Prevalence of hypothermia on admission to recovery room remains high despite a large use of forced-air warming devices: Findings of a non-randomized observational multicenter and pragmatic study on perioperative hypothermia prevalence in France

Autoři: Pascal Alfonsi aff001;  Samir Bekka aff001;  Philippe Aegerter aff002
Působiště autorů: Department of Anesthesiology, Groupe Hospitalier Paris Saint Joseph, Paris, France aff001;  Clinical Research Unit Paris Ile-de-France Ouest (URCPO) and UMR 1168 UVSQ INSERM, Hôpital Ambroise Paré–AP-HP, Boulogne-Billancourt, France aff002
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article



Despite the availability of effective warming systems, the prevalence of hypothermia remains high in patients undergoing surgery. Occurrence of perioperative hypothermia may influence the rate of postoperative complications. Recommendations for the prevention of inadvertent perioperative hypothermia have been developed and are effective to reduce the frequency of perioperative hypothermia when professionals comply with. French Society of Anesthesiology (SFAR) decided to promote guidelines for the prevention of inadvertent hypothermia, and to conduct beforehand a pragmatic assessment of the prevalence of hypothermia in France. The hypothesis was that the rate of hypothermic patients (Tc<36°C) admitted to the RR remains high (around 50%), and that was the consequence of a warming device underutilization and/or was related to the type of health facilities.


An observational, prospective and multi-centric study was conducted in France between October 2014 and May 2016 among patients over 45 years undergoing non-cardiac, non-outpatient surgery with anesthesia lasting >30 minutes in 52 centers. Patients undergoing pulmonary or proctologic surgery and those having non-invasive procedures performed under general anesthesia (for example, digestive endoscopy) were excluded from our study. Patients being operated under plexus anesthesia alone, surgeries involving hemorrhaging or infection, and patients presenting at least one organ failure were also excluded. The primary endpoint was the percentage of patients with a core temperature (Tc) <36°C on admission to the recovery room (RR).


Among 893 subjects (median age 66.9 years), prevalence of hypothermia on admission to the RR was 53.5%. At least one warming system was used for 90.4% of the patients. Identified risk factors for Tc<36°C included age≥70 years (OR = 1.41 [CI95%: 1.02–1.94]), duration of anesthesia from 1 to 2 hours (OR = 1.94 [CI95%: 1.04–3.64]) and a decrease in Tc of >0.5°C between anesthesia induction and surgical incision (OR = 1.82 [CI95%: 1.15–2.89]). Only a combination of pre-warming and intraoperative warming prevented a Tc<36°C (OR = 0.48 [CI95%: 0.24–0.96]).


The prevalence of hypothermia among patients admitted to the RR remains high. Our results suggest that only the combination of pre-warming and intraoperative warming significantly decreases it.

Klíčová slova:

Anesthesia – Anesthesiology monitoring – Digestive system procedures – General anesthesia – Hypothermia – Orthopedic surgery – Surgical and invasive medical procedures – Hypothermic anesthesia


1. Sessler D. Perioperative thermoregulation and heat balance. Lancet. 2016 Jun 25; 387(10038):2655–2664. doi: 10.1016/S0140-6736(15)00981-2 26775126

2. Frank S, Fleisher L, Breslow M, Higgins M, Olson K, Kelly S et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997 Apr 9; 277(14):1127–34. 9087467

3. Sun Z, Honar H, Sessler D, Dalton J, Yang D, Panjasawatwong K et al. Intraoperative core temperature patterns, transfusion requirement, and hospital duration in patients warmed with forced air. Anesthesiology. 2015 Feb; 122(2):276–85. doi: 10.1097/ALN.0000000000000551 25603202

4. Madrid E, Urrútia G, Roqué i Figuls M, Pardo-Hernandez H, Campos J, Paniagua P et al. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Database Syst Rev. 2016 Apr 21; 4: CD009016. doi: 10.1002/14651858.CD009016.pub2 27098439

5. Burns S, Piotrowski K, Caraffa G, Wojnakowski M. Incidence of postoperative hypothermia and the relationship to clinical variables. J Perianesth Nurs. 2010 Oct; 25(5):286–9. doi: 10.1016/j.jopan.2010.07.001 20875882

6. Long K, Tanner E, Frey M, Leitao M, Levine D, Gardner G, et al. Intraoperative hypothermia during primary surgical cytoreduction for advanced ovarian cancer: risk factors and associations with postoperative morbidity. Gynecol Oncol. 2013 Dec; 131(3):525–30. doi: 10.1016/j.ygyno.2013.08.034 24016410

7. Torossian A; TEMMP (Thermoregulation in Europe Monitoring and Managing Patient Temperature) Study Group. Survey on intraoperative temperature management in Europe. Eur J Anaesthesiol. 2007 Aug; 24(8):668–75. doi: 10.1017/S0265021507000191 17425815

8. Abelha F, Castro M, Neves A, Landeiro N, Santos C. Hypothermia in a surgical intensive care unit. BMC Anesthesiol. 2005 Jun 6; 5:7. doi: 10.1186/1471-2253-5-7 15938757

9. Kongsayreepong S, Chaibundit C, Chadpaibool J, Komoltri C, Suraseranivongse S, Suwannanonda P et al. Predictor of core hypothermia and the surgical intensive care unit. Anesth Analg. 2003 Mar; 96(3):826–33. doi: 10.1213/01.ane.0000048822.27698.28 12598269

10. Forbes S, Eskicioglu C, Nathens A, Fenech D, Laflamme C, McLean R et al. Best Practice in General Surgery Committee, University of Toronto. Evidence-based guidelines for prevention of perioperative hypothermia. J Am Coll Surg. 2009 Oct; 209(4):492–503. doi: 10.1016/j.jamcollsurg.2009.07.002 19801323

11. Hooper V, Chard R, Clifford T, Fetzer S, Fossum S, Godden B et al. ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia: second edition. J Perianesth Nurs. 2010 Dec; 25(6):346–65. doi: 10.1016/j.jopan.2010.10.006 21126665

12. Torossian A, Bräuer A, Höcker J, Bein B, Wulf H, Horn E. Preventing inadvertent perioperative hypothermia. Dtsch Arztebl Int. 2015 Mar 6; 112(10):166–72. doi: 10.3238/arztebl.2015.0166 25837741

13. NICE: National Collaborating Centre for Nursing and Supportive Care commissioned by National Institute for Health and Clinical Excellence (NICE). Clinical-Practice-Guideline, the management of inadvertent perioperative hypothermia in adults. Available on

14. Forbes S, Stephen W, Harper W, Loeb M, Smith R, Christoffersen E et al. Implementation of evidence-based practices for surgical site infection prophylaxis: results of a pre- and postintervention study. J Am Coll Surg. 2008 Sep; 207(3):336–41. doi: 10.1016/j.jamcollsurg.2008.03.014 18722937

15. Scott A, Stonemetz J, Wasey J, Johnson D, Rivers R, Koch C et al. Compliance with Surgical Care Improvement Project for Body Temperature Management (SCIP Inf-10) Is Associated with Improved Clinical Outcomes. Anesthesiology. 2015 Jul; 123(1):116–25. doi: 10.1097/ALN.0000000000000681 25909970

16. Niven D, Gaudet J, Laupland K, Mrklas K, Roberts D, Stelfox H. Accuracy of peripheral thermometers for estimating temperature: a systematic review and meta-analysis. Ann Intern Med. 2015 Nov 17;163(10):768–77 doi: 10.7326/M15-1150 26571241

17. Eshraghi Y, Nasr V, Parra-Sanchez I, Van Duren A, Botham M, Santoscoy T et al. An evaluation of a zero-heat-flux cutaneous thermometer in cardiac surgical patients. Anesth Analg. 2014 Sep; 119(3):543–9. doi: 10.1213/ANE.0000000000000319 25045862

18. Dahyot-Fizelier C, Lamarche S, Kerforne T, Bénard T, Giraud B, Bellier R et al. Accuracy of Zero-Heat-Flux Cutaneous Temperature in Intensive Care Adults. Crit Care Med. 2017 Jul; 45(7):e715–e717. doi: 10.1097/CCM.0000000000002317 28410347

19. Iden T, Horn E, Bein B, Böhm R, Beese J, Höcker J. Intraoperative temperature monitoring with zero heat flux technology (3M SpotOn sensor) in comparison with sublingual and nasopharyngeal temperature: An observational study. Eur J Anaesthesiol. 2015 Jun; 32(6):387–91. Erratum in: Eur J Anaesthesiol. 2015 Oct; 32(10):747. doi: 10.1097/EJA.0000000000000232 25693138

20. Douketis J, Spyropoulos A, Kaatz S, Becker R, Caprini J, Dunn A et al. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation. N Engl J Med. 2015 Aug 27; 373(9):823–33. doi: 10.1056/NEJMoa1501035 26095867

21. Horn E, Bein B, Böhm R, Steinfath M, Sahili N, Höcker J. The effect of short time periods of pre-operative warming in the prevention of peri-operative hypothermia. Anaesthesia. 2012 Jun; 67(6):612–7. doi: 10.1111/j.1365-2044.2012.07073.x 22376088

22. Frank S, El-Rahmany H, Cattaneo C, Barnes R. Predictors of hypothermia during spinal anesthesia. Anesthesiology. 2000 May; 92(5):1330–4. doi: 10.1097/00000542-200005000-00022 10781278

23. Yamakage M, Kamada Y, Honma Y, Tsujiguchi N, Namiki A. Predictive variables of hypothermia in the early phase of general anesthesia. Anesth Analg. 2000 Feb; 90(2):456–9. doi: 10.1097/00000539-200002000-00040 10648339

24. Lau L, Hung C, Chan C, Chow B, Chui P, Ho B et al. Anaesthetic clinical indicators in public hospitals providing anaesthetic care in Hong Kong: prospective study. Hong Kong Med J. 2001 Sep; 7(3):251–60. 11590266

25. Vaughan M, Vaughan R, Cork R. Postoperative hypothermia in adults: relationship of age, anesthesia, and shivering to rewarming. Anesth Analg. 1981 Oct; 60(10):746–51. 7197479

26. Sessler D, Rubinstein E, Moayeri A. Physiologic responses to mild perianesthetic hypothermia in humans. Anesthesiology. 1991 Oct;75(4):594–610. doi: 10.1097/00000542-199110000-00009 1928769

27. Connelly L, Cramer E, DeMott Q, Piperno J, Coyne B, Winfield C et al. The Optimal Time and Method for Surgical Prewarming: A Comprehensive Review of the Literature. J Perianesth Nurs. 2017 Jun; 32(3):199–209. doi: 10.1016/j.jopan.2015.11.010 28527547

28. Alfonsi P, Adam F, Passard A, Guignard B, Sessler D, Chauvin M. Nefopam, a nonsedative benzoxazocine analgesic, selectively reduces the shivering threshold in unanesthetized subjects. Anesthesiology. 2004 Jan; 100(1):37–43. doi: 10.1097/00000542-200401000-00010 14695722

29. Wetz A, Perl T, Brandes I, Harden M, Bauer M, Bräuer A. Unexpectedly high incidence of hypothermia before induction of anesthesia in elective surgical patients. J Clin Anesth. 2016 Nov; 34:282–9. doi: 10.1016/j.jclinane.2016.03.065 27687393

30. Sund-Levander M, Forsberg C, Wahren LK. Normal oral, rectal, tympanic and axillary body temperature in adult men and women: a systematic literature review. Scand J Caring Sci. 2002 Jun;16(2):122–8. doi: 10.1046/j.1471-6712.2002.00069.x 12000664

31. Kurz A, Sessler DI, Annadata R, Dechert M, Christensen R, Bjorksten A. Midazolam minimally impairs thermoregulatory control. Anesth Analg. 1995 Aug; 81(2):393–8. doi: 10.1097/00000539-199508000-00032 7618734

Článek vyšel v časopise


2019 Číslo 12
Nejčtenější tento týden