a forced-air warming system applied to the upper body (0.3 °C and 95% confidence intervals = [0.3 to 0.4], 1.0 °C [0.7 to 1.3]), lower body (0.4 °C [0.3 to 0.5], 0.9 °C [0.5 to 1.2]), and underbody (0.5 °C [0.5 to 0.6], 1.2 °C [0.9 to 1.6]) was superior to passive insulation in terms of core body temperature regulation. Compared with passive insulation, the forced-air warming system applied to the lower body (odds ratio = 0.06) or underbody (0.44) and the electric heating blanket to the lower body (0.02) or the whole body (0.07) significantly reduced the risk of shivering. ConclusionsThe results of this NMA revealed that forced-air warming with an underbody blanket effectively elevates core body temperatures in 60 and 120 min after induction of anesthesia and prevents shivering in patients recovering from abdominal surgery.

Incidence and associated factors of perioperative hypothermia in adult patients at a university-based, tertiary care hospital in Thailand

BackgroundInadvertent perioperative hypothermia is an unintentional drop in core body temperature to less than 36 °C perioperatively and is associated with many negative outcomes such as infection, a prolonged stay in a recovery room, and decreased patient comfort.ObjectiveTo determine the incidence of postoperative hypothermia and to identify the associated factors with postoperative hypothermia in patients undergoing head, neck, breast, general, urology, and vascular surgery. The incidences of pre- and intraoperative hypothermia were examined as the intermediate outcomes.Materials and methodsA retrospective chart review was conducted in adult patients undergoing surgery at a university hospital in a developing country for two months (October to November 2019). Temperatures below 36 °C were defined as hypothermia. Univariate and multivariate analyses were used to identify factors associated with postoperative hypothermia.ResultsA total of 742 patients were analyzed, the incidence of postoperative hypothermia was 11.9% (95% CI 9.7%-14.3%), and preoperative hypothermia was 0.4% (95% CI 0.08%-1.2%). Of the 117 patients with intraoperative core temperature monitoring, the incidence of intraoperative hypothermia was 73.5% (95% CI 58.8–90.8%), and hypothermia occurred most commonly after anesthesia induction. Associated factors of postoperative hypothermia were ASA physical status III-IV (OR = 1.78, 95%CI 1.08–2.93, p = 0.023) and preoperative hypothermia (OR = 17.99, 95%CI = 1.57-206.89, p = 0.020). Patients with postoperative hypothermia had a significantly longer stay in the PACU (100 min vs. 90 min, p = 0.047) and a lower temperature when discharged from PACU (36.2 °C vs. 36.5 °C, p < 0.001) than those without hypothermia.ConclusionThis study confirms that perioperative hypothermia remains a common problem, especially in the intraoperative and postoperative periods. High ASA physical status and preoperative hypothermia were associated factors of postoperative hypothermia. In order to minimize the incidence of perioperative hypothermia and enhance patient outcomes, appropriate temperature management should be emphasized in patients at high risk.RegistrationClinical Trials.gov (NCT04307095) (13/03/2020).

Risk factors and prediction model for inadvertent intraoperative hypothermia in patients undergoing robotic surgery: a retrospective analysis

This study explored the risk factors and established a prediction model for intraoperative hypothermia (IOH) in patients undergoing robotic surgery. We conducted a retrospective survey of patients undergoing elective robotic surgery at the China-Japan Union Hospital of Jilin University during June 2020–October 2021 using institutional medical records. Intraoperative core temperatures and potential influencing factors were collected, and regression analyses were used to assess the risk factors for IOH and establish a prediction model for the incidence of IOH. Overall, 833 patients who underwent robotic surgery were included in the final analysis; IOH was observed in 344 patients (incidence, 0.41; 95% confidence interval [CI] 0.38–0.45). A higher body mass index (BMI) and baseline core temperature were protective factors for IOH. A final prediction model for IOH was developed based on the determining factors with an area under the receiver operating characteristic curve of 0.85 under fivefold cross validation (95% CI 0.83–0.88). Accordingly, a lower BMI and baseline core temperature, thoracic surgeries, morning surgeries, and surgeries with longer durations were risk factors for IOH during robotic surgeries. Our prediction model has an excellent discrimination ability for predicting IOH in robotic surgeries.

Effect of neoadjuvant chemotherapy on intraoperative core temperature in patients with breast cancer: a retrospective cohort study.

Clinical evidence suggests that chemotherapeutic agents are associated with neuropathy and peripheral autonomic dysfunction. However, the possible effects of neoadjuvant chemotherapy on intraoperative temperature remain poorly characterised. We evaluated patients who underwent a mastectomy for breast cancer between April 2016 and July 2020. Propensity scores were used to match patients who received neoadjuvant chemotherapy with those who did not, and intraoperative core temperature patterns were analysed in the matched cohort. The independent associations between vasopressor use and heart rate during general anaesthesia in the matched cohort were also analysed. Data from 1764 patients were analysed (882 patients in each group). Both groups presented a similar pattern of heat redistribution and subsequent rewarming; however, the neoadjuvant chemotherapy group did not reach the same intraoperative plateau temperature as the group that did not receive prior chemotherapy, with differences of up to 0.4°C (95% confidence interval: 0.11-0.63°C; P=0.005). In a subgroup analysis, neuropathy in patients who received neoadjuvant chemotherapy was associated with increased use of vasopressors and higher heart rate. In patients with breast cancer, neoadjuvant chemotherapy is associated with lower plateau core temperatures, increased vasopressor use, and higher heart rates during general anaesthesia, which is more severe in the presence of neuropathy.

Comparative Efficacy of Six Active Warming Systems for Intraoperative Warming in Adult Patients Undergoing Laparoscopic Surgery: A Systematic Review and Network Meta-Analysis.

Intraoperative hypothermia is very common and harmful in adult patients undergoing laparoscopic surgery. A variety of active warming systems has received close attention and has been researched by related scholars. However, the relative efficacy of these systems and which active warming system is preferred for such patients remain unclear. The aim of this study was to compare and rank six active warming systems regarding intraoperative warming efficacy in adult patients undergoing laparoscopic surgery. Following the PRISMA 2020 guidelines, relevant randomized controlled trials (RCTs) on the efficacy of different active warming systems in warming adult patients undergoing laparoscopic surgery were searched from five English databases and three Chinese databases. The quality of the studies was assessed using the Cochrane Risk of Bias tool (RoB2). The outcome was the final intraoperative core temperature. We estimated direct effects by using pairwise meta-analysis, estimated relative effects and ranking with the consistency model to conduct an NetworkMeta-Analysis (NMA). We used GRADE (Grading of Recommendations Assessment, Development, and Evaluation) to assess the certainty of the evidence. Sensitivity analysis was performed to test the robustness of the results. This study is registered with PROSPERO, with number CRD42022309057. In total, 19 RCTs involving 6 active warming systems and comprising 1364 patients were included in this NMA. The NMA once again confirmed the validity of forced-air warming (FAW) systems compared with other active warming systems, and further showed that underbody FAW was associated with more remarkable warming efficacy in different types of FAW systems. NMA was used to perform an exhaustive comparison of the warming efficacy of six active warming systems and indicated that underbody FAW was most likely to be the most effective warming system in adult patients undergoing laparoscopic surgery; however, considering the sparsity of the network, our results should be cautiously interpreted. Furthermore, a large number of high-quality RCTs comparing the warming efficacy of different competitive active warming systems are needed.

Effect of active airway warming with a heated-humidified breathing circuit on core body temperature in patients under general anesthesia: a systematic review and meta-analysis with trial sequential analysis.

The application of a heated-humidified breathing circuit (HHBC) may reduce respiratory heat loss during mechanical ventilation, but its effect in preventing intraoperative hypothermia is controversial. This study aimed to investigate the effectiveness of HHBC in maintaining the core temperature of patients receiving mechanical ventilation under general anesthesia. We searched MEDLINE, Embase, Cochrane library (CENTRAL), and Google Scholar to identify all randomized controlled trials (RCTs) up to February 2022 that compared the intraoperative core temperature in patients with heated humidifier (HH) and other circuit devices. The primary outcome was the intraoperative core temperature at the end of surgery. The weighted mean differences (WMDs) between the groups and their 95% CIs were calculated for each outcome. We performed a trial sequential analysis of the primary outcomes to assess whether our results were conclusive. Eighteen RCTs with 993 patients were included in the analysis. A significantly higher core temperature was observed at the end of surgery in patients with HH than those with no device (WMD = 0.734, 95% CI [0.443, 1.025]) or heat and moisture exchanger (WMD = 0.368, 95% CI [0.118, 0.618]), but with substantial heterogeneity. Although HHBC did not absolutely prevent hypothermia, this meta-analysis suggests that it can be used as an effective supplemental device to maintain the intraoperative core temperature under general anesthesia. However, considering the substantial heterogeneity and limitations of this study, further well-designed studies are needed to clarify the effectiveness of HHBC.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Aggressive intraoperative warming versus routine thermal management during non-cardiac surgery (PROTECT): a multicentre, parallel group, superiority trial

Moderate intraoperative hypothermia promotes myocardial injury, surgical site infections, and blood loss. Whether aggressive warming to a truly normothermic temperature near 37°C improves outcomes remains unknown. We aimed to test the hypothesis that aggressive intraoperative warming reduces major perioperative complications. In this multicentre, parallel group, superiority trial, patients at 12 sites in China and at the Cleveland Clinic in the USA were randomly assigned (1:1) to receive either aggressive warming to a target core temperature of 37°C (aggressively warmed group) or routine thermal management to a target of 35·5°C (routine thermal management group) during non-cardiac surgery. Randomisation was stratified by site, with computer-generated, randomly sized blocks. Eligible patients (aged ≥45 years) had at least one cardiovascular risk factor, were scheduled for inpatient non-cardiac surgery expected to last 2-6 h with general anaesthesia, and were expected to have at least half of the anterior skin surface available for warming. Patients requiring dialysis and those with a body-mass index exceeding 30 kg/m2 were excluded. The primary outcome was a composite of myocardial injury (troponin elevation, apparently of ischaemic origin), non-fatal cardiac arrest, and all-cause mortality within 30 days of surgery, as assessed in the modified intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03111875. Between March 27, 2017, and March 16, 2021, 5056 participants were enrolled, of whom 5013 were included in the intention-to-treat population (2507 in the aggressively warmed group and 2506 in the routine thermal management group). Patients assigned to aggressive warming had a mean final intraoperative core temperature of 37·1°C (SD 0·3) whereas the routine thermal management group averaged 35·6°C (SD 0·3). At least one of the primary outcome components (myocardial injury after non-cardiac surgery, cardiac arrest, or mortality) occurred in 246 (9·9%) of 2497 patients in the aggressively warmed group and in 239 (9·6%) of 2490 patients in the routine thermal management group. The common effect relative risk of aggressive versus routine thermal management was an estimated 1·04 (95% CI 0·87-1·24, p=0·69). There were 39 adverse events in patients assigned to aggressive warming (17 of which were serious) and 54 in those assigned to routine thermal management (30 of which were serious). One serious adverse event, in an aggressively warmed patient, was deemed to be possibly related to thermal management. The incidence of a 30-day composite of major cardiovascular outcomes did not differ significantly in patients randomised to 35·5°C and to 37°C. At least over a 1·5°C range from very mild hypothermia to full normothermia, there was no evidence that any substantive outcome varied. Keeping core temperature at least 35·5°C in surgical patients appears sufficient. 3M and the Health and Medical Research Fund, Food and Health Bureau, Hong Kong. For the Chinese translation of the abstract see Supplementary Materials section.

A descriptive study of the relationship between preoperative body temperature and intraoperative core temperature change in adults under general anaesthesia

Background: Despite numerous guidelines on perioperative temperature management, perioperative hypothermia remains common. Prewarming to prevent redistribution hypothermia is supported by evidence, but not widely practised. We investigate the measurement of preoperative mean body temperature as a potential tool for individualising the practice of prewarming. Methods: We hypothesised that patients who experience intraoperative hypothermia have a lower preoperative mean body temperature. A longitudinal study was conducted in adult patients presenting for ophthalmological surgery under general anaesthesia, to describe the relationship between the incidence of hypothermia within the first hour of anaesthesia and preoperative mean body temperature. Results: Sixty-five patients were enrolled. Twelve participants (18%) presented to the operating theatre hypothermic (core temperature < 36.0 °C). A further 28 (43%) became hypothermic during the procedure. All hypothermia events occurred within 60 minutes after induction of anaesthesia, and half of the events occurred within 19 minutes. The difference in preoperative mean body temperature between those with and without intraoperative hypothermia was only -0.2 °C (95% CI -0.4, 0.1). This is neither clinically relevant nor statistically noteworthy. In Cox proportional hazards analysis, BMI and ASA status compounded the observed association between preoperative mean body temperature and the incidence of intraoperative hypothermia. A higher BMI and ASA are associated with a lower incidence of hypothermia. Conclusion: We conclude that intraoperative hypothermia is common and occurs early after induction of anaesthesia. We observed no useful difference in preoperative mean body temperature to help distinguish between patients who become hypothermic and those who do not. Without a useful risk prediction tool, a generic approach to prewarming remains appropriate. Preoperative screening for pre-existing hypothermia should be practised, even in cases considered as low risk.

Changes in Coagulation and Fibrinolysis Systems During the Perioperative Period of Acute Type A Aortic Dissection.

Acute type A aortic dissection (ATAAD) has a high risk of perioperative bleeding and often requires extensive blood product infusions. Analysis of the changes in coagulation and fibrinolysis is both helpful for proper treatment and an improved prognosis. The present study investigated the changes in the coagulation and fibrinolysis systems during the perioperative period of ATAAD. Twenty-two patients with ATAAD were included in this study. After diagnosis, all patients underwent ascending aorta replacement, aortic arch replacement, and implantation of a special stented endovascular graft. The control group included 25 patients undergoing elective aortic surgery. Baseline preoperative, intraoperative, and postoperative data were collected in both groups. Venous blood samples of all subjects were collected at five time points, after admission (T1), before surgery (T2), after protamine reversal (T3), postoperative 6 h (T4), and postoperative 24 h (T5), measuring the concentrations of platelet factor 4 (PF4), prothrombin fragment 1 + 2 (F1+2), tissue factor (TF), tissue factor pathway inhibitor (TFPI), plasminogen activator (PA), plasminogen activator inhibitor-1 (PAI-1) and thrombin antithrombin complex (TAT) by enzyme-linked immunosorbent assays (ELISAs). The average age of the ATAAD group was 49.9±12.5 years old, while that of the control group was 57.0±12.1 years old. There were more patients with a smoking history, and the cardiopulmonary bypass time, aortic cross-clamp time, and preoperative left ventricular ejection fraction were higher in the ATAAD group than in the control group (P < 0.05). Additionally, preoperative fibrin degradation products (FDP) and preoperative D-dimer were higher in the ATAAD group than in the control group (P < 0.05). However, time from onset to operation, intraoperative core temperature, preoperative B-type natriuretic peptide (BNP), and left ventricular end-diastolic diameter in the ATAAD group were lower than those in the control group (P < 0.05). In contrast, however, the proportion of abnormal bicuspid aortic valves in the control group was higher (P < 0.05). TF in the ATAAD group was significantly higher at T1 (7.9±3.7 ng/mL versus 0.9±0.7 ng/mL, P < 0.05). The TFPI in the ATAAD group was higher than that in the control group at T1 and T2 (P < 0.05). Additionally, PA in the ATAAD group was higher than that in the control group at T1, T2, T3, and T5 (P < 0.05), while PA in the control group was significantly higher at T3 than at T1 (P < 0.05). There was no significant difference in PAI-1 between the two groups before surgery (P > 0.05). Nevertheless, both groups reached their peak value at T3. The platelet count and fibrinogen (FBG) in the ATAAD group decreased significantly from T1 to T2 and continued to decrease after cardiopulmonary bypass. F1+2 and TAT in the ATAAD group were higher than in the control group (P < 0.05); however, they peaked at T3. The PF4 in the ATAAD group slightly increased at T1, while PF4 at T3 was significantly higher than at T1 (P < 0.05). The changes in coagulation and fibrinolysis in the ATAAD group before surgery were very significant, which caused a large amount of fibrinogen and platelet consumption. Cardiopulmonary bypass (CPB) and a lower intraoperative core temperature exacerbated the coagulation and fibrinolysis disorder, and the pro-coagulant function of the platelets was activated after surgery. Maintaining the normal concentration of fibrinogen was helpful to correct the coagulation function disorder.

Effect of intravenous fluid warming devices on intraoperative core temperature during maintenance fluid therapy: a prospective randomized controlled trial

Effect of intravenous fluid warming devices on intraoperative core temperature during maintenance fluid therapy: a prospective randomized controlled trial

Development of an Electronic Dashboard to Monitor Intra-operative Patient Core Temperatures

<h3>Background</h3> Maintaining normothermia is a complex process which requires collaboration from perioperative personnel throughout all phases of perioperative care. It's essential that a patient's core temperature remain within normothermic range (36°C-38°C) to mitigate risk for surgical site infections (SSI) as well as other complications. Our surgical site infection performance improvement team (SSI-PI) implemented several interventions to maintain normothermia for our surgical patients but lacked an efficient process to obtain intra-operative core temperatures from the medical record to measure the efficacy of these interventions. This need led to development of an electronic dashboard to streamline review of intra-operative core temperatures. <h3>Methods</h3> At a 1,541 bed academic medical center, an Infection Preventionist along with SSI-PI team members collaborated with our Joint Data Analytics Team to create an electronic dashboard which communicates with our electronic medical record system to collate intra-operative core temperatures that are recorded every minute. Colorectal, abdominal hysterectomy and total joint arthroplasty procedures were chosen as the primary focus to develop this interactive dashboard. The dashboards contents and format were selected based on feedback provided by SSI-PI team members. Data within the dashboard was validated for accuracy by an Infection Preventionist. <h3>Results</h3> The dashboard shows starting, final, mean, and median core temperature measurements and calculates the percentage of core temperatures below 36.0°C for each patient. All temperature metrics can be displayed as an aggregate as well. Data can be analyzed by date range and filtered by hospital within our healthcare system, procedure type, surgeon, anesthesiologist, warming method, and by infection status. <h3>Conclusions</h3> Overall, this electronic dashboard has helped our SSI-PI team better understand the core temperature distribution among patients during their surgical procedures. More importantly, it has allowed the SSI-PI team to measure the effectiveness of warming practices in order to better maintain patient normothermia throughout the perioperative period.

Efficacy of prewarming prophylaxis method for intraoperative hypothermia during thoracoscopic esophagectomy

This study was performed to elucidate the clinical efficacy of the prewarming prophylaxis method for intraoperative hypothermia during thoracoscopic esophagectomy for esophageal cancer. We enrolled 100 consecutive patients with esophageal cancer. Two patients in the prewarming group could not undergo thoracoscopic esophagectomy because of conversion to thoracotomy. The intraoperative core temperature was measured in 50 and 48 patients classified into the control and prewarming groups, respectively. Patients in the prewarming group wore a Bair Hugger warming gown (3M, Maplewood, MN, USA) in the ward for 30min before entering the operation room. The primary outcome measure was the difference in the intraoperative body core temperature between the control and prewarming groups, and the secondary outcome measure was the difference in postoperative infectious complications between the control and prewarming groups. The intraoperative core temperature was significantly different between the two groups at each 30-min time point from the starting of operation to the ending of the thoracic procedure (P < 0.001). The incidence of infectious surgical complications was not significantly different between the control and prewarming groups (30.0% vs. 14.6%, respectively; P = 0.11). The prewarming prophylaxis method was effective for maintaining normothermia during thoracoscopic esophagectomy.

Intraoperative core temperature and infectious complications after colorectal surgery: A registry analysis

Study objectiveModerate hypothermia (e.g., 34.5 °C) causes surgical site infections, but it remains unknown whether mild hypothermia (34.6 °C–35.9 °C) causes infection. Therefore, the objective of this study was to evaluate the relationship between intraoperative time-weighted average core temperature and a composite of serious wound and systemic infections in adults having colorectal surgery over a range of near-normal temperatures. DesignRetrospective, single center study. SettingThe operating rooms of the Cleveland Clinic Foundation from January 2005 to December 2014. PatientsAdult patients having colorectal surgery at least 1 h in length who received both general anesthesia and esophageal core temperature monitoring. Intervention(s)Time weighted average intraoperative core temperature. MeasurementsOur primary outcome was a composite of serious infections obtained from a surgical registry and billing codes. Average intraoperative esophageal temperatures and the composite of serious 30-day complications were assessed with logistic regression, adjusted for potential confounding factors. Main resultsA total of 7908 patients were included in the analysis. A 0.5 °C decrease in time-weighted average intraoperative core temperature ≤ 35.4 °C was associated with an increased odds of serious infection (OR = 1.38, P = .045); that is, hypothermia below 35.4 °C progressively worsened infection risk. Additionally, at higher core temperatures, the odds of serious infection increased slightly with each 0.5 °C increase in average temperature (OR = 1.10, P = .047). ConclusionsBelow 35.5 °C, hypothermia was associated with increased risk of serious infectious complications. Why composite complications increased at higher temperatures remains unclear, but the highest temperatures may reflect febrile patients who had pre-existing infections. Avoiding time-weighted average core temperatures <35.5 °C appears prudent from an infection perspective, but higher temperatures may be needed to prevent other hypothermia-related complications.

Effect of heated humidified ventilation on intraoperative core temperature and prognosis in normothermic thoraco-abdominal aortic aneurysm repair.

BackgroundTo evaluate whether the heated humidified ventilation can effectively maintain core temperature and improve prognosis in normothermic thoraco-abdominal aortic aneurysm repair surgery.MethodsPatients who were scheduled for normothermic thoraco-abdominal aortic aneurysm repair surgery were randomized into the group using heated humidified ventilation combined with water blanket and the group using water blanket only. During the operation, the core temperature will be measured every 30 minutes. We analyzed intraoperative core-temperature, coagulation function and in-hospital mortality.ResultsHHV&WB group showed lesser decrease in core temperature than WB groups in the first two hours, while WB group had a higher body temperature at the third to fifth hour (2-hour: 35.45±0.47 vs. 35.24±0.59 °C, P=0.284; 5-hour: 35.38±0.70 vs. 35.51±0.88 °C, P=0.664). There was less blood loss, dosage of coagulation drugs and in-hospital mortality (13.33% vs. 20.00%, P=1) in the HHV&WB group.ConclusionsHeated humidified ventilation can improve the prognosis of normothermic thoraco-abdominal aortic aneurysm repair surgery to some extent, but it can only maintain the core temperature during the first 2 hours.