Active perioperative patient warming using a self-warming blanket (BARRIER EasyWarm) is superior to passive thermal insulation: a multinational, multicenter, randomized trial - 12/10/16

Doi : 10.1016/j.jclinane.2016.06.030

Alexander Torossian, MD ^a,^{^⁎,}^{^{1
Authors contributed equally to the manuscript.}} : Professor of Anesthesiology, Associate Head of Clinic, Elke Van Gerven, MD ^b,^{^{1
Authors contributed equally to the manuscript.}} : Staff Anesthesiologist, Associate Head of Clinic, Karin Geertsen, MD ^c : Senior Consultant, Bengt Horn, MD ^d : Senior Consultant, Marc Van de Velde, MD ^b : Professor of Anesthesiology, Head of Department, Johan Raeder, MD ^e : Professor in Anesthesiology, Consultant
^a Department of Anesthesiology and Critical Care, University Hospital Marburg and Medical Faculty, Philipps-University of Marburg, Germany
^b Department Cardiovascular Sciences and Department of Anesthesiology, KU Leuven, University Hospitals Leuven, Belgium
^c Department of Operative and Intensive Care, Hallands sjukhus Varberg, Sweden
^d Department of Orthopedics, Aleris Specialistvård, Motala Hospital, Sweden
^e Department of Anesthesiology, Oslo University Hospital and Medical Faculty, University of Oslo, Norway

^⁎Correspondence: Alexander Torossian, MD, Department of Anesthesiology and Critical Care, University Hospital Marburg, Baldinger Str 1, 34033 Marburg, Germany. Tel.: +49 6421 5869864; fax: +49 6421 5866996.Department of Anesthesiology and Critical CareUniversity Hospital MarburgBaldinger Str 1Marburg34033Germany

Abstract

Study Objective

Incidence of inadvertent perioperative hypothermia is still high; therefore, present guidelines advocate “prewarming” for its prevention. Prewarming means preoperative patient skin warming, which minimizes redistribution hypothermia caused by induction of anesthesia. In this study, we compared the new self-warming BARRIER EasyWarm blanket with passive thermal insulation regarding mean perioperative patient core body temperature.

Design

Multinational, multicenter randomized prospective open-label controlled trial.

Setting

Surgical ward, operation room, postanesthesia care unit at 4 European hospitals.

Patients

A total of 246 adult patients, American Society of Anesthesiologists class I to III undergoing elective orthopedic; gynecologic; or ear, nose, and throat surgery scheduled for 30 to 120 minutes under general anesthesia.

Interventions

Patients received warmed hospital cotton blankets (passive thermal insulation, control group) or BARRIER EasyWarm blanket at least 30 minutes before induction of general anesthesia and throughout the perioperative period (intervention group).

Measurements

The primary efficacy outcome was the perioperative mean core body temperature measured by a tympanic infrared thermometer. Secondary outcomes were hypothermia incidence, change in core body temperature, length of stay in postanesthesia care unit, thermal comfort, patient satisfaction, ease of use, and adverse events related to the BARRIER EasyWarm blanket.

Main Results

The BARRIER EasyWarm blanket significantly improved perioperative core body temperature compared with standard hospital blankets (36.5°C, SD 0.4°C, vs 36.3, SD 0.3°C; P<.001). Intraoperatively, in the intervention group, hypothermia incidence was 38% compared with 60% in the control group (P=.001). Postoperatively, the figures were 24% vs 49%, respectively (P=.001). Patients in the intervention group had significantly higher thermal comfort scores, preoperatively and postoperatively. No serious adverse effects were observed in either group.

Conclusions

Perioperative use of the new self-warming blanket improves mean perioperative core body temperature, reduces the incidence of inadvertent perioperative hypothermia, and improves patients' thermal comfort during elective adult surgery.

Il testo completo di questo articolo è disponibile in PDF.

Highlights

•	We compared the new self-warming Barrier® EasyWarm® blanket with passive thermal insulation with regard to perioperative patient body temperature in a multinational randomized clinical trial (n=246).
•	Secondary endpoints were incidence of perioperative hypothermia (<36°C) and patients' comfort level.
•	The Barrier® EasyWarm® blanket improved perioperative patient body temperature compared with standard hospital blankets (p<0.001). Intra- and postoperative incidence of hypothermia was reduced using the new actively warming blanket (p=0.001).
•	Patients' thermal comfort was improved with the Barrier® EasyWarm® blanket without serious adverse effects.
•	The new actively warming blanket seems feasible for prewarming of surgical patients and could be easily integrated in their perioperative clinical pathway.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Perioperative hypothermia, Guideline on surgical patient thermal management, Prewarming, Self-warming blanket

Mappa

Introduction

Materials and methods

Study population and study protocol

Interventions and measurements

Study end points

Patients' assessments

Sample size calculation

Statistical analysis

Results

Patients' temperature measurements

Room temperature interval

Thermal comfort levels and length of stay in PACU

Patient overall hospital satisfaction

Safety outcome

Discussion

Conclusion

☆	Disclosure: The clinical trial was supported by Mölnlycke Health Care AB, Gothenburg, Sweden.

Esportazione

Vol 34

P. 547-554 - novembre 2016 Ritorno al numero

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