Clinical evidence of prewarming patients.

Transcription

1 3M TM Patient Temperature Solutions Clinical evidence of prewarming patients..

2 Modern perioperative thermal management aims at the prevention of hypothermia during the whole perioperative process to protect the patient from the adverse outcomes associated with hypothermia. Anselm Bräuer, MD PhD Bräuer, A.; Bauer, M.; Modern Perioperative Thermal Management; Hospital Healthcare Europe 2014

3 Prewarming to Prevent Unplanned Hypothermia during General Anaesthesia. Prewarmed vs. non-prewarmed in 68 elective spinal surgery patients. Andrzejowski J, Hoyle J, Eapen G, Turnbull D. Effect of Prewarming on Post-Induction Core Temperature and the Incidence of Inadvertent Perioperative Hypothermia in Patients Undergoing General Anaesthesia. Brit Journal of Anaesth. 2008;101(5): This study of 68 elective spinal surgery patients compared prewarming vs. no prewarming. It indicates that prewarming with forced-air warming can result in a lower occurrence of unintended perioperative hypothermia, and can reduce the decline in core temperature after the induction of general anaesthesia. Indicates prewarming with a forced-air warming gown can: Result in a lower occurrence of unintended perioperative hypothermia. 5 Reduce the decline in core temperature after the induction of general anaesthesia. 5 % hypothermic patients Comparsion of Patient Temperature Non-prewarmed Prewarmed Graph adapted from: Andrzejowski J, et al. Brit Journal of Aneasth. 2008;101(5):

4 Duration of Prewarming and Postoperative Temperatures. Effects of prewarming duration on perioperative hypothermia and post-operative shivering. Horn EP, Bein B, Bohm R, Steinfath M, Sahili N, Hocker J. The Effect of Short Time Periods of Pre-Operative Warming in the Prevention of Peri-operative Hypothermia. Anaesth (6). Prewarming utilising forcedair warming methods is effective at preventing hypothermia perioperatively and shivering postoperatively. 2 Approximately 70% of patients who received passive insulation (no prewarming) experienced hypothermia. 2 Short durations of prewarming at 10 or 20 minutes before anaesthesia induction generally prevents hypothermia. 2

5 Impact of Prewarming during Colorectal Surgery. Intraoperative warming vs. preoperative/intraoperative warming in 141 colorectal surgery patients. Yilmaz M, Popwich D, Halverson A, Mullaghy E, McCarthy R. Impact of Preoperative Warming on Maintenance of Normothermia and Outcome after Colorectal Surgery. Anesth. 2008;109:A880. This study of 141 patients undergoing colorectal surgery indicates that normothermia in PACU patients is achieved more effectively by prewarming versus warming a patient intraoperatively. Additionally, the study finds prewarmed patients had a propensity toward fewer infections and spent less time in the hospital. Normothermia in PACU patients is achieved more effectively by prewarming combined with intraoperative warming versus only using intraoperative warming. 3 Prewarmed patients had a propensity toward fewer infections and spent less time in the hospital. 3 Change in heat content. Temperature ( C) Intraoperative warming (n=82) Preoperative/intraoperative warming (n=60) Graph adapted from: Yilmaz M, et al. Anesth. 2008;109:A880.

6 Surgical Site Infection Rates. Project targeting the reduction of SSIs in total hip and knee arthroplasty patients. 4 Hogenmiller J, et al. APIC Abstracts. June A recent project undertaken by a clinician targeting the reduction of SSIs in patients undergoing total hip and knee arthroplasty. A checklist was created in the facility which included, among other things, warming patients for one half hour before surgery and during surgery using a forced-air warming gown. Implementation and adherence to the checklist which included warming patients, significantly reduced the number of SSIs on THA/TKA patients. 4 A half-hour of warming before surgery and warming during surgery using a forced-air warming gown. Additional components including CHG cloth baths 2x prior to surgery, pre-op nasal antiseptic, antibiotic infusion, and team participation in checklist review at start of surgical instrumentation. # Surgeries THA/TKA Surgeries and Infections Infections THA/TKA Surgeries Graph adapted from: Hogenmiller J, et al. APIC Abstracts. June # Infections

7 Effects of Prewarming Following Anaesthesia Induction. Actively prewarmed vs. passively prewarmed patients. Camus Y, Delva E, Sessler DI, Lienhart A. Pre-Induction Skin-Surface Warming Minimizes Intraoperative Core Hypothermia. J Clinical Anaesthesia. 1995;7: This randomised, prospective study of 16 laparoscopic cholecystectomy patients indicates that 60 minutes of prewarming with forced-air warming can lessen a patient s core temperature drop after anaesthesia induction, and reduce redistribution temperature drop. It also indicates that prewarming is beneficial during shorter duration procedures minutes of prewarming with forced-air warming can lessen a patient s core temperature drop after anaesthesia induction, and reduce redistribution temperature drop. 6 Prewarming is beneficial during shorter duration procedures. 6 Core Temperature ( C) Comparsion of Patient Temperature Passively Prewarmed Group Actively Prewarmed Group Graph adapted from: Camus Y, et al. Journal of Clinical Anaesthesia. 1995;7:

8 Prevention of Intraoperative Hypothermia with Prewarming. Review article on prewarming to prevent intraoperative hypothermia. Kiekkas P, Karga M. Prewarming: Preventing Intraoperative Hypothermia. BJPN. 2005;15(10). Studies show that prewarming before the induction of anaesthesia for at least 30 minutes and up to one hour can: Raise a patient s mean body temperature. 7,8 Prevent or significantly reduce redistribution temperature drop. 7 Help prevent hypothermia and its potential complications. 8

9 Effects of Prewarming and Intraoperative Warming. Prospective, randomised trial of 30 patients undergoing elective abdominal surgery. Vanni SM, Braz JR, Modolo NS, Amorim RB, Rodrigues GR. Preoperative Combined with Intraoperative Skin-Surface Warming Avoids Hypothermia Caused by General Anaesthesia and Surgery. J. Clinical Anaesthesia. 2008;15: This prospective, randomised, blinded study on 30 patients undergoing elective abdominal surgery indicates that combining prewarming with forced-air warming before the induction of anaesthesia followed by intraoperative warming with forced-air warming prevented patients from experiencing hypothermia in surgeries of at least two hours in length. Combining prewarming with forced-air warming before the induction of anaesthesia followed by intraoperative warming with forced-air warming prevented patients from experiencing hypothermia in surgeries of at least two hours in length. 8 Core Temperature ( C) Comparsion of Patient Temperature Prewarming + Intraop Warming: Maintain the warmth already gained while the patient was prewarmed by monitoring temps and adjusting the warming unit in the OR accordingly. Intraop Warming Only: To re-warm following temperature afterdrop requires time and may require maximum operating temperature of warming device. Graph a dapted from: Vanni S., et al. J of Clinical Anaesthesia. 2003; 15:

10 Effect of Prewarming on Regional Anaesthesia. Study evaluated 7 patients receiving no prewarming vs. prewarming with forced-air warming prior to epidural anaesthesia. Glosten B, Hynson J, Sessler DI, McGuire J. Preanesthetic Skin-Surface Warming Reduces Redistribution Hypothermia Caused by Epidural Block. Anesth Analg. 1993;77: This study compared the results of no prewarming vs. prewarming of patients prior to receiving epidural anaesthesia. This study found that a decrease in core temperature or a result of redistribution temperature drop induced by epidural anaesthesia can be prevented by prewarming. Prewarming is beneficial during procedures of shorter duration. Hypothermia as a result of redistribution temperature drop occurs during regional anaesthesia. 9 A decrease in temperature can be prevented by prewarming. 9 Comparsion of Patient Skin Temperature Core Temperature ( C) Non-prewarmed Prewarmed Graph adapted from: Glosten B, et al. Anesth Analg. 1993;77:

11 Perioperative warming with the 3M Bair Paws system results in cost savings 10 Wasfie TJ, Barber KR. Value of Extended Warming in Patients Undergoing Elective Surgery. Int Surg. 2015;100: This RCT of 94 patients compared the rates of hypothermia (<36ºC), patient well-being and the costs of warming for two different groups.10 The standard warming group utilised cotton blankets in pre-op and 3M Bair Hugger forced-air warming blankets from anaesthesia induction through the end of surgery. The extended warming group utilised the 3M Bair Paws system for prewarming, intraoperative warming and PACU recovery until patient discharge. Cost Saving Comparsion 10 The rate of hypothermia was reduced by 48% and intraoperative core temperature drop was minimised with the extended warming group. 10 In addition, patients in the extended warming group had decreased anxiety levels and apprehension with increased patient comfort. 10 Extended warming with the Bair Paws system resulted in an estimated cost savings of $84 per patient versus standard warming processes in this study. 10 Standard Warming Per patient cost for standard warming, linen (cotton blankets and gowns), laundry and linen replacement costs. Extended Warming Per patient cost for extended warming with the 3M Bair Paws system.

12 Prewarming: Temperatures and Length of Time. Effects of prewarming on RTD on 7 healthy male volunteers. Sessler DI, Schroeder M, Merrifield B, Matsukawa T., Cheng C. Optimal Duration and Temperature of Prewarming. Anesth. 1995;82(3): This study of 7 healthy male volunteers indicates that 30 minutes of forced-air warming before induction of anaesthesia, i.e. prewarming, can increase the temperature of the periphery by an amount greater than the amount of heat redistributed from the core during Phase I of anaesthesia. This can prevent core temperature drop that ordinarily follows anesthetic-induced vasodilation. This study indicates that 30 minutes of forced-air prewarming can prevent core temperature drop. Indicates 30 minutes of prewarming with forced-air before anaesthesia can: Increase the temperature of the periphery by an amount greater than the amount of heat redistributed from the core during Phase I of anaesthesia 1 Prevent core temperature drop 1 Kilocalorie (Kcal) Change in heat content. Graph adapted from: Sessler DI, et al. Anesth. 1995;82(3):

13 Summary Prewarming Works. Providing more warmth to the Core. Flexibility of Prewaming. A positive effect on patients. Prewarming can prevent or reduce redistribution temperature drop (RTD) 1,7,9 Prewarming + intraoperative warming can help patients achieve a higher core temperature in PACU 2,3,5,6 Prewarming is beneficial in procedures of shorter duration 2, 6 Prewarming can positively affect patient comfort and satisfaction 10,11,12,13,14

14 References 1. Sessler DI, Schroeder M, Merrifield B, Matsukawa T, Cheng C. Optimal duration and temperature of prewarming. Anesthesiology. 1995;82(3): Horn EP, Bein B, Bohm R, Steinfath M, Sahili N, Hocker J. The Effect of Short Time Periods of Pre-Operative Warming in the Prevention of Peri-operative Hypothermia. Anaesth (6). 3. Yilmaz M, et al. Impact of Preoperative Warming on Maintenance of Normothermia and Outcome after Colorectal Surgery. Anesth. 2008;109:A Hogenmiller J, Hamilton J, Clayman T, Casper B, Sparks K, Cil A, Stanford J, Darby S, Pilsl C, Settles K, Kratz J, DeGarmo S, Williams S, Zinyemba T. Preventing Orthopedic Total Joint Replacement Surgical Site Infections through a Comprehensive Best Practice Bundle/Checklist. Hospital: Truman Medical Center, Kansas City, MO. APIC abstracts, June Andrzejowski J, Hoyle J, Eapen G, Turnbull D. Effect of Prewarming on Post-Induction Core Temperature and the Incidence of Inadvertent Perioperative Hypothermia in Patients Undergoing General Anaesthesia. Brit Journal of Anaesth. 2008;101(5): Camus Y, Delva E, Sessler DI, Lienhart A. Pre-Induction Skin-Surface Warming Minimizes Intraoperative Core Hypothermia. Journal of Clinical Anaesthesia. 1995;7: Kiekkas P, Karga M. Prewarming: Preventing intraoperative hypothermia. BJPN. Vol 15 No 10. October Vanni SM, Braz JR, Modolo NS, Amorim RB, Rodrigues GR. Preoperative Combined with Intraoperative Skin-Surface Warming Avoids Hypothermia Caused by General Anaesthesia and Surgery. Journal of Clinical Anaesthesia. 2003;15: Glosten B, Hynson J, Sessler DI, McGuire J. Preanesthetic Skin-Surface Warming Reduces Redistribution Hypothermia Caused by Epidural Block. Anesth Analg. 1993;77: Wasfie TJ, Barber KR. Value of Extended Warming in Patients Undergoing Elective Surgery. Int Surg. 2015;100: O Brien D, Greenfield ML, et al. Comfort, satisfaction, and anxiolysis in surgical patients using a patient-adjustable comfort warming system: a prospective randomized clinical trial. J Perianesth Nurs. Apr 2010; 25(2): Leeth D, Mamril M, et al. Normothermia and patient comfort: a comparative study in an outpatient surgery setting. J Perianesth Nurs. Jun 2010;25(3): Wagner VD, Byrne MJ, Kolcaba KL. Effects of Comfort Warming on Preoperative Patients. AORN Journal. September 2006:84(3): Ember E. Benson, MN, RN, Diana E. McMillan, PhD, RN, and Bill Ong, MD, FRCPC. AJN May 2012 Vol. 112, No. 5

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