Intraoperative Core Temperature Patterns, Transfusion Requirement, and Hospital Duration in Patients Warmed with Forced Air

Abstract

Background Core temperature patterns in patients warmed with forced-air remain poorly characterized. Also unknown is the extent to which transient and mild intraoperative hypothermia contributes to adverse outcomes in broad populations. Methods We evaluated esophageal (core) temperatures in 58,814 adults having surgery lasting >60 min who were warmed with forced air. Independent associations between hypothermic exposure and transfusion requirement and duration of hospitalization was evaluated. Results In every percentile subgroup, core temperature decreased during the first hour and subsequently increased. The mean lowest core temperature during the first hour was 35.7 ± 0.6°C. Sixty-four percent of the patients reached a core temperature threshold of <36°C 45 min after induction; 29% reached a core temperature threshold of <35.5°C. Nearly half the patients had continuous core temperatures <36°C for more than an hour, and 20% of the patients were <35.5°C for more than an hour. Twenty percent of patients had continuous core temperatures <36°C for more than 2 h, and 8% of the patients were below 35.5°C for more than 2 h. Hypothermia was independently associated with both transfusion and duration of hospitalization, although prolongation of hospitalization was small. Conclusions Even in actively warmed patients, hypothermia is routine in the first hour of anesthesia. Thereafter, average core temperatures progressively increase. Nonetheless, intraoperative hypothermia was common, and often prolonged. Hypothermia was associated with increased transfusion requirement which is consistent with numerous randomized trials.

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“…Likewise, the US Institute for Healthcare Improvement suggests the use of active methods to maintain normothermia in surgical patients . However, even when active warming techniques are used, perioperative hypothermia is common . This meta‐analysis demonstrates a benefit with the use of warmed, humidified CO 2 , with an overall effect size of +0.3°C.…”

Intravascular temperature management of a patient undergoing pancreatic head resection

“…1), which is likely to be of higher importance than the mere determination of core temperature at suture time [1]. 1), which is likely to be of higher importance than the mere determination of core temperature at suture time [1].…”

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