Warming Blanket Research Articles

DECREASING PAIN, ANXIETY, AND CONFUSION IN TERMINALLY ILL VETERANS

Abstract Terminally ill patients often receive medications for pain and anxiety that result in sedation that may inhibit communication with their loved ones. Balancing comfort while maintaining meaningful communications is a common dilemma for patients, staff, and families. Many patients report confusion and a decreased ability to communicate with families and health care providers, resulting in fear, anger, and frustration. Additionally, family members (25 to 33%) also feel frustrated and angry not being able to communicate with their loved ones needs and wishes. Delirium, a distressing syndrome characterized by disturbed consciousness, reduced ability to focus attention, altered cognition is experienced by 62–88% of terminally ill patients. Unfortunately, it is often underdiagnosed and undertreated. While not all delirium can be prevented it is estimated that 50% of terminal delirium may be ameliorated. This project was designed to proactively identify terminally ill veteran preferences for nonpharmacological interventions to reduce pain, anxiety, and prevent delirium. In the sample of Veterans from an inpatient VAMC Hospice (n=31) the mean age was 79.46 (sd=10.69); 60.7% were Black and 39.3% were white; 60.9% had cancer and 27.6% had heart failure. The most common patient delirium related behaviors were verbal agitation, physical agitations, physical aggression, anxiety, and confusion. Veterans identified the following comfort priorities: decreased noise (82.6%) and lighting (82.6%), warm blankets (78.3%), music (65.2%), emotional support (73.9%), increased family involvement (43.5%) and (20.8%) going outdoors. Preventative individualized nonpharmacological interventions decreased disruptive delirium related behaviors over 95% of the time and should be incorporated into routine hospice care.

Effects of dietary antioxidant supplementation on metabolism and inflammatory biomarkers in heat-stressed dairy cows

Heat-stress-induced inflammation may be ameliorated by antioxidant supplementation due to the purported effects of increased production of reactive oxygen species or oxidative stress on the gastrointestinal tract barrier. Thus, study objectives were to evaluate whether antioxidant supplementation [AGRADO Plus 2.0 (AP); EW Nutrition] affects metabolism and inflammatory biomarkers in heat-stressed lactating dairy cows. Thirty-two mid-lactation multiparous Holstein cows were assigned to 1 of 4 dietary-environmental treatments: (1) thermoneutral (TN) conditions and fed a control diet (TN-CON; n = 8), (2) TN and fed a diet with AP (10 g antioxidant; n = 8), (3) heat stress (HS) and fed a control diet (HS-CON; n = 8), or (4) HS and fed a diet with AP (HS-AP; n = 8). The trial consisted of a 23-d prefeeding phase and 2 experimental periods (P). Respective dietary treatments were top-dressed starting on d 1 of the prefeeding period and continued daily throughout the duration of the experiment. During P1 (4 d), baseline data were collected. During P2 (7 d), HS was artificially induced using an electric heat blanket (Thermotex Therapy Systems Ltd.). During P2, the effects of treatment, day, and treatment-by-day interaction were assessed using PROC MIXED of SAS (SAS Institute Inc.). Heat stress (treatments 3 and 4) increased rectal, vaginal, and skin temperatures (1.2°C, 1.1°C, and 2.0°C, respectively) and respiration rate (33 breaths per minute) relative to TN cows. As expected, HS decreased dry matter intake, milk yield, and energy-corrected milk yield (32%, 28%, and 28% from d 4 to 7, respectively) relative to TN. There were no effects of AP on body temperature indices or production. Milk fat, protein, and lactose concentrations remained unaltered by HS or AP; however, milk urea nitrogen was increased during HS regardless of AP supplementation (26% relative to TN). Circulating glucose remained unchanged by HS, AP, or time. Additionally, HS decreased circulating glucagon (29% from d 3 to 7 relative to TN), but there was no additional effect of AP. There was a tendency for nonesterified fatty acid concentrations to be increased in HS-AP cows throughout P2 (60% relative to TN-CON), whereas it remained similar in all other treatments. Blood urea nitrogen increased for both HS treatments from d 1 to 3 before steadily decreasing from d 5 to 7, with the overall increase being most pronounced in HS-CON cows (27% relative to TN-CON). Further, supplementing AP decreased blood urea nitrogen in HS-AP on d 3 relative to HS-CON (15%). Circulating serum amyloid A tended to be and lipopolysaccharide binding protein was increased by HS, but neither acute-phase protein was affected by AP. Overall, AP supplementation appeared to marginally alter metabolism but did not meaningfully alter inflammation during HS.

ANALISIS TEMPERATUR PADA PROSES TERBENTUKNYA BAHAN BAKAR MINYAK (BBM) DENGAN METODE PIROLISIS PADA PROTOTYPE ALAT PENGOLAH LIMBAH PLASTIK MENJADI BBM

The physical properties of plastic waste that is not easily biodegradable is a serious problem in pollution on land and at sea. Therefore, technology to be able to solve these problems needs to be developed. This study aims to understand at what temperature plastic waste can produce fuel oil. The type of waste used in this research is polyethylene terephthalate (PET), which is a type of plastic that uses drink bottles. The design of the device to convert plastic into fuel oil in this study consisted of 3 components, namely a valve which functions to regulate the flow of steam from the reactor tube to the condensate tube, the temperature gauge functions to measure the temperature contained in the reactor tube, and the heat blanket functions as a coating, this can reduce excessive heat in the reactor tube. The results revealed that at a temperature of 100ºC to 150ºC with a variation of time (26.3, 27.3, and 28) minutes did not produce oil. At a temperature of 200ºC to 250ºC with time variations (33, 34, and 35) minutes, the condensate tube begins to produce fuel above the water surface.

The relationship between operation duration and shivering in post-spinal anaesthesia patients

Background: Giving spinal anaesthesia is an effort to relieve pain to create optimal conditions for surgery operation consciously. A shivering event frequently follows the phenomenon of the long duration of the operation. 
 Purpose: The study aimed to determine the relationship between operation duration and shivering in post spinal anaesthesia patients.
 Methods: The study design is a quantitative study and uses a cross-sectional approach. Sampling used a systematic sampling technique on the population of patients undergoing surgery under spinal anaesthesia. The instrument used Croessley and Mahajan’s observation sheet. This study uses Spearman rank rho as the statistical test with a significant value of p=0.05. 
 Results: The study showed almost respondents, as many as 86.15 respondents (56 patients) experienced shivering. Based on the Spearman statistical test, the p-value is 0.046.
 Conclusions: It can be concluded that there was a relationship between operation duration and incidence of shivering. Therefore, to reduce the occurrence of shivering, it is necessary to take measures such as giving warm blankets, warm fluids, and tools to maintain body temperature (force air warming).

Evaluation of Active Warming and Surgical Draping for Perioperative Thermal Support in Laboratory Mice.

Surgical procedures are commonly performed using mice but can have major effects on their core body temperature, including development of hypothermia. In this study, we evaluated active perioperative warming with and without surgical draping with adherent plastic wrap to refine practices, improve animal welfare, and optimize research experiments. Mice were randomized into treatment groups (n = 6; 8 CD1 mice per group). Treatments included placement within a small-animal forced-air incubator at 38 ° C for 30 min before surgery (Pre), after surgery (Post), or before and after surgery (Both). To explore the effect of surgical draping, one group received incubator warming before and after surgery in addition to surgical draping (Both/ Drape), whereas another group received surgical draping only without incubator warming (Control/Drape). The final group of mice received neither warming nor draping (Control). Subcutaneous temperature transponders were placed in all mice. Approximately 5 d after transponder placement, mice were anesthetized with ketamine-xylazine and underwent laparotomy. Subcutaneous body temperatures were collected perioperatively from transponders, and rectal temperatures were taken every minute during surgery. For recovery from anesthesia, mice were placed either in a standard cage on a warm water blanket set to 38 °C (100.4 °F) or in the incubator. Subcutaneous body temperatures were significantly higher in mice prewarmed for 30 min (Pre, Both, Both/Drape) as compared with mice that were not prewarmed. Anesthetic recovery times were significantly longer for mice placed in the incubator (Pre, Post, Both, Both/Drape) than for those that did not receive incubator warming (Control, Control/Drape). Mean intraoperative rectal temperatures of Both/Drape mice tended to be greater than those of mice in the Both group, suggesting a warming benefit of surgical draping. Using a forced air incubator and adherent plastic draping mitigated body temperature loss in mice during both surgery and postoperative recovery.

Rumen-protected methionine during heat stress alters mTOR, insulin signaling, and 1-carbon metabolism protein abundance in liver, and whole-blood transsulfuration pathway genes in Holstein cows

We investigated effects of rumen-protected Met (RPM) during a heat stress (HS) challenge on (1) hepatic abundance of mTOR, insulin, and antioxidant signaling proteins, (2) enzymes in 1-carbon metabolism, and (3) innate immunity. Holstein cows (n = 32; mean ± standard deviation, 184 ± 59 d in milk) were randomly assigned to 1 of 2 environmental groups, and 1 of 2 diets [total mixed ration (TMR) with RPM (Smartamine M; 0.105% dry matter as top-dress) or TMR without (CON); n = 16/diet] in a split-plot crossover design. There were 2 periods with 2 phases. During phase 1 (9 d), all cows were in thermoneutral conditions (TN; temperature-humidity index = 60 ± 3) and fed ad libitum. During phase 2 (9 d), half the cows (n = 8/diet) were exposed to HS using electric heat blankets. The other half (n = 8/diet) remained in TN, but was pair-fed to HS counterparts. After a 14-d washout and 7-d adaptation period, the study was repeated (period 2) and environmental treatments were inverted relative to phase 2, but dietary treatments were the same. Blood was collected on d 6 of each phase 2 to measure immune function and isolate whole-blood RNA. Liver biopsies were performed at the end of each period for cystathione β-synthase (CBS) and methionine adenosyltransferase activity, glutathione concentration, and protein abundance. Data were analyzed using PROC MIXED in SAS. Abundance of CUL3, inhibitor of antioxidant responses, tended to be downregulated by HS suggesting increased oxidative stress. Heat-shock protein 70 abundance was upregulated by HS. Phosphorylated mTOR abundance was greater overall with RPM, suggesting an increase in pathway activity. An environment × diet (E × D) effect was observed for protein kinase B (AKT), whereas there was a tendency for an interaction for phosphorylated AKT. Abundance of AKT was upregulated in CON cows during HS versus TN, this was not observed in RPM cows. For phosphorylated AKT, tissue from HS cows fed CON had greater abundance compared with all other treatments. The same effect was observed for EIF2A (translation initiation) and SLC2A4 (insulin-induced glucose uptake). An E × D effect was observed for INSR due to upregulation in CON cows during HS versus TN cows fed CON or RPM. There was an E × D effect for CBS, with lower activity in RPM versus CON cows during HS. The CON cows tended to have greater CBS during HS versus TN. An E × D effect was observed for methionine adenosyltransferase, with lower activity in RPM versus CON during HS. Although activity increased in CON during HS versus TN, RPM cows tended to have greater activity during TN. Neutrophil and monocyte oxidative burst and monocyte phagocytosis decreased with HS. An (E × D) effect was observed for whole-blood mRNA abundance of CBS, SOD1 and CSAD; RPM led to upregulation during TN versus HS. Regardless of diet, CDO1, CTH, and SOD1 decreased with HS. Although HS increased hepatic HSP70 and seemed to alter antioxidant signaling, feeding RPM may help cows maintain homeostasis in mTOR, insulin signaling, and 1-carbon metabolism. Feeding RPM also may help maintain whole-blood antioxidant response during HS, which is an important aspect of innate immune function.

Combination of Warm Infusion Fluid and Warm Electric Blanket on the Body Temperature of Patients Post-Sectio Caesarea

Sectio Caesarea has various complications during the postoperative period, one of which is a decrease in body temperature, if not handled properly it can cause hypothermia and cause discomfort to the patient. This study aims to determine the effectiveness of the combination of warm infusion fluids and warm electric blankets on the body temperature of post-sectio caesarea patients in the recovery room. This research is a true-experimental study with pretest and post-test with control group design approach. The research sample was divided into 4 groups, each group was given treatment for 60 minutes. The results showed that warm infusion fluids and warm electric blankets were adequate compared to other groups, with p-value = 0.000 (p<0.05). Based on this study, it can be concluded that the combination of warm infusion fluids and warm electric blankets effectively increases the body temperature of post-sectio caesarea patients.

Hydrotherapeutic Heat Application as Support in Febrile Patients: A Scoping Review.

Background: Most often, fever is still treated by lowering body temperature with medication. In complementary and integrative health care, patients are supported during illness to use the positive effects of fever. Accompanying applications from the field of hydrotherapy are often used for gentle cooling, but there are references that warming in fever can also be used as a support. The aim of this scoping review was to identify available evidence on how, when, and why patients with fever are treated with heat application. Methods: The MEDLINE, CINAHL, EMBASE, COCHRANE, Google, and Google Scholar databases as well as references of identified literature were searched. As sources of evidence, publications studying patients who received heat application or were kept warm in febrile condition, regardless of medical situation, type of health care setting, and geographical background, were taken into consideration. Results: The literature search identified 1698 publications, of which only 7 were included. Methods of applying heat were the use of electric warming blankets, hot packs, hot-water bottles, or hot water footbaths. Most of the studies on heat application used temperatures of about 40°C and reported significantly lower body temperature after heat application. Conclusions: The literature suggests that hydrotherapeutic heat application is a common and well-appreciated method in Middle Eastern and Asian regions to support febrile patients. Using heat to support the energy-intensive and uncomfortable phase of rising fever may improve comfort, prevent unnecessarily high fever, and save biological energy. Therefore, high-quality studies on the role of heat application in fever are expected to be of high relevance for future fever management guidelines and integrative health care in general.

Supplemental reflective blankets and wool socks help maintain body temperature in dogs undergoing celiotomy procedures: a prospective randomized controlled clinical trial.

To compare results for body (esophageal) temperature measurements obtained during celiotomy in normothermic (presurgical) canine patients receiving routine heat support versus routine heat support plus supplemental support (consisting of covering the thorax in a reflective blanket and placing reflective blankets plus wool socks on 3 limbs) in a prospective randomized controlled clinical trial. 44 dogs requiring celiotomy that were presented sequentially to an emergency and specialty referral veterinary hospital. The 44 dogs undergoing celiotomy were randomly assigned to 2 groups. The control group received routine intraoperative heat support consisting of a circulating warm water blanket and either a towel or blanket. The supplemental group received the same routine heat support plus a reflective blanket covering the cervical and thoracic regions and reflective blankets wrapped around 3 limbs and covered with wool socks from the digits to the axillary or inguinal region. Mean esophageal temperature for both the control and supplemental groups dropped throughout celiotomy. Esophageal temperature measurements at several time points were significantly higher for the supplemental group than for the control group. The lowest temperature measurement for the supplemental group, adjusted for initial esophageal temperature and procedure duration, was significantly higher by 0.8 °C than that for the control group. Covering the cervical and thoracic regions with a reflective blanket and wrapping limbs in reflective blankets and wool socks is an affordable adjunctive method to provide passive heat support and minimize perioperative hypothermia in canine patients undergoing celiotomy.

Physiological effects of Therapeutic Body Wraps in healthy volunteers: An observational study

IntroductionThe clinical management of severe anxiety is challenging. Along with specific medication, several nonpharmacological treatments exist, among which the Therapeutic Body Wraps (TBW). While TBW is clinically known to be efficient, the absence of objective physiological measurements raised some debates about its harmlessness. AimsThis observational study investigated TBW in healthy volunteers. MethodsMeasurements were done in 26 participants, who experienced TBW, which consisted of tightly wrapping the body in one layer of wet cold sheets and several warm blankets. These were compared to 13 participants, who rested in supine position. ResultsOur results showed increase in the trunk skin temperature by the end of TBW similar to rest. Somatosensory perception as assessed with quantitative sensory testing was stable after both TBW and rest. The heart and breath rates decreased both during TBW and rest. It was accompanied by increase in heart rate variability parameters and decrease in salivary cortisol levels. DiscussionOur data indicate anxiolytic effect of TBW in healthy participants. Implications for practiceThe TBW is harmless and might be used in patients, who are unable to relax by themselves and/or without anxiolytic medication. Further studies are necessary to investigate physiological response to TBW in clinical population.

Study on Thermal Insulation Measures for Construction of Reinforcement Sleeve Grouting Connection in Winter

In this paper, the feasibility of winter construction of steel sleeve grouting connection is studied, and two technical schemes of thermal insulation measures for winter construction are provided. This paper mainly introduces the experimental research work of sleeve grouting by simulating winter construction, including test scheme, test operation flow, test equipment and test data collection and analysis. It is concluded that the thermal insulation measures of prefabricated wall panel covering electric heating blanket, XPS insulation board and sleeve outer wall winding electric companion heat preservation are feasible. Finally, according to the actual project case to verify the feasibility of thermal insulation measures, so that the project can progress smoothly, for similar projects in winter construction to provide reference and reference.

Metaphors and the Transplant Experience

Metaphors and the Transplant Experience Madalina Meirosu Fire and ice. I felt so cold. Every evening, I was shivering, and I had no idea why. I was just a kid, twelve years old, and shivering every [End Page E6] night before going to bed, even though it was warm in the house, even though we had plenty of warm blankets. I hated evenings because the cold was unbearable when the sun went down, and I had no way to escape it. It was emanating from my bones. I no longer mentioned it to the adults because the few times I had spoken of it, teeth chattering, I was just told to get under the blankets. Winter was coming from inside my bones, every evening, and I was freezing, and there was nothing I could do about it. And then, one evening, fire broke out inside my body. It was as if my body had had enough of winter and was conjuring up a volcano—the fever was so high that I was delirious, dreaming of fires and bombardments, and fighting on a battlefield where everything spelled doom. It took doctors a long time to figure out what was wrong. Romania had barely emerged from a bloody revolution in 1990, overthrowing a dictatorial regime, and medical equipment and knowledge were limited. Doctors struggled to make sense of my symptoms and tests, and by the time I was diagnosed with obstructive nephropathy and renal failure a few months later, it was clear that there was nothing to be done for me, at least not in Romania. Or as a famous Romanian kidney specialist told my desperate parents, towering over my bed: there is nothing to be done other than find a burial spot. Cold, again, in my bones, day and night. And now the cold took on a different meaning—the prelude to the cold of an open grave in front of me. My parents did not give up, they could not accept that their child would die so young, and a doctor in the capital city suggested that my situation would have been different had I been able to go abroad. Western Europe had the medical resources to treat me, but it was financially impossible for us to afford it. But my parents did not give up, and eventually, after numerous appeals, a miracle took place, and a teaching hospital abroad agreed to treat me. After a couple of surgeries, I gradually emerged from the winter within. I grew in height dramatically, put on weight, and began to thrive, though the occasional cold shivers in the evening reminded me what the doctors had said: the surgeries were a temporary patch. My remaining kidney had very limited functionality and would give out sooner or later, thereby forcing me to be on dialysis or to have a kidney transplant. Just before my 18th birthday, we began to prepare for the worst. The cold had returned in the evening, this time accompanied by nausea. I was asked if I would like to go ahead with the transplantation—I had been on the transplant list, and though nothing had come available, my father was a match—or if I preferred dialysis. I understood the benefits and advantages of both. I also understood that there would be more chances for a kidney from a post-mortem donation if I were on dialysis. I did not want my father to donate. There was shame and stigma in being chronically ill in Romanian culture, a shame that had been a constant reality for me. Especially in families with uneducated backgrounds, deeply steeped in a poor peasant mentality, being ill meant not being useful or worthy. Disability equaled shame. I did not want that for him. From what I understood, his health and ability could have been impacted after the donation. And I did not want that for me; I preferred to finish high school and deal with whatever health challenges I might have after finishing. My doctors suggested that I reconsider—that it would be better for me to receive the transplant as soon as possible. But I stuck to my plan, and my parents went...

Increased supply of methionine during a heat-stress challenge in lactating holstein cows alters mammary tissue mTOR signaling and its response to lipopolysaccharide.

The first objective was to investigate the effects of feeding rumen-protected methionine (RPM) during a heat stress (HS) challenge on abundance and phosphorylation of mechanistic target of rapamycin (mTOR)-related signaling proteins in mammary gland. The second objective was to investigate how HS and RPM may modulate the response of mammary gland explants to an inflammatory challenge using lipopolysaccharide (LPS). Thirty-two multiparous, lactating Holstein cows (184 ± 59 DIM) were randomly assigned to 1 of 2 environmental treatment groups, and 1 of 2 dietary treatments [TMR with RPM (Smartamine M; Adisseo Inc.; 0.105% DM as top dress) or TMR without RPM (CON)] in a crossover design. There were two periods with two phases per period. In phase 1 (9 d), all cows were in thermoneutral conditions (TN) and fed ad libitum. During phase 2 (9 d), group 1 (n = 16) cows were exposed to HS using electric heat blankets, whereas group 2 cows (n = 16) remained in TN but were pair-fed to HS counterparts to control for DMI decreases associated with HS. After a washout period (14 d), the study was repeated (period 2). Environmental treatments were inverted in period 2 (sequence), whereas dietary treatments remained the same. Mammary tissue was harvested via biopsy at the end of both periods. Tissue was used for protein abundance analysis and also for incubation with 0 or 3 μg/mL of LPS for 2 h and subsequently used for mRNA abundance. Data were analyzed using PROC MIXED in SAS. Analysis of protein abundance data included the effects of diet, environment and their interaction, and period and sequence to account for the crossover design. The explant data model also included the effect of LPS and its interaction with environment and diet. Abundance of phosphorylated mTOR and ratio of phosphorylated eukaryotic translation elongation factor 2 (p-EEF2) to total EEF2 in non-challenged tissue was greater with RPM supplementation (P = 0.04 for both) and in both cases tended to be greater with HS (P = 0.08 for both). Regardless of RPM supplementation, incubation with LPS upregulated mRNA abundance of IL8, IL6, IL1B, CXCL2, TNF, NFKB1, and TLR2 (P < 0.05). An environment × LPS interaction was observed for NFKB1 (P = 0.03); abundance was greater in LPS-treated explants from non-HS compared with HS cows. Abundance of CXCL2, NFKB1, NOS2, NOS1, and SOD2 was lower with HS (P < 0.05). Although LPS did not alter mRNA abundance of the antioxidant transcription factor NFE2L2 (P = 0.59), explants from HS cows had lower abundance of NFE2L2 (P < 0.001) and CUL3 (P = 0.04). Overall, RPM supplementation may alter mTOR activation in mammary tissue. Additionally, although HS reduced explant immune and antioxidant responses, RPM did not attenuate the inflammatory response induced by LPS in vitro.

Role of Non-pharmacological Intervention for Pain Management in Nursing Home Residents During COVID-19: A Systematic Review

Pain experienced by nursing home residents (NHRs) is a significant concern, especially in patients with cognitive impairment. In this group, pain can be revealed through agitation, facial expressions, and altered movements. Palliative care, warm blankets, and peer-led pain management are some of the non-pharmacological management options. Our aim is to explore non-pharmacological interventions used for pain control during the COVID-19 pandemic. Google Scholar and PubMed were utilized to retrieve comprehensive non-pharmacologic pain management studies published between 2020 and 2021. Some targeted studies included randomized controlled, clustered, and clinical trials. The study targeted the general global NHR population. Keywords used: “Pain Management Program”, “nursing home”, “Pain management post-COVID-19”. Seven independent analysts reviewed the study. Eleven studies investigated non-pharmacological interventions in pain management. Five met the inclusion criteria. Two studies assessed peer-led pain management programs (PAPs). The first study found that PAPs improved pain knowledge and skills of peer volunteers in nursing homes. The second study revealed that PAP significantly improved pain self-efficacy, pain inference, and quality of life. Another study showed that visually appealing digital elements such as family photographs and natural sceneries relaxed older adults with chronic pain. Using warm blankets reduced pain and agitation in one study. An improvement in pain and severity complaints, and analgesic use requests was noted. One study revealed the insignificance of palliative care residents’ comfort in the last week of life comparing intervention and control groups. Pain is a symptom often under-reported in nursing homes. Current evidence indicates the potential role of non-pharmacological interventions, mainly utilizing appealing digital devices, warm blankets, and PAP programs. This review found that non-pharmacological interventions increase awareness about pain and increase NHRs’ quality of life during COVID19 pandemic. Further studies are needed to assess effectiveness of non-pharmacological interventions as pain management tools.

Age‐related changes in the control mechanisms for vasomotion in the microcirculation

Ageing causes deterioration in function and structure of the skin microcirculation which has been reported to reflect similar deterioration in the microcirculation of other organs. The deterioration in function has been shown to reduce the total microvascular blood flow. The objective of our study was to determine the extent to which the three main control mechanisms of cutaneous microcirculation i.e., myogenic, neurogenic, and metabolic (endothelium dependent and non‐endothelium dependent) are affected by ageing. We used young (approximately 2 weeks old, n=10) and older (approximately 12 weeks old, n=10) Sprague‐Dawley rats. The animals were sedated, their body temperature maintained at 35 – 37oC with a heating blanket and Laser‐Doppler Flowmetry recorded from the palmar surface of the forepaw. Perfusion analysis was used to estimate the microvascular blood flow within a selected region of the palm, whilst the spectral composition of flowmotion was analyzed with Continuous Wavelet Transform using the Morlet mother wavelet. We used the following published frequency bands for rats for the spectral analysis of the microcirculation: myogenic (0.20 – 0.70 Hz), neurogenic (0.08 – 0.20 Hz), and metabolic control (0.01 – 0.08 Hz). Statistical significance was examined with one‐tailed, two‐sample t‐Test. The weights (in grams) of the young and older rats were 114±6 and 542±11 (mean±SEM). The skin perfusion for the young and older rats were 377±31 and 189±18 (perfusion units) respectively; the difference was significant with p&lt;0.01. The mean amplitudes of the wavelet components for myogenic, neurogenic, and metabolic microvascular control for the young rats were 56.8, 71.6 and, 105.4 respectively, whilst those for the older rats were 30.4, 48.2, and 63.3; the decreases in the values for the older rats were significant (p&lt;0.05). The study demonstrates that aging causes significant impairment of all the three major control mechanisms that influence cutaneous microcirculation. The results provide an approach to investigate interventions that may affect specific control mechanisms of the microcirculation.

Intraoperative Flap Warming: The Novel Use of a Sterile Cardiac Forced Warm Air Blanket for Maintaining Optimal Flap Perfusion

The 2-team approach in major head and neck/reconstructive surgery can occasionally lead to delays between flap harvest and detachment, due to the complexity and length of the ablative procedure. In order to minimize the potential for flap cooling and the adverse impact on microcirculation, active warming can be beneficial. We present an inexpensive, readily available method of active flap warming, that can be easily introduced into practice.

Comparison of two different uses of underbody forced-air warming blankets for the prevention of hypothermia in patients undergoing arthroscopic shoulder surgery: a prospective randomized study

BackgroundForced-air warming (FAW) is an effective method of preventing inadvertent perioperative hypothermia (IPH). However, its warming effects can be influenced by the style and position of the FAW blanket. This study aimed to compare the effects of underbody FAW blankets being placed under or over patients in preventing IPH.MethodsPatients (n=100) undergoing elective arthroscopic shoulder surgery in the lateral decubitus position were randomized into either under body (UB) group or the over body (OB) group (50 per group). The body temperature of the patients was recorded from baseline to the end of anesthesia. The incidences of postoperative hypothermia and shivering were also collected.ResultsA steady decline in the body temperature was observed in both groups up to 60 minutes after the start of FAW. After 60 minutes of warming, the OB group showed a gradual increase in the body temperature. However, the body temperature still decreased in UB group until 75 minutes, with a low of 35.7℃ ± 0.4℃. Then the body temperature increased mildly and reached 35.8℃ ± 0.4℃ at 90 minutes. After 45 minutes of warming, the body temperature between the groups was significantly different (P < 0.05). The incidence of postoperative hypothermia in the UB group was significantly higher than that in the OB group (P = 0.023).ConclusionsThe body temperature was significantly better with the use of underbody FAW blankets placed over patients than with them placed under patients. However, there was not a clinically significant difference in body temperature. The incidence of postoperative hypothermia was much lower in the OB group. Therefore, placing underbody FAW blankets over patients is recommended for the prevention of IPH in patients undergoing arthroscopic shoulder surgery.Trial registrationThis single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 13/1/2021 with the registration number ChiCTR2100042071. It was conducted from 14/1/2021 to 30/10/2021 as a single, blinded trial in Sichuan Provincial Orthopedic Hospital.

Excellent Rectal Temperature Cooling Rates in the Polar Life Pod Consistent With Stationary Tubs.

Several tools exist to reduce rectal temperature (TREC) quickly for patients experiencing exertional heatstroke (EHS). Stationary tubs effectively treat EHS but are bulky and impractical in some situations. More portable cold-water immersion techniques, such as tarp-assisted cooling with oscillation, are gaining popularity because of their benefits (eg, less water needed, portability). The Polar Life Pod (PLP) may be another portable way to reduce TREC, but few researchers have examined its effectiveness. To determine whether the PLP and stationary tub reduced TREC at acceptable or ideal rates, whether TREC cooling rates differed by method, and how participants felt before, during, and after cooling. Randomized crossover study. Laboratory. Thirteen individuals (8 men, 5 women; age = 21 ± 2 years, mass = 73.99 ± 11.24 kg, height = 176.2 ± 11.1 cm). Participants exercised in the heat until TREC was 39.5°C. They immersed themselves in either the PLP (202.7 ± 23.8 L, 3.2 ± 0.6°C) or a stationary tub (567.8 ± 7.6 L, 15.0 ± 0.1°C) until TREC was 38°C. Thermal sensation and environmental symptom questionnaire (ESQ) responses were recorded before, during, and after exercise and cooling. Rectal temperature cooling rates, thermal sensation, and ESQ responses. Participants had similar exercise durations (PLP = 41.6 ± 6.9 minutes, tub = 42.2 ± 9.3 minutes, t12 = 0.5, P = .31), thermal sensation scores (PLP = 7.0 ± 0.5, tub = 7.0 ± 0.5, P > .05), and ESQ scores (PLP = 25 ± 13, tub = 29 ± 14, P > .05) immediately postexercise each day. Although TREC cooling rates were excellent in both conditions, the PLP cooled faster than the stationary tub (PLP = 0.28 ± 0.09°C/min, tub = 0.20 ± 0.09°C/min, t12 = 2.5, P = .01). Thermal sensation in the PLP condition was lower than that in the tub condition halfway through cooling (PLP = 1 ± 1, tub = 2 ± 1, P < .05) and postcooling (PLP = 2 ± 1, tub = 3 ± 1, P < .05). The ESQ scores were higher for PLP than for the stationary tub postcooling (PLP = 25 ± 14, tub = 12 ± 9, P < .05). The PLP and the stationary tub cooled individuals with hyperthermia at ideal rates for treating patients with EHS (ie, >0.16°C/min). The PLP may be an effective tool for treating EHS when limited water volumes and portability are concerns. Clinicians should have rewarming tools and strategies (eg, heating blankets) available to improve patients' comfort after PLP use.

Therapeutic Hyperthermia Is Associated With Improved Survival in Afebrile Critically Ill Patients With Sepsis: A Pilot Randomized Trial.

To test the hypothesis that forced-air warming of critically ill afebrile sepsis patients improves immune function compared to standard temperature management. Single-center, prospective, open-label, randomized controlled trial. One thousand two hundred-bed academic medical center. Eligible patients were mechanically ventilated septic adults with: 1) a diagnosis of sepsis within 48 hours of enrollment; 2) anticipated need for mechanical ventilation of greater than 48 hours; and 3) a maximum temperature less than 38.3°C within the 24 hours prior to enrollment. Primary exclusion criteria included: immunologic diseases, immune-suppressing medications, and any existing condition sensitive to therapeutic hyperthermia (e.g., brain injury). The primary outcome was monocyte human leukocyte antigen (HLA)-DR expression, with secondary outcomes of CD3/CD28-induced interferon gamma (IFN-γ) production, mortality, and 28-day hospital-free days. External warming using a forced-air warming blanket for 48 hours, with a goal temperature 1.5°C above the lowest temperature documented in the previous 24 hours. We enrolled 56 participants in the study. No differences were observed between the groups in HLA-DR expression (692 vs 2,002; p = 0.396) or IFN-γ production (31 vs 69; p = 0.678). Participants allocated to external warming had lower 28-day mortality (18% vs 43%; absolute risk reduction, 25%; 95% CI, 2-48%) and more 28-day hospital-free days (difference, 2.6 d; 95% CI, 0-11.6). Participants randomized to external forced-air warming did not have a difference in HLA-DR expression or IFN-γ production. In this pilot study, however, 28-day mortality was lower in the intervention group. Future research should seek to better elucidate the impact of temperature modulation on immune and nonimmune organ failure pathways in sepsis.

Determining the Effectiveness of Forced-Air Warming Blankets in Maintaining Postoperative Body Temperature: A Randomized Controlled Trial

PurposeThe aim of this study is to determine the effectiveness of forced-air warming blankets in normalizing body temperature in the postoperative period. DesignRandomized controlled trial MethodsThe study sample consisted of patients (N = 67) who underwent lung lobectomy in the Thoracic Surgery Service of a university hospital. Forced-air warming blankets were used in the treatment group and 100% cotton blankets were used in the control group. Patients’ body temperatures were monitored using a tympanic thermometer until it reached 37°C. FindingsThe body temperature of the patients in the treatment group reached 37°C in a shorter time than that of the patients in the control group (52.27 ± 29.79 min and 139.0 ± 81.93 min, respectively; P < .001), and that the perception of comfort of the patients in the treatment and control groups increased (P < .001) after warming. ConclusionsWe recommend that forced-air warming blankets are used for patients undergoing lung lobectomy in order to reach normal body temperature in a shorter time.