Effect of Active Airway Warming on Body Core Temperature During Adult Liver Transplantation

Han, Seok Joo; Gwak, Mi Sook; Choi, Soo Joo; Kim, M.H.; Ko, Justin Sangwook; Kim, G.S.; Joo, Haemi

doi:10.1016/j.transproceed.2012.05.088

Cited by 15 publications

(22 citation statements)

References 14 publications

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“…Second, the bioreactance signal was still affected by patient body temperatures despite the improvement of the processing algorithm. Transplant recipients face challenging thermal environments and significant intraoperative body core/skin temperature changes during surgery [ 21 , 22 ]. It can be assumed that the changes in underlying body temperatures and the difference between skin and core temperature affected the results of this study.…”

Section: Discussionmentioning

confidence: 99%

Bioreactance Is Not Interchangeable with Thermodilution for Measuring Cardiac Output during Adult Liver Transplantation

et al. 2015

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BackgroundThermodilution technique using a pulmonary artery catheter is widely used for the assessment of cardiac output (CO) in patients undergoing liver transplantation. However, the unclearness of the risk-benefit ratio of this method has led to an interest in less invasive modalities. Thus, we evaluated whether noninvasive bioreactance CO monitoring is interchangeable with thermodilution technique.MethodsNineteen recipients undergoing adult-to-adult living donor liver transplantation were enrolled in this prospective observational study. COs were recorded automatically by the two devices and compared simultaneously at 3-minute intervals. The Bland–Altman plot was used to evaluate the agreement between bioreactance and thermodilution. Clinically acceptable agreement was defined as a percentage error of limits of agreement <30%. The four quadrant plot was used to evaluate concordance between bioreactance and thermodilution. Clinically acceptable concordance was defined as a concordance rate >92%.ResultsA total of 2640 datasets were collected. The mean CO difference between the two techniques was 0.9 l/min, and the 95% limits of agreement were -3.5 l/min and 5.4 l/min with a percentage error of 53.9%. The percentage errors in the dissection, anhepatic, and reperfusion phase were 50.6%, 56.1%, and 53.5%, respectively. The concordance rate between the two techniques was 54.8%.ConclusionBioreactance and thermodilution failed to show acceptable interchangeability in terms of both estimating CO and tracking CO changes in patients undergoing liver transplantation. Thus, the use of bioreactance as an alternative CO monitoring to thermodilution, in spite of its noninvasiveness, would be hard to recommend in these surgical patients.

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Section: Discussionmentioning

confidence: 99%

Bioreactance Is Not Interchangeable with Thermodilution for Measuring Cardiac Output during Adult Liver Transplantation

et al. 2015

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“…Medical records of 220 recipients who underwent elective adult-to-adult living donor liver transplantation between April 2009 and October 2011 were initially screened. Exclusion criteria included autonomic neuropathy, thyroid dysfunction, use of a heated-humidifier during transplantation [5], nonuse of a pulmonary arterial catheter, and induced hypothermia. Sample size (n = 17 for each group) was determined based on our previous study which compared the warming function of an active vs. passive airway humidifier during living donor liver transplantation [5].…”

Section: Methodsmentioning

confidence: 99%

“…Exclusion criteria included autonomic neuropathy, thyroid dysfunction, use of a heated-humidifier during transplantation [5], nonuse of a pulmonary arterial catheter, and induced hypothermia. Sample size (n = 17 for each group) was determined based on our previous study which compared the warming function of an active vs. passive airway humidifier during living donor liver transplantation [5]. Seventeen randomly selected recipients who were given a countercurrent heat exchange fluid warmer (Smiths Medical, Level 1H-1000, Rockland, MA) were matched 1 : 1 with recipients who were given a magnetic induction fluid warmer (Belmont Instrument, Fluid Management system [FMS] 2000, Billerica, MA) with the following factors contributing to the propensity score [10]: age, gender, body mass index, the model for end-stage-liver disease (MELD) score, graft-to-recipient weight ratio and time under anesthesia.…”

Section: Methodsmentioning

confidence: 99%

“…Accordingly, rapid infusion of large volume of fluids and blood products is common during liver transplantation and can significantly decrease body core temperature (BCT) and consequently lead to hypothermia. As hypothermia is known to result in multiple adverse effects including coagulopathy and cardiac arrhythmia [1,2], rapid fluid warming has represented an important part of anesthetic management during liver transplantation [3,4,5]. …”

Section: Introductionmentioning

confidence: 99%

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Comparison of two fluid warming devices for maintaining body core temperature during living donor liver transplantation: Level 1 H-1000 vs. Fluid Management System 2000

Han

Choi

et al. 2014

Korean J Anesthesiol

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BackgroundRapid fluid warming has been a cardinal measure to maintain normothermia during fluid resuscitation of hypovolemic patients. A previous laboratory simulation study with different fluid infusion rates showed that a fluid warmer using magnetic induction is superior to a warmer using countercurrent heat exchange. We tested whether the simulation-based result is translated into the clinical liver transplantation.MethodsTwo hundred twenty recipients who underwent living donor liver transplantation between April 2009 and October 2011 were initially screened. Seventeen recipients given a magnetic induction warmer (FMS2000) were matched 1 : 1 with those given a countercurrent heat exchange warmer (Level-1 H-1000) based on propensity score. Matched variables included age, gender, body mass index, model for end-stage liver disease score, graft size and time under anesthesia. Core temperatures were taken at predetermined time points.Results Level-1 and FMS groups had comparable core temperature throughout the surgery from skin incision, the beginning/end of the anhepatic phase to skin closure. (P = 0.165, repeated measures ANOVA). The degree of core temperature changes within the dissection, anhepatic and postreperfusion phase were also comparable between the two groups. The minimum intraoperative core temperature was also comparable (Level 1, 35.6℃ vs. FMS, 35.4℃, P = 0.122).ConclusionsA countercurrent heat exchange warmer and magnetic induction warmer displayed comparable function regarding the maintenance of core temperature and prevention of hypothermia during living donor liver transplantation. The applicability of the two devices in liver transplantation needs to be evaluated in various populations and clinical settings.

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“…Decreased body temperature after surgery is a well-known outcome in many patients 2,3 , because surgery is an invasive process that can induce a shock effect to the body 4,5 . In addition, the temperature of the body at rest is slightly lower than while active and most surgical suites are air-conditioned and tend to be very cold 3 .…”

Section: Introductionmentioning

confidence: 99%

Influence of Hepatectomy on Body Temperature Change in Rats

Otaki

Abe

Mishima

et al. 2014

Showa Univ J Med Sci

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: Abdominal surgery, especially liver resection and transplantation, increases body temperature during and after surgery, but the precise mechanism s underlying this effect are not well understood. The present study thus sought to investigate this phenomenon using an experimental rat model. Speci c pathogenfree male Sprague-Dawley rats, 5 weeks of age, underwent a two-thirds partial hepatectomy PH , one-third splenectomy, or left kidney resection, and then rectal temperature was measured for 5 consecutive days after surgery. Rectal temperature increased in PH rats to a peak on day 4, but no change in temperature was detected after splenectomy and kidney resection. In the second part of the study, we examined the in uence of gadolinium chloride and interleukin-1 monoclonal antibody IL-1 mAb on the increase in rectal temperature following PH. Treatment of rats with 20 mg / kg gadolinium chrolide or 200 µg IL-1 mAb inhibited the PH-induced increase in rectal temperature and decrease in IL-1 and prostaglandin E2, which act as pyrogens to change the thermoregulatory set point in the hypothalamus. These results suggest that abdominal surgery, especially liver resection, caused an increase in endogenous pyrogen production that results in increased body temperature.

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Effect of Active Airway Warming on Body Core Temperature During Adult Liver Transplantation

Cited by 15 publications

References 14 publications

Bioreactance Is Not Interchangeable with Thermodilution for Measuring Cardiac Output during Adult Liver Transplantation

Bioreactance Is Not Interchangeable with Thermodilution for Measuring Cardiac Output during Adult Liver Transplantation

Comparison of two fluid warming devices for maintaining body core temperature during living donor liver transplantation: Level 1 H-1000 vs. Fluid Management System 2000

Influence of Hepatectomy on Body Temperature Change in Rats

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