Pasientvarming

Warming Update: Next steps in patient warming

Av:: Mölnlycke Health Care, april 11 2014Postet i: Pasientvarming

It is widely known that hypothermia can result from temperature drops that occur during surgical procedures, which can lead to potentially severe health consequences. Highlighting how important patient warming is, how perioperative hypothermia happens, its potential consequences and preventive measures, with an emphasis on prewarming, Mölnlycke Health Care hosted a Warming Update webinar on November 8, 2012, to illustrate how adopting a critical but simple activity (patient warming) can result in cost savings and reduced risk of complications.

Featuring Dr Dan Sessler from the Cleveland Clinic and Dr Johan Raeder from Oslo University Hospital, renowned experts in this field, the webinar aimed to instruct participants on how and why they need to improve patient warming. In addition, Dr Karin Ganlöv presented Mölnlycke Health Care's BARRIER® EasyWarm® solution as one way to combat perioperative hypothermia.

“Importance of patient warming”
Dr Dan Sessler, Cleveland Clinic, Cleveland, Ohio, USA
Dr Sessler started by describing normal thermoregulation and how this is affected by anaesthesia. He described how hypothermia develops during surgery and how quickly it happens. He moved on to discuss the many well-documented complications of inadvertent intraoperative hypothermia; complications increase significantly already at temperatures below 36°C. Inadvertent hypothermia increases the risk of myocardial events, especially myocardial infarctions, increases bleeding and the need for transfusions, triples the risk of surgical wound infections, prolongs the effects action of anaesthetic (and other) drugs, doubles the time in postoperative recovery, prolongs hospitalization and in addition, decreases the patient’s well-being, as it reduces thermal comfort. Dr Sessler’s advice was to monitor core body temperature in all patients undergoing surgery planned to last more than 30 minutes and to maintain normothermia (prewarming helps).

“Prewarming, why and how?”
Dr Johan Raeder, Oslo University Hospital, Ullevål, Oslo, Norway
Dr Raeder described in detail the different phases of inadvertent intraoperative hypothermia, and the conventional approaches in counteracting this development. He also showed that current clinical practice fails to prevent the initial drop in temperature occurring immediately after induction of anaesthesia. Regardless of which warming technique is applied, after induction of anaesthesia, the initial post-induction temperature drop occurs anyway. Dr Raeder continued by describing how we can prevent the rapid initial drop in core body temperature by prewarming the periphery of the patient. He showed evidence from both patients and healthy volunteers. He went on to emphasize the risks of hypothermia. Dr Raeder concluded by emphasizing the risks of hypothermia and by advising the introduction of prewarming as a clinical practice to prevent inadvertent intraoperative hypothermia along with regular patient warming practices.

“BARRIER EasyWarm - a new, innovative patient-warming solution”
Dr Karin Ganlöv, Medical Director, Mölnlycke Health Care
The BARRIER EasyWarm solution is a self-activating warming blanket that generates heat by an exothermic reaction and starts to warm up as soon as it is removed from its outer packaging and comes in contact with air. Since the warming blanket has no additional equipment it can be put on the patient before surgery, i.e. be used for prewarming, and can then stay with the patient both during and after surgery. It is regarded as very easy and quick to set up and use.

Below is a brief video from the event.

 

 

Webinar Q & A: Questions and answers

 

The drop in temperature visualized/brought up in both Dr Sessler’s and Dr Raeder’s presentations seems very large. Is this valid for all types of surgeries? (Sessler and Raeder)

The initial temperature drop (1-1.5°C) happens before surgery starts, and is caused by induction of general anaesthesia. Further drop(s) during surgery will depend upon the type of surgery.

Redistribution hypothermia results from an internal flow of body heat and is thus essentially independent of the type of surgery. It does, though, depend on the patient’s prior thermal environment. Patients who are kept in a warm (or prewarmed) environment will have a low core-to-peripheral tissue temperature gradient and thus little redistribution hypothermia. Patients kept in a cool environment in the hours before surgery will have considerable redistribution hypothermia. Studies of redistribution hypothermia usually try to maximise the effect and thus largely represent the latter circumstance. In “real life” the effect might be somewhat less.

 

Can you repeat the three risks for patient with temperatures that are too low? (Raeder)

  • Increased rate of infection
  • Increased bleeding tendency
  • Increased risk of cardiovascular incidents, especially during recovery (shivering, adrenergic stress)

 

Most guidelines recommend active warming in surgeries lasting more than 30-60 minutes. As we have seen from the data presented here the temperature drop occurs immediately after anaesthesia induction. Shouldn’t all patients be warmed then? (Sessler)

Personally, I warm all surgical patients. The 30-60 minute window was included in guidelines so that clinicians doing very short operations (i.e., a 10-minute D&C) would not be required to warm. Warming patients during the first 30-60 minutes of anaesthesia doesn’t much change core temperature because core temperature is primarily determined by redistribution hypothermia. Nonetheless, warming does transfer heat into the peripheral thermal compartment and increases mean skin temperature. It thus increases postoperative thermal comfort and speeds overall rewarming.

Dr Karin Ganlöv

 

Is there anything specific one should think about when using BARRIER® EasyWarm®? (Ganlöv)

The blanket is very easy to use – you simply open the packaging, unfold the blanket to let it warm up and put the blanket on top of the patient. Here are a few things to consider:

  • It takes half an hour for the blanket to get warm.
  • Don’t fold the blanket.
  • Don’t put pressure on the blanket.
  • Don’t use on patient with impaired peripheral circulation.
  • Monitor the patient’s skin regularly, especially post-op.

Download the full Q&A document.

The live webinar event was held in Leipzig, Germany. Several local meetings featuring local speakers were held across Europe in connection with the live event. Please read on for an article from the local Belgium event, which includes interviews with Dr Sessler and Dr Raeder.

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