Risk Factors for Hypothermia in EMS-treated Burn Patients

Weaver, Matthew D.; Rittenberger, Jon C.; Patterson, P. Daniel; McEntire, Serina J.; Corcos, A; Ziembicki, Jenny; Hostler, David

doi:10.3109/10903127.2013.864354

Cited by 33 publications

(20 citation statements)

References 25 publications

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“…Clinical variables associated with perioperative hypothermia have differed among studies [ 29 – 31 ]. In this study, major-plus surgery and duration of anesthesia, either 1–2 hours or longer than 2 hours, were significant risk factors in predicting hypothermia, a finding consistent with those of a previous study [ 32 ] but different from others’ findings [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Inadvertent Intraoperative Hypothermia and Its Risk Factors in Patients Undergoing General Anesthesia in Beijing: A Prospective Regional Survey

Xiang²,

Deng

et al. 2015

PLoS ONE

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Background/ObjectiveInadvertent intraoperative hypothermia (core temperature <360 C) is a recognized risk in surgery and has adverse consequences. However, no data about this complication in China are available. Our study aimed to determine the incidence of inadvertent intraoperative hypothermia and its associated risk factors in a sample of Chinese patients.MethodsWe conducted a regional cross-sectional survey in Beijing from August through December, 2013. Eight hundred thirty patients who underwent various operations under general anesthesia were randomly selected from 24 hospitals through a multistage probability sampling. Multivariate logistic regression analyses were applied to explore the risk factors of developing hypothermia.ResultsThe overall incidence of intraoperative hypothermia was high, 39.9%. All patients were warmed passively with surgical sheets or cotton blankets, whereas only 10.7% of patients received active warming with space heaters or electric blankets. Pre-warmed intravenous fluid were administered to 16.9% of patients, and 34.6% of patients had irrigation of wounds with pre-warmed fluid. Active warming (OR = 0.46, 95% CI 0.26–0.81), overweight or obesity (OR = 0.39, 95% CI 0.28–0.56), high baseline core temperature before anesthesia (OR = 0.08, 95% CI 0.04–0.13), and high ambient temperature (OR = 0.89, 95% CI 0.79–0.98) were significant protective factors for hypothermia. In contrast, major-plus operations (OR = 2.00, 95% CI 1.32–3.04), duration of anesthesia (1–2 h) (OR = 3.23, 95% CI 2.19–4.78) and >2 h (OR = 3.44, 95% CI 1.90–6.22,), and intravenous un-warmed fluid (OR = 2.45, 95% CI 1.45–4.12) significantly increased the risk of hypothermia.ConclusionsThe incidence of inadvertent intraoperative hypothermia in Beijing is high, and the rate of active warming of patients during operation is low. Concern for the development of intraoperative hypothermia should be especially high in patients undergoing major operations, requiring long periods of anesthesia, and receiving un-warmed intravenous fluids.

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Section: Discussionmentioning

confidence: 99%

Incidence of Inadvertent Intraoperative Hypothermia and Its Risk Factors in Patients Undergoing General Anesthesia in Beijing: A Prospective Regional Survey

Xiang²,

Deng

et al. 2015

PLoS ONE

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“…This volume overload reported to the time of intervention is potentially the consequence of the dogma of aggressive filling in the burn and the consequence of the automatic administration of a unit of crystalloid to each patient. This should question our practices in terms of volume expansion, especially for patients suffering small burns, from whom capillary leak should not be predominant but hypothermia could happen [31,32]. However, the accuracy of very early fluid resuscitation remain, to our knowledge, a topic of debate.…”

Section: Discussionmentioning

confidence: 99%

Prehospital management of burns requiring specialized burn centre evaluation: a single physician-based emergency medical service experience

Maudet

Pasquier

Pantet

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Emergency medical services regularly encounter severe burns. As standards of care are relatively wellestablished regarding their hospital management, prehospital care is comparatively poorly defined. The aim of this study was to describe burned patients taken care of by our physician-staffed emergency medical service (PEMS). Methods: All patients directly transported by our PEMS to our burn centre between January 2008 and December 2017 were retrospectively enrolled. We specifically addressed three "burn-related" variables: prehospital and hospital burn size estimations, type and volume of infusion and pain assessment and management. We divided patients into two groups for comparison: TBSA < 20% and ≥ 20%. We a priori defined clinically acceptable limits of agreement in the small and large burn group to be ±5% and ± 10%, respectively. Results: We included 86 patients whose median age was 26 years (IQR 12-51). The median prehospital TBSA was 10% (IQR 6-25). The difference between the prehospital and hospital TBSA estimations was outside the limits of agreement at 6.2%. The limits of agreement found in the small and large burn groups were − 5.3, 4.4 and − 10.1, 11, respectively. Crystalloid infusion was reported at a median volume of 0.8 ml/kg/TBSA (IQR 0.3-1.4) during the prehospital phase, which extrapolated over the first 8 h would equal to a median volume of 10.5 ml/kg/TBSA. The median verbal numeric rating scale on scene was 6 (IQR 3-8) and 3 (IQR 2-5) at the hospital (p < 0.001). Systemic analgesia was provided to 61 (71%) patients, predominantly with fentanyl (n = 59; 69%), followed by ketamine (n = 7; 8.1%). The median doses of fentanyl and ketamine were 1.7 mcg/kg (IQR 1-2.6) and 2.1 mg/kg (IQR 0.3-3.2), respectively. Conclusions: We found good agreement in burn size estimations. The quantity of crystalloid infused was higher than the recommended amount, suggesting a potential risk for fluid overload. Most patients benefited from a correct systemic analgesia. These results emphasized the need for dedicated guidelines and decision support aids for the prehospital management of burned patients.

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“…169 Loss of dermal and epidermal tissue leads directly to impaired thermoregulation after a severe burn 170 and this is highlighted by the positive association between burn size and the incidence of hypothermia. 171,172 Most patients with severe burns arrive to hospital hypothermic (<36.0°C). 171 In nonburn trauma patients, hypothermia is considered part of the ''lethal triad'' along with coagulopathy and acidosis, 173 and although no such ''lethal triad'' concept exists in burns management, hypothermia certainly appears to be harmful in burn patients.…”

Section: Wound Cooling and Hypothermiamentioning

confidence: 99%

A Critical Update of the Assessment and Acute Management of Patients with Severe Burns

Lang

Zhao²,

Kim

et al. 2019

Advances in Wound Care

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Burns are debilitating, life threatening, and difficult to assess and manage. Recent advances in assessment and management have occurred since a comprehensive review of the care of patients with severe burns was last published, which may influence research and clinical practice. Recent Advances: Recent advances have occurred in the understanding of burn pathophysiology, which has led to the identification of potential biomarkers of burn severity, such as protein C. There is new evidence about the potential superiority of natural colloids over crystalloids during fluid resuscitation, and new evidence about components of initial and perioperative management, including an improved understanding of pain following burns. Critical Issues: The limitations of the clinical examination highlight the need for imaging and biomarkers to assist in estimations of burn severity. Fluid resuscitation reduces mortality, although there is conjecture over the ideal method. The subsequent perioperative period is associated with significant morbidity and the evidence for preventing and treating pain, infection, and fluid overload while maximizing wound healing potential is described. Future Directions: Promising developments are ongoing in imaging technology, histopathology, biomarkers, and wound healing adjuncts such as hyperbaric oxygen therapy, topical negative pressure therapy, stem cell treatments, and skin substitutes. The greatest benefit from further research on management of patients with burns would most likely be derived from the elucidation of optimal fluid resuscitation protocols, pain management protocols, and surgical techniques from randomized controlled trials.

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Risk Factors for Hypothermia in EMS-treated Burn Patients

Abstract: A substantial proportion of burn patients demonstrate hypothermia at hospital arrival. Risk factors for hypothermia are readily identifiable by prehospital providers. Maintenance of normothermia should be stressed during prehospital care.

Cited by 33 publications

References 25 publications

Incidence of Inadvertent Intraoperative Hypothermia and Its Risk Factors in Patients Undergoing General Anesthesia in Beijing: A Prospective Regional Survey

Incidence of Inadvertent Intraoperative Hypothermia and Its Risk Factors in Patients Undergoing General Anesthesia in Beijing: A Prospective Regional Survey

Prehospital management of burns requiring specialized burn centre evaluation: a single physician-based emergency medical service experience

A Critical Update of the Assessment and Acute Management of Patients with Severe Burns

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