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

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.

Long-term effects of snowmelt timing and climate warming on phenology, growth and reproductive effort of arctic tundra plant species

Arctic regions are particularly affected by rapidly rising temperatures and altered snow regimes. Snowmelt timing depends on spring temperatures and winter snow accumulation. Scenarios for the Arctic include both decreases and increases in snow accumulation. Predictions of future snowmelt timing are thus difficult and experimental evidence for ecological consequences is scarce. In 1995, a long-term factorial experiment was set up in a High Arctic evergreen shrub heath community on Ellesmere Island, Canada. We investigated how snow removal, snow addition and passive warming affected phenology, growth and reproductive effort of the four common tundra plant species <i>Cassiope tetragona</i>, <i>Dryas integrifolia</i>, <i>Luzula arctica</i> and <i>Papaver radicatum</i>. Timing of flowering and seed maturation as well as flower production were more strongly influenced by the combined effects of snowmelt timing and warming in the two shrub species than in the two herbaceous species. Warming effects persisted over the course of the growing season and resulted in increased shrub growth. Moreover, the long-term trend of increasing growth in two species suggests that ambient warming promotes tundra plant growth. Our results confirm the importance of complex interactions between temperature and snowmelt timing in driving species-specific plant responses to climate change in the Arctic.

Cushion bog plant community responses to passive warming in southern Patagonia

Vascular plant-dominated cushion bogs, which are exclusive to the Southern Hemisphere, are highly productive and constitute large sinks for atmospheric carbon dioxide compared to their moss-dominated counterparts around the globe. In this study, we experimentally investigated how a cushion bog plant community responded to elevated surface temperature conditions as they are predicted to occur in a future climate. We conducted the study in a cushion bog dominated by Astelia pumila on Tierra del Fuego, Argentina. We installed a year-round passive warming experiment using semicircular plastic walls that raised average near-surface air temperatures by between 0.4 and 0.7 ∘C (at the 3 of the 10 treatment plots which were equipped with temperature sensors). We focused on characterizing differences in morphological cushion plant traits and in carbon dioxide exchange dynamics using chamber gas flux measurements. We used a mechanistic modeling approach to quantify physiological plant traits and to partition the net carbon dioxide flux into its two components of photosynthesis and total ecosystem respiration. We found that A. pumila reduced its photosynthetic activity under elevated temperatures. At the same time, we observed enhanced respiration which we largely attribute, due to the limited effect of our passive warming on soil temperatures, to an increase in autotrophic respiration. Passively warmed A. pumila cushions sequestered between 55 % and 85 % less carbon dioxide than untreated control cushions over the main growing season. Our results suggest that even moderate future warming under the SSP1-2.6 scenario could decrease the carbon sink function of austral cushion bogs.

Cholinergic Urticaria Associated with Acquired Generalized Hypohidrosis: Two Case Reports and Review of the Literature

Cholinergic urticaria is a relatively common condition defined by itching, redness and whealing induced by exercise and passive warming. In turn, acquired idiopathic generalized anhidrosis is a rare disorder of unknown pathogenesis, characterized by an impairment in total body sweating despite exposure to heat or exercise. We report two cases of this extremely rare association of cholinergic urticaria and acquired generalized hypohidrosis, and briefly review current knowledge with regard to classification, ethiopathogenesis and therapeutic options.

Flowering Phenology Adjustment and Flower Longevity in a South American Alpine Species

Delayed flowering due to later snowmelt and colder temperatures at higher elevations in the alpine are expected to lead to flowering phenological adjustment to prevent decoupling of peak flowering from the warmest time of the year, thereby favoring pollination. However, even if flowering is brought forward in the season at higher elevations, an elevational temperature gap is likely to remain between the high- and low-elevation populations of a species at the time these reach peak flowering on account of the atmospheric reduction in temperature with increasing elevation. The negative effect of this temperature gap on pollination could be compensated by plastically-prolonged flower life spans at higher elevations, increasing the probability of pollination. In a tightly temperature-controlled study, the flowering phenology adjustment and flower longevity compensation hypotheses were investigated in an alpine species in the Andes of central Chile. The snow free period varied from 7 to 8.2 months over 810 m elevation. Temperatures were suitable for growth on 82–98% of the snow free days. Flowering onset was temporally displaced at the rate of 4.6 d per 100 m increase in elevation and flowering was more synchronous at higher elevations. Flowering phenology was adjusted over elevation. The latter was manifest in thermal sums tending to decrease with elevation for population flowering onset, 50% flowering, and peak flowering when the lower thermal limit for growth (TBASE) was held constant over elevation. For TBASE graded over elevation so as to reflect the growing season temperature decline, thermal sums did not vary with elevation, opening the door to a possible elevational decline in the thermal temperature threshold for growth. Potential flower longevity was reduced by passive warming and was more prolonged in natural populations when temperatures were lower, indicating a plastic trait. Pollination rates, as evaluated with the Relative Pollination Rate index (RPR), when weighted for differences in floral abundance over the flowering season, declined with elevation as did fruit set. Contrary to expectation, the life-spans of flowers at higher elevations were not more prolonged and failed to compensate for the elevational decrease in pollination rates. Although strong evidence for phenological adjustment was forthcoming, flower longevity compensation did not occur over Oxalis squamata’s elevational range. Thus, flower longevity compensation is not applicable in all alpine species. Comparison with work conducted several decades ago on the same species in the same area provides valuable clues regarding the effects of climate change on flowering phenology and fitness in the central Chilean alpine where temperatures have been increasing and winter snow accumulation has been declining.

Cushion bog plant community responses to passive warming in southern Patagonia

Vascular plant-dominated cushion bogs, which are exclusive to the southern hemisphere, are highly productive and constitute large sinks for atmospheric carbon dioxide compared to their moss-dominated counterparts around the globe. In this study, we experimentally investigated how a cushion bog plant community responded to elevated surface temperature conditions as they are predicted to occur in a future climate. We conducted the study in a cushion bog dominated by Astelia pumila on Tierra del Fuego, Argentina. We installed a year-round passive warming experiment using semicircular plastic walls that raised average near-surface air temperatures between 0.4 °C and 0.7 °C (n = 3). We focused on characterizing differences in morphological cushion plant traits and in carbon dioxide exchange dynamics using chamber gas flux measurements. We used a mechanistic modeling approach to quantify physiological plant traits and to partition the net carbon dioxide flux into its two components photosynthesis and total ecosystem respiration. We found that A. pumila reduced its photosynthetic activity under elevated temperatures. At the same time, we observed enhanced respiration which we largely attribute, due to the limited effect of our passive warming on soil temperatures, to an increase in autotrophic respiration. Passively warmed A. pumila cushions sequestered between 55 % and 85 % less carbon dioxide than untreated control cushions over the main growing season. These results suggest that future warming could decrease the carbon sink function of austral cushion bogs.

Assessing the Effectiveness of in-situ Active Warming Combined With Open Top Chambers to Study Plant Responses to Climate Change

Temperature manipulation experiments are an effective way for testing plant responses to future climate conditions, especially for predicting shifts in plant phenological events. While passive warming techniques are widely used to elevate temperature in low stature plant communities, active warming has been applied less frequently due to the associated resource requirements. In forest ecosystems, however, active warming is crucial to simulate projected air temperature rises of 3–5 K, especially at the warm (i.e., southern and low elevation) range edges of tree species. Moreover, the warming treatment should be applied to the complete height of the experimental plants, e.g., regenerating trees in the understory. Here, we combined open top chambers (OTCs) with active heat sources, an electric heater (OTC-EH) and warming cables (OTC-WC), and tested the effectiveness of these set-ups to maintain constant temperature differences compared to ambient temperature across 18 m2 plots. This chamber size is needed to grow tree saplings in mixture in forest gaps for 3 to 10 years. With passive warming only, an average temperature increase of approx. 0.4 K as compared to ambient conditions was achieved depending on time of the day and weather conditions. In the actively warmed chambers, average warming exceeded ambient temperatures by 2.5 to 2.8 K and was less variable over time. However, active warming also reduced air humidity by about 15%. These results underline the need to complement passive warming with active warming in order to achieve constant temperature differences appropriate for climate change simulations under all weather conditions in large OTCs. Since we observed considerable horizontal and vertical temperature variation within OTCs with temperature differences of up to 16.9 K, it is essential to measure and report within-plot temperature distribution as well as temporal temperature variation. If temperature distributions within large OTCs are well characterized, they may be incorporated in the experimental design helping to identify non-linear or threshold responses to warming.

Prehospital interventions to prevent hypothermia in trauma patients: a scoping review

Objective: The aim of this review is to map the prehospital rewarming measures used to prevent hypothermia among trauma victims. Background: Hypothermia is responsible for an increase of the mortality and morbidity in trauma victims and its recognition and early treatment are crucial for the victim’s haemodynamic stabilisation. Prehospital interventions are particularly important, especially those that target bleeding control, haemodynamic stability, and safe body temperature. Registered nurses may be pivotal to prevention and minimisation of the dangerous effects of hypothermia. Study design and methods: A scoping review was used to identify articles from several online databases from 2010 to 2018. Studies in English, Spanish, and Portuguese were included. Two reviewers performed data extractions independently. Results: Seven studies were considered eligible for this review: two quantitative research studies, one qualitative research study, and four literature reviews. Rewarming measures can be divided into two main groups: passive rewarming, which includes the use of blankets, positioning the response unit to act as a windbreak, removing the patients’ wet clothes, drying the patient’s body, and increasing the ambient temperature; and active rewarming which includes the use of heating pads, heated oxygen, warmed intravenous fluids, peritoneal irrigation, arteriovenous rewarming, and haemodialysis. Discussion: Active measures reported by the included studies were always used as a complement to the passive measures. Active rewarming produced an increase in core temperature, and passive rewarming was responsible for intrinsic heat-generating mechanisms that will counteract heat loss. Patients receiving passive warming in addition to active warming measures presented a statistically significant increase in body core temperature as well as an improvement in the discomfort caused by cold. Conclusion: Rewarming measures seem to be essential for the prevention of hypothermia and to minimise the discomfort felt by the patient. In many countries registered nurses can play important roles in the prehospital context of trauma victim’s assistance. Greater understanding of these roles is necessary to the development of better practices.