Prevention of hypothermia in patients undergoing orthotopic liver transplantation using the humigard® open surgery humidification system: a prospective randomized pilot and feasibility clinical trial

Abstract

BackgroundPerioperative thermal disturbances during orthotopic liver transplantation (OLT) are common. We hypothesized that in patients undergoing OLT the use of a humidified high flow CO2 warming system maintains higher intraoperative temperatures when compared to standardized multimodal strategies to maintain thermoregulatory homeostasis.MethodsWe performed a randomized pilot study in adult patients undergoing primary OLT. Participants were randomized to receive either open wound humidification with a high flow CO2 warming system in addition to standard care (Humidification group) or to standard care alone (Control group). The primary end point was nasopharyngeal core temperature measured 5 min immediately prior to reperfusion of the donor liver (Stage 3 − 5 min). Secondary endpoints included intraoperative PaCO2, minute ventilation and the use of vasoconstrictors.ResultsEleven patients were randomized to each group. Both groups were similar for age, body mass index, MELD, SOFA and APACHE II scores, baseline temperature, and duration of surgery. Immediately prior to reperfusion (Stage 3 − 5 min) the mean (SD) core temperature was higher in the Humidification Group compared to the Control Group: 36.0 °C (0.13) vs. 35.4 °C (0.22), p = 0.028. Repeated measured ANOVA showed that core temperatures over time during the stages of the transplant were higher in the Humidification Group compared to the Control Group (p < 0.0001). There were no significant differences in the ETCO2, PaCO2, minute ventilation, or inotropic support.ConclusionThe humidified high flow CO2 warming system was superior to standardized multimodal strategies in maintaining normothermia in patients undergoing OLT. Use of the device was feasible and did not interfere with any aspects of surgery. A larger study is needed to investigate if the improved thermoregulation observed is associated with improved patient outcomes.Trial registration ACTRN12616001631493. Retrospectively registered 25 November 2016.

Comparison of the WarmCloud and Bair Hugger Warming Devices for the Prevention of Intraoperative Hypothermia in Patients Undergoing Orthotopic Liver Transplantation: A Randomized Clinical Trial

“…Preoperative temperature homeostasis was standardized for all participants as previously reported by our research group. 8 Ambient room temperature was set at 21°C to 22°C using a thermostatic control. Participants were randomized to either the WarmCloud device, or the Bair Hugger device.…”

Perioperative hypothermia in open and laparoscopic colorectal surgery

“…13 During open surgery, significant heat loss occurs with exposure of the abdominal or thoracic cavity to ambient air and downflow from laminar flow air conditioning systems. 16,17 There is a perception that the abdominal or thoracic cavities are less vulnerable to heat loss during laparoscopic surgery. However, minimally invasive surgery (laparoscopic or thoracoscopic), exposes the cavities to insufflation with carbon dioxide (CO 2 ).…”

Effects of Warmed and Humidified CO2 Surgical Site Insufflation in a Novel Experimental Model of Magnetic Compression Colonic Anastomosis

“…The potential beneficial impact of peritoneal insufflation with warmed and humidified CO 2 (WH-CO 2 ) during abdominal surgery has been a matter of debate for decades. Some studies suggest that there is a variety of systemic and local positive effects of WH-CO 2 , including a reduced risk of hypothermia, [1][2][3] reduced postoperative pain, 4 augmented tissue oxygenation, 5 reduced adhesion formation, a reduced risk of peritoneal tumor cell implantation, 6,7 reduced peritoneal desiccation, 8 and a reduced risk of surgical site infections. 2 In a recent experimental study, Marshall et al 5 demonstrated a significant increase in tissue oxygenation induced by the local insufflation of WH-CO 2 in a rodent model of open abdominal surgery.…”