scholarly journals 2521 Use of forced air warming devices to induce fever-range hyperthermia in critically ill septic patients

2018 ◽  
Vol 2 (S1) ◽  
pp. 50-50
Author(s):  
Anne M. Drewry ◽  
Enyo A. Ablordeppey ◽  
Marin H. Kollef ◽  
Richard S. Hotchkiss
Keyword(s):  
Heart Rate ◽  
Body Temperature ◽  
Control Group ◽  
Clinical Effects ◽  
Intervention Period ◽  
Secondary Infections ◽  
Forced Air Warming ◽  
Severity Scores ◽  
Forced Air ◽  
Warming Devices

OBJECTIVES/SPECIFIC AIMS: Afebrile septic patients are twice as likely to die and develop nosocomial infections as compared with those with fever; the reason for these differences is unknown. One hypothesis is that elevated temperatures directly boost immunity and inhibit microorganism growth. However, there is little data examining the clinical effects of warming septic patients. The goal of this study was to determine whether warming afebrile septic patients to fever-range hyperthermia with noninvasive forced air warmers is feasible and safe. METHODS/STUDY POPULATION: This is an ongoing randomized trial on afebrile mechanically ventilated patients with severe sepsis. The intervention consisted of 48 hours of external warming with a forced air warming device to a goal core temperature of 1.5°C higher than the lowest recorded temperature within the 24 hours preceding enrollment. Efficacy of the intervention and adverse event data (i.e., increases in heart rate and vasopressor doses) were collected. Clinical outcomes included 28-day mortality and acquisition of secondary infections. RESULTS/ANTICIPATED RESULTS: In total, 18 patients were randomized to the control and warming groups, respectively. Baseline characteristics (including demographics, comorbidities, and illness severity scores) were similar among the 2 groups, except the control group had more males (61% vs. 28%, p=0.04). Median (IQR) body temperature averaged over the 48-hour intervention period was higher in the warming group [38.2 (37.6, 38.6) vs. 37.1 (36.4, 37.4) °C, p<0.001). Patients in the warming group achieved core temperatures above their goal for a median of 37 (IQR 11, 45) hours during the 48-hour intervention period. There were no differences in heart rate or vasopressor dose changes or acquisition of secondary infections between the groups. Eight (44.4%) control patients and 3 (16.7%) warmed patients died by day 28 (p=0.07). DISCUSSION/SIGNIFICANCE OF IMPACT: Externally warming severe septic patients with forced air warming devices effectively raises core body temperature and is safe. Additional research will focus on cellular and immunological changes seen in warmed Versus control patients.

Effects of a Heated Anesthesia Breathing Circuit on Body Temperature in Anesthetized Rhesus Macaques (Macaca mulatta)

2021 ◽  
Author(s):  
Philip A Bowling ◽  
Michael A Bencivenga ◽  
Mary E Leyva ◽  
Briittnee E Grego ◽  
Robin N Cornelius ◽  
...  
Keyword(s):  
Body Temperature ◽  
Rhesus Macaques ◽  
Breathing Circuit ◽  
Body Temperatures ◽  
Intraoperative Complication ◽  
Forced Air Warming ◽  
Initial Drop ◽  
Anesthesia Breathing ◽  
Forced Air ◽  
Warming Devices

This study evaluated the effects of using a heated anesthesia breathing circuit in addition to forced-air warming on bodytemperature in anesthetized rhesus macaques as compared with forced-air warming alone. Hypothermia is a common perianestheticand intraoperative complication that can increase the risk of negative outcomes. Body heat is lost through 4 mechanisms during anesthesia: radiation, conduction, convection, and evaporation. Typical warming methods such as forced-air warming devices, conductive heating pads, and heated surgical tables only influence radiative and conductive mechanisms of heatloss. A commercially available heated breathing circuit that delivers gas warmed to 104 °F can easily be integrated into ananesthesia machine. We hypothesized that heating the inspired anesthetic gas to address the evaporative mechanism of heatloss would result in higher body temperature during anesthesia in rhesus macaques. Body temperatures were measured at 5-min intervals in a group of 10 adult male rhesus macaques during 2 anesthetic events: one with a heated anesthesia breathing circuit in addition to forced-air warming, and one with forced-air warming alone. The addition of a heated breathing circuit had a significant positive effect on perianesthetic body temperature, with a faster return to baseline temperature, earlier nadir of initial drop in body temperature, and higher body temperatures during a 2-h anesthetic procedure. Use of a heated anesthesia breathing circuit should be considered as a significant refinement to thermal support during macaque anesthesia, especially for procedures lasting longer than one hour.

Comparison of Three Intraoperative Patient Warming Systems

2012 ◽  
Vol 48 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Michelle A. Franklin ◽  
Mark C. Rochat ◽  
Mark E. Payton ◽  
Kristyn D. Broaddus ◽  
Kenneth E. Bartels
Keyword(s):  
Clinical Trial ◽  
Body Temperature ◽  
Surgical Procedures ◽  
Circulating Water ◽  
Forced Air Warming ◽  
Warming Blanket ◽  
Significant Temperature ◽  
Forced Air ◽  
Warming Devices ◽  
Over Time

The purpose of this randomized clinical trial was to compare the efficacy of three patient warming devices (i.e., circulating water blanket, forced-air, and warming panels) used either alone or in combination on patients undergoing surgeries lasting &gt;60 min. In total, 238 dogs were included and divided into either the celiotomy or nonceliotomy group. Dogs in each group were further divided into one of three subgroups. Dogs in subgroup 1 (n=39) were placed on a circulating water blanket with a forced-air warming blanket placed over the trunk. Subgroup 2 dogs (n=40) were placed on a forced-air warming blanket only. Subgroup 3 dogs (n=40) were placed on warming panels. Significant temperature drops occurred from time of induction (38.1°C±0.64°C) to the start of surgical procedures (36.7°C±0.95°C). Although body temperature was maintained once the warming units were started in all groups, there were significant differences in temperatures for the type of surgical procedures (i.e., celiotomies versus nonceliotomies) performed over time except for subgroup 3. The warming panels and forced-air devices were equally effective in preserving body temperature in anesthetized patients.

scholarly journals Efficacy and Safety of Forced-Air Warming System versus Passive Warming Measures in Major Surgeries: A Systematic Review

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Wenxi Tang
Keyword(s):  
Body Temperature ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Current Status ◽  
Cochrane Library ◽  
Major Surgery ◽  
Clinical Effects ◽  
Passive Warming ◽  
Forced Air Warming ◽  
Forced Air

Purpose: To compare the clinical impact of forced-air warming system (Bair HuggerTM, BH) and passive warming measures in major surgery patients. Methods: Databases including Pubmed, Cochrane Library, Clinical Trials.Gov and CNKI were searched to collect studies published before January 2019 that were concerned the clinical effects of Bair Hugger. Two reviewers independently screened the literatures, extracted the data. The revised Jadad scale was used to evaluate the methodological quality of the literatures. Meta-analysis was performed by using Review Manager 5.3.0. Findings: A total of 27 studies were included. The result of meta-analysis showed that BH had a significant advantage in rate of hypothermia (RD = -0.42, 95%CI (-0.68, -0.16)) , shivering (RD = -0.28, 95%CI (-0.43, -0.13)), anesthesia recovery time (MD = -8.27, 95% CI (-13.49, -3.05)), hospital stay (MD = -1.27, 95% CI (-2.05) , -0.48)), while incision infection RD = -0.15, 95%CI (-0.40,0.11)) , intraoperative blood loss (MD = -16.88, 95%CI(-34.73,0.96)), intraoperative blood transfusion (MD = -41.49, 95% CI( -108.36, 25.38)) , pain RD = -0.02, 95%CI(-0.08, 0.03)) and other complications (RD = -0.13, 95%CI(-0.39,0.12)) had an advantage but not significant. Subgroup analyses showed that operation mode and operation duration was the sensitive factors. Conclusion: Compared to passive warming, Bair Hugger has significant advantages in hypothermia protection and further reduces the risk of incision chills and prolonged hospital stay. Combined with the current status of body temperature protection in China, it is necessary to enhance the awareness of body temperature protection, standardize medical behavior, and increase the popularity of active warming systems.

Comparison of two forced-air warming devices during foot and ankle surgery: a randomised controlled trial

2020 ◽  
Vol 30 (11) ◽  
pp. 340-344
Author(s):  
Jorge Javier Del Vecchio ◽  
Lucas Nicolás Chemes ◽  
Mauricio Esteban Ghioldi ◽  
Eric Daniel Dealbera ◽  
Pablo Daniel Morgillo
Keyword(s):  
Controlled Trial ◽  
Foot And Ankle ◽  
Air Heating ◽  
Forced Air Warming ◽  
Ankle Surgery ◽  
Forced Air ◽  
Randomised Controlled ◽  
Warming Devices ◽  
Frequent Problem ◽  
Uniform Population

Inadvertent perioperative hypothermia is a frequent problem associated with surgical patients which can have significant consequences during surgery and in the immediate postoperative period. We compared 35 randomised patients using over vs. under body forced air heating. There were no statistically significant differences between some demographic and surgical parameters such as: age, weight, height, body mass index, length of anaesthesia and operation. Statistically significant differences were found between the patient’s admission to the operating room and 30 minutes and the end of the procedure on the under body patients group. This study analyses a uniform population of patients (Foot and Ankle Surgery) previously not studied and supports the use of under body blankets.

Efficacy of Two Methods for Reducing Postbypass Afterdrop

2000 ◽  
Vol 92 (2) ◽  
pp. 447-447 ◽  
Author(s):  
Angela Rajek ◽  
Rainer Lenhardt ◽  
Daniel I. Sessler ◽  
Gabriele Brunner ◽  
Markus Haisjackl ◽  
...  
Keyword(s):  
Sodium Nitroprusside ◽  
Core Temperature ◽  
Heat Content ◽  
Tissue Temperature ◽  
Control Group ◽  
Peripheral Tissues ◽  
The Core ◽  
Forced Air Warming ◽  
Forced Air ◽  
Body Heat

Background Afterdrop, defined as the precipitous reduction in core temperature after cardiopulmonary bypass, results from redistribution of body heat to inadequately warmed peripheral tissues. The authors tested two methods of ameliorating afterdrop: (1) forced-air warming of peripheral tissues and (2) nitroprusside-induced vasodilation. Methods Patients were cooled during cardiopulmonary bypass to approximately 32 degrees C and subsequently rewarmed to a nasopharyngeal temperature near 37 degrees C and a rectal temperature near 36 degrees C. Patients in the forced-air protocol (n = 20) were assigned randomly to forced-air warming or passive insulation on the legs. Active heating started with rewarming while undergoing bypass and was continued for the remainder of surgery. Patients in the nitroprusside protocol (n = 30) were assigned randomly to either a control group or sodium nitroprusside administration. Pump flow during rewarming was maintained at 2.5 l x m(-2) x min(-1) in the control patients and at 3.0 l x m(-2) x min(-1) in those assigned to sodium nitroprusside. Sodium nitroprusside was titrated to maintain a mean arterial pressure near 60 mm Hg. In all cases, a nasopharyngeal probe evaluated core (trunk and head) temperature and heat content. Peripheral compartment (arm and leg) temperature and heat content were estimated using fourth-order regressions and integration over volume from 18 intramuscular needle thermocouples, nine skin temperatures, and "deep" hand and foot temperature. Results In patients warmed with forced air, peripheral tissue temperature was higher at the end of warming and remained higher until the end of surgery. The core temperature afterdrop was reduced from 1.2+/-0.2 degrees C to 0.5+/-0.2 degrees C by forced-air warming. The duration of afterdrop also was reduced, from 50+/-11 to 27+/-14 min. In the nitroprusside group, a rectal temperature of 36 degrees C was reached after 30+/-7 min of rewarming. This was only slightly faster than the 40+/-13 min necessary in the control group. The afterdrop was 0.8+/-0.3 degrees C with nitroprusside and lasted 34+/-10 min which was similar to the 1.1+/-0.3 degrees C afterdrop that lasted 44+/-13 min in the control group. Conclusions Cutaneous warming reduced the core temperature afterdrop by 60%. However, heat-balance data indicate that this reduction resulted primarily because forced-air heating prevented the typical decrease in body heat content after discontinuation of bypass, rather than by reducing redistribution. Nitroprusside administration slightly increased peripheral tissue temperature and heat content at the end of rewarming. However, the core-to-peripheral temperature gradient was low in both groups. Consequently, there was little redistribution in either case.

scholarly journals Heart Rate Variability and Inflammatory Response in Rats With Lipopolysaccharide-Induced Endotoxemia

2015 ◽  
pp. S669-S676 ◽  
Author(s):  
I. ZILA ◽  
D. MOKRA ◽  
J. KOPINCOVA ◽  
M. KOLOMAZNIK ◽  
M. JAVORKA ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Body Temperature ◽  
High Frequency ◽  
Heart Tissue ◽  
Frequency Domain Analysis ◽  
Control Group ◽  
Necrosis Factor Alpha ◽  
Saline Administration ◽  
Tissue Homogenates

The aim of the study was to evaluate short-term heart rate variability (HRV) as an index of cardiac autonomic control in rats with lipopolysaccharide (LPS)-induced endotoxemia. Animals were injected intraperitoneally with LPS (100 µg/kg b.w.) and control group with an equivalent volume of saline. ECG recordings were done before (base) and 60, 120, 180, 240 and 300 min after LPS or saline administration. HRV magnitude was quantified by time and frequency-domain analysis (mean RR interval, SDRR, RMSSD, spectral powers in low (LF) and high frequency (HF) bands. Heart tissue homogenates and plasma were analyzed to determine interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α) and oxidative stress level (TBARS). Administration of lipopolysaccharide was followed by continuous rise in colonic body temperature compared to saline-treated controls. Endotoxemia in rats was accompanied by significant decrease in HRV spectral activity in high-frequency range at maximal body temperature (logHFpower: 1.2±0.5 vs. 1.9±0.6 ms2, P<0.01). Increased IL-6 was found in heart tissue homogenates of LPS rats (8.0±0.6 vs. 26.4±4.8 pg/ml, (P<0.05). In conclusions, reduced HRV in HF band may indicate a decreased parasympathetic activity in LPS-induced endotoxemia as basic characteristics of altered cardiac control during response to endotoxemia.

scholarly journals Induction techniques that reduce redistribution hypothermia: A prospective, randomized, controlled, single blind study.

2019 ◽  
Author(s):  
Jonathan Roth ◽  
Leonard E Braitman ◽  
Lacy H. Hunt
Keyword(s):  
Nitrous Oxide ◽  
Blind Study ◽  
Control Group ◽  
Randomized Controlled ◽  
Forced Air Warming ◽  
The Mean ◽  
Forced Air ◽  
Oxygen Group ◽  
Oxide Group ◽  
Single Blind

Abstract BACKGROUND While much effort has been devoted to correcting intraoperative hypothermia, less attention has been directed to preventing redistribution hypothermia. In this study, we compared three different induction techniques to standard IV propofol inductions (control) in their effect on reducing redistribution hypothermia. METHODS Elective, afebrile patients, age 18 to 55 years, were randomly assigned to one of four groups (n=50 each). Group “INH/100” was induced with 8% sevoflurane in 100% oxygen, Group “INH/50” with 8% sevoflurane in 50% oxygen and 50% nitrous oxide, Group “PROP” with 2.2 mg/kg propofol, and Group “Phnl/PROP” with 2.2 mg/kg propofol immediately preceded by 160 mcg phenylephrine. Patients were maintained with sevoflurane in 50% nitrous oxide and 50% oxygen in addition to opioid narcotic. Forced air warming was used. Core temperatures were recorded every 15 minutes after induction for one hour. (Inhalation inductions only were also studied in patients age >55 years.) RESULTS Compared to control group PROP, the mean temperatures in groups INH/100, INH/50, and Phnl/PROP were higher 15, 30, 45 and 60 minutes after induction (p<0.0001 for all comparisons), averaging between 0.39oC and 0.54oC higher. In group PROP, 60% of patients had at least one temperature below 36.0oC in the first hour whereas only 16% did in each of groups INH/100, INH/50, and Phnl/PROP (p<0.0001 in each group compared to PROP). (Inhalation inductions were also effective in reducing redistribution hypothermia in patients age >55 years.) CONCLUSIONS Inhalation inductions with sevoflurane or prophylactic phenylephrine bolus prior to propofol induction reduced the magnitude of redistribution hypothermia by an average of 0.4 to 0.5°C in patients aged 18 to 55 years. Registered on clinical-trials.gov as NCT02331108, November 20, 2014.

Sign in / Sign up

Export Citation Format

Share Document