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
doi: 10.1371/journal.pone.0226038

Souhrn

Background

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.

Methods

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).

Results

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]).

Conclusions

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


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