|
1
|
Carvalho I, Carvalho M, Abelha F, Martins T. Effectiveness of a new thermal insulation blanket in the control of inadvertent perioperative hypothermia and comfort: a randomized controlled trial. BMC Anesthesiol 2024; 24:455. [PMID: 39695930 DOI: 10.1186/s12871-024-02830-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 11/21/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Disturbances in the thermoregulatory system can precipitate inadvertent hypothermia in patients undergoing surgeries lasting over 60 min, causing serious complications in the recovery process. Cutaneous thermal protection is relevant for the control of temperature of patients in the perioperative setting. The standard thermal protection widely utilized is an electric forced warm air blanket. This study compared a new layered textile blanket with the standard protection. The hypothesis posited that the textile blanket could provide cutaneous thermal protection comparable to that of the standard protection (forced-air warming blanket), in terms of temperature variation and safety. METHODS This randomized controlled trial was conducted at a Portuguese orthopedic hospital from October 2018 to January 2019, comprising 124 adult patients undergoing elective total knee arthroplasty. Participants were randomly allocated to either the intervention group, receiving the textile blanket, or to the control group, receiving standard measures. Tympanic temperature, shivering, and thermal comfort perception were evaluated at six time points. Comfort dimensions and ergonomic aspects were also assessed. Parametric statistics were performed, and independent samples t-tests and repeated measures were used to compare temperature variations and thermal comfort. RESULTS No statistically significant differences were found between groups in mean temperature variation, visual perception of thermal comfort, and thermal and perioperative comfort scales. The intervention group (n = 65) scored significantly higher in ergonomic evaluations compared to the control group (n = 59) for: fit to body and general comfort (p = 0.004), touch (p = 0.005), and feeling of comfort with the inner layer texture and shape (p < 0.001). CONCLUSION The tested blanket had a comparable performance to the standard protection, suggesting it as a potential sustainable alternative to the recommended measures for thermal protection. However, further investigations across diverse contexts and populations are needed to validate these findings.
Collapse
Affiliation(s)
| | - Miguel Carvalho
- Department of Textile Engineering, University of Minho, Braga, Portugal
| | - Fernando Abelha
- Department Hospital S. João, Porto, Medical Sciences Faculty, University of Porto, Porto, Portugal
| | - Teresa Martins
- Escola Superior de Enfermagem do Porto, CINTESIS@RISE, Rua Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal.
| |
Collapse
|
|
2
|
Ribero L, Santía MC, Borchardt K, Zabaneh F, Beck A, Sadhu A, Edwards K, Harrelson M, Pinales-Rodriguez A, Yates EM, Ramirez PT. Surgical site infection prevention bundle in gynecology oncology surgery: a key element in the implementation of an enhanced recovery after surgery (ERAS) program. Int J Gynecol Cancer 2024; 34:1445-1453. [PMID: 38876786 DOI: 10.1136/ijgc-2024-005423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
Surgical site infection rates are among 5-35% in all gynecologic oncology procedures. Such infections lead to increased patient morbidity, reduction in quality of life, higher likelihood of readmissions, and reinterventions, which contribute directly to mortality and increase in health-related costs. Some of these are potentially preventable by applying evidence-based strategies in the peri-operative patient setting. The objective of this review is to provide recommendations for the individual components that most commonly comprise the surgical site infection prevention bundles that could be implemented in gynecologic oncology procedures. We searched articles from relevant publications with specific topics related to each surgical site infection intervention chosen to be reviewed. Studies on each topic were selected with an emphasis on meta-analyses, systematic reviews, randomized control studies, non-randomized controlled studies, reviews, clinical practice guidelines, and case series. Data synthesis was done through content and thematic analysis to identify key themes in the included studies. This review intends to serve as the most up-to-date frame of evidence-based peri-operative care in our specialty and could serve as the first initiative to introduce an enhanced recovery after surgery (ERAS) program.
Collapse
Affiliation(s)
- Lucia Ribero
- Division of Gynecologic Surgery, European Institute of Oncology, Milan, Italy
| | - María Clara Santía
- Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
| | - Kathleen Borchardt
- Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
| | - Firaz Zabaneh
- Department of System Infection Control, Houston Methodist Hospital, Houston, Texas, USA
| | - Amanda Beck
- Department of Pharmacy, Houston Methodist Hospital, Houston, Texas, USA
| | - Archana Sadhu
- Department of Endocrinology, Houston Methodist Hospital, Houston, Texas, USA
| | - Karen Edwards
- Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
| | - Monica Harrelson
- Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
| | - Aimee Pinales-Rodriguez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
| | - Elise Mann Yates
- Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
| | - Pedro T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
| |
Collapse
|
|
3
|
Bretherton D, Baker L, Eftekhar B. Optimal Temperature of Irrigation Fluid for Hemostasis in Neurosurgery: A Narrative Literature Review. J Neurol Surg A Cent Eur Neurosurg 2024; 85:405-411. [PMID: 37595630 DOI: 10.1055/a-2156-5285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
BACKGROUND Hemostasis in neurosurgery is crucial to patient and surgery outcomes, with many techniques developed for this. One area that is not appropriately characterized despite continuous anecdotal evidence the temperature of the irrigation fluid (IF) used and its effects on stemming hemorrhages. Given the ubiquitous use of IF in neurosurgery for clearing blood from the surgical field, it is important to explore its role as a hemostat and whether or not the temperature of the IF influences its hemostatic capacity. This review explored the literature for an optimal IF temperature for hemostasis in neurosurgery. METHODS Database searches were conducted using MEDLINE, Scopus, Web of Science, and CINAHL, with citation chaining occurring where applicable. Standard terms around neurosurgery, hemostasis, and irrigation were used. RESULTS Seven articles were identified. No optimal temperature for hemostasis could be confidently synthesized from the literature owing to lack of primary investigation on the subject. After collating available information into common themes, it is suggested that that temperatures >38°C are preferred. CONCLUSION The literature in this area is limited. Despite a lack of applicable systematic investigation on the topic, by exploring the physiology of hemostasis and IF, best practice guidelines for IF, and the literature on the role of the temperature of IF in other surgical specialties, it is suggested that a temperature in the range of 38 to 40°C would be most applicable to a value optimal for neurosurgery.
Collapse
Affiliation(s)
- Dylan Bretherton
- Department of Neurosurgery, The University of Sydney, Sydney, New South Wales, Australia
| | - Lucy Baker
- Department of Neurosurgery, The University of Sydney, Sydney, New South Wales, Australia
| | - Behzad Eftekhar
- Department of Neurosurgery, The University of Sydney, Sydney, New South Wales, Australia
- Department of Neurosurgery, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
|
4
|
Liu QY, You TY, Zhang DY, Wang J. Clinical application of multidisciplinary team- and evidence-based practice project in gynecological patients with perioperative hypothermia. World J Psychiatry 2023; 13:848-861. [DOI: 10.5498/wjp.v13.i11.848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/04/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Perioperative hypothermia (PH) negatively affects the physical and mental health of patients to varying degrees. Currently, there is no effective multidisciplinary team (MDT) intervention for gynecological patients with PH.
AIM To apply the best evidence on the prevention and management of PH in gynecological patients, improve the quality of perioperative evidence-based care based on treatment by an MDT for gynecological patients and analyze the effect of MDT- and evidence-based practice (EBP) projects on the psychological status and cognitive function of gynecological patients with PH.
METHODS Under the guidance of knowledge translation and combined with the opinions of involved stakeholders and clinical experts, the best evidence for PH prevention and management in gynecological patients was selected and adjusted to suit the practice setting. Based on the evidence, the practice plan was developed, and the MDT intervention was carried out in the preoperative ward, the preoperative preparation room, the intraoperative operating room, the postanesthesia care unit, and the 24-hour postoperative gynecological ward through the EBP program. The incidence of hypothermia, the nurses’ awareness, the implementation rate of examination indicators, and the thermal comfort level, psychological status and cognitive function of patients were compared before and after the implementation of the program.
RESULTS The incidence of PH in gynecological patients decreased from 43.33% to 13.33% after the implementation of the scheme. The implementation rate of examination indicators 6-10, 12, 14, 16-18, 21, and 22 reached 100%, and that of other indicators was above 90%, except for examination indicators 5 and 13, which was 66.67%; the indices were significantly improved compared with the baseline (before evidence application) (P < 0.05). The score of nurses' awareness of PH prevention and management in gynecological patients increased from 60.96 ± 9.70 to 88.08 ± 8.96, and the difference was statistically significant (P < 0.001). The total score of the perioperative thermal comfort level of patients undergoing gynecological surgery was 27.97 ± 2.04, which was significantly increased compared with the score of 21.27 ± 1.57 observed by researchers at baseline (P < 0.001). The perioperative Hamilton Depression Scale and Hamilton Anxiety Scale scores of patients undergoing gynecological surgery decreased from 15.03 ± 3.16 and 13.93 ± 2.64 to 4.30 ± 1.15 and 3.53 ± 0.78, respectively, with statistically significant differences (P < 0.001). The perioperative Montreal Cognitive Assessment Scale score of the gynecological surgery patients increased from 23.17 ± 1.68 to 26.93 ± 1.11, also with statistical significance (P < 0.001).
CONCLUSION MDT-based EBP for PH prevention and management in gynecological patients during the perioperative period can standardize nursing operations, improve nurses' awareness and behavioral compliance with gynecological hypothermia management, and reduce the occurrence of PH in gynecological patients while playing a positive role in reducing patients’ negative emotions and enhancing their cognitive function.
Collapse
Affiliation(s)
- Qing-Yan Liu
- The Operating Room, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Tong-Yang You
- The Operating Room, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Dai-Ying Zhang
- The Operating Room, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Juan Wang
- The Operating Room, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| |
Collapse
|
|
5
|
Carvalho I, Carvalho M, Fontes L, Martins T, Abelha F. Development of a perioperative thermal insulation system: Testing comfort properties for different textile sets. PLoS One 2023; 18:e0291424. [PMID: 37699056 PMCID: PMC10497167 DOI: 10.1371/journal.pone.0291424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
The poorly physical and psychological conditions of the patients make the body thermal protection crucial in the perioperative context, due to the risk of hypothermia. The lack of evidence regarding the effectiveness of textile coverings in protecting patients in the operating room, underscores the recommendation of the forced warming system using non-woven fabric for ensuring the best thermal protection in the perioperative context. This study is part of a development process of a three-layered thermal insulation system, a blanket for use in the perioperative context. After previous selection of two fabrics for the mid and outer layers, in this study three fabric samples for the inner layer with same soft tactile sensation and different textile compositions were tested to find its effect on increasing the thermal insulation of the whole set, using a thermal manikin. The serial method was used to calculate the thermal insulation properties of the sets. The best thermal insulation and thermal comfort performance was obtained by the set using an inner layer composed of polypropylene, polyamide, and elastane whose results were the highest thermal conductivity and thickness and the lowest maximum stationary heat flow density. The results indicated that this fabric influenced positively the values of the whole set once increased its thermal protection effectiveness when compared to the other tested sets. This set is more suitable for future testing in patients during their stay in the perioperative setting.
Collapse
Affiliation(s)
- Isaura Carvalho
- Department of Operating Room, Hospital da Prelada, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS@RISE) Porto, Porto, Portugal
| | - Miguel Carvalho
- Department of Textile Engineering, University of Minho, Guimarães, Portugal
| | - Liliana Fontes
- Department of Textile Engineering, University of Minho, Guimarães, Portugal
| | - Teresa Martins
- Center for Health Technology and Services Research (CINTESIS@RISE) Porto, Porto, Portugal
- Escola Superior de Enfermagem do Porto, Porto, Portugal
| | - Fernando Abelha
- Medical Faculty University of Porto, Porto, Portugal
- Director of the Anesthesiology Service, Centro Hospitalar Universitário S. João, Porto, Portugal
| |
Collapse
|
|
6
|
Hara K, Kuroda H, Matsuura E, Ishimatsu Y, Honda S, Takeshita H, Sawai T. Underbody blankets have a higher heating effect than overbody blankets in lithotomy position endoscopic surgery under general anesthesia: a randomized trial. Surg Endosc 2022; 36:670-678. [PMID: 33512629 PMCID: PMC7845577 DOI: 10.1007/s00464-021-08335-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/13/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgery under general anesthesia results in temperature decrease due to the effect of anesthetics and peripheral vasodilation on thermoregulatory centers. Perioperative temperature control is therefore an issue of high importance. In this study, we aimed to compare the warming effect of underbody and overbody blankets in patients undergoing surgery in the lithotomy position under general anesthesia. METHODS From September 2018 to October 2019, 99 patients undergoing surgery for colorectal cancer in the lithotomy position were included in this randomized controlled trial and assigned to the intervention group (underbody blanket) or control group (overbody blanket). RESULTS The central temperature was significantly higher in the underbody blanket group than in the overbody blanket group at 90 min after the beginning of the surgery (p = 0.02); also in this group, the peripheral temperature was significantly higher 60 min after the beginning of the surgery (p = 0.02). Regarding postoperative factors, the underbody blanket group had a significantly lower frequency of postoperative shivering (p < 0.01) and a significantly shorter postoperative hospital stay (p = 0.04) than the overbody blanket group. CONCLUSIONS We recommend the use of underbody blankets for intraoperative temperature control in patients undergoing surgery in the lithotomy position under general anesthesia. Underbody blankets showed improved rise and maintenance of central and peripheral temperature, decreased the incidence of postoperative shivering, and shortened the postoperative length of hospital stay.
Collapse
Affiliation(s)
- Kentaro Hara
- Department of Operation Center, National Hospital Organization Nagasaki Medical Center, Kubara 2-1001-1, Omura, Nagasaki, 856-8562, Japan.
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8523, Japan.
| | - Hiromi Kuroda
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8523, Japan
| | - Emi Matsuura
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8523, Japan
| | - Yuji Ishimatsu
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8523, Japan
| | - Sumihisa Honda
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8523, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, 856-8562, Japan
| | - Terumitsu Sawai
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8523, Japan
| |
Collapse
|
|
7
|
Steyn F, Du Toit L, Naidoo T, Hofmeyr R. A descriptive study of the relationship between preoperative body temperature and intraoperative core temperature change in adults under general anaesthesia. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.6.2600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- F Steyn
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, and Groote Schuur Hospital, Cape Town,
South Africa
| | - L Du Toit
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, and Groote Schuur Hospital, Cape Town,
South Africa
| | - T Naidoo
- Statistical Consulting Services, University of Cape Town,
South Africa
| | - R Hofmeyr
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, and Groote Schuur Hospital, Cape Town,
South Africa
| |
Collapse
|
|
8
|
Honkavuo L, Loe SAK. Nurse Anesthetists' and Operating Theater Nurses' Experiences with Inadvertent Hypothermia in Clinical Perioperative Nursing Care. J Perianesth Nurs 2020; 35:676-681. [PMID: 32605863 DOI: 10.1016/j.jopan.2020.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To deepen the understanding of and describe nurse anesthetists' and operating theater nurses' experiences with inadvertent hypothermia in clinical perioperative nursing care. DESIGN Qualitative, explorative, and descriptive study that carries an inductive nature. METHODS Focus group interviews with 16 nurse anesthetists and operating theater nurses from four hospitals in Norway. Gadamer's hermeneutics has guided the study's interpretation. FINDINGS Taking the temperature and measures against inadvertent hypothermia perioperatively are not always systematically implemented. In the data material, three thematic units emerged: routines and habits, the culture of the perioperative unit, and silent suffering. CONCLUSIONS Complications caused by inadvertent hypothermia in surgical patients can lead to unnecessary suffering and prolong the hospital stay. The surgical team's cooperation and responsibility are linked to routine nursing interventions. These depend on the nurses' knowledge and experience as well as their clinical and subjective assessment of the patient's physical condition and the surgical techniques used.
Collapse
Affiliation(s)
- Leena Honkavuo
- Department of Caring Science, Faculty of Educational and Welfare Studies, Åbo Akademi University, Vasa, Finland.
| | | |
Collapse
|
|
9
|
Rodriguez-Diaz JM, Hayes GM, Boesch J, Martin-Flores M, Sumner JP, Hayashi K, Ma E, Todhunter RJ. Decreased incidence of perioperative inadvertent hypothermia and faster anesthesia recovery with increased environmental temperature: A nonrandomized controlled study. Vet Surg 2020; 49:256-264. [PMID: 31617950 DOI: 10.1111/vsu.13328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/09/2019] [Accepted: 09/02/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine perioperative inadvertent hypothermia (PIH) incidence, risk factors, prevention methods, and effect of PIH prevention on anesthesia recovery times. STUDY DESIGN Nonrandomized controlled before-and-after trial. ANIMALS Dogs (n = 277) and cats (n = 20) undergoing open surgery. METHODS Incidence and risk factors for PIH (core temperature <96.8°F), existing thermal care practices, and recovery times were documented at baseline. For group 1, a thermal care bundle consisting of protocol-driven active warming combined with raised environmental temperatures (75°F) in induction rooms (IR) and operating rooms (OR) was implemented. Perioperative inadvertent hypothermia incidence and recovery times were recorded. For group 2, baseline active warming practices were resumed while environmental temperatures remained elevated. RESULTS Perioperative inadvertent hypothermia was associated with preoperative imaging (P = .039) and percentage clip area (P = .037). Perioperative inadvertent hypothermia decreased in group 1 (13.5%, n = 96, P < .001) and group 2 (13.0%, n = 100, P < .001) compared with baseline (35.6%, n = 101). Median time from anesthesia withdrawal to extubation decreased in group 1 (5 minutes, P = .028) and group 2 (5 minutes, P = .018) compared with baseline (7 minutes). Median time from anesthesia recovery to spontaneous food intake decreased in group 1 (6 hours, n = 92, P = .016) but not in group 2 (6.0 hours, n = 88, P = .060) compared with baseline (n = 94, 6.7 hours). No group differences in PIH risk factors were identified. CONCLUSION Perioperative inadvertent hypothermia incidence was high but reducible by raising environmental temperatures alone or in combination with increased focus on active warming. Reductions in PIH shortened recovery times. CLINICAL SIGNIFICANCE Maintaining IR and OR temperatures at the standard-of-care for human pediatric surgery reduces PIH and may improve outcomes.
Collapse
Affiliation(s)
| | - Galina M Hayes
- Section of Small Animal Surgery, Cornell University College of Veterinary Medicine, Ithaca, New York
| | - Jordyn Boesch
- Section of Anesthesiology and Pain Medicine, Cornell University College of Veterinary Medicine, Ithaca, New York
| | - Manuel Martin-Flores
- Section of Anesthesiology and Pain Medicine, Cornell University College of Veterinary Medicine, Ithaca, New York
| | - Julia P Sumner
- Section of Small Animal Surgery, Cornell University College of Veterinary Medicine, Ithaca, New York
| | - Kei Hayashi
- Section of Small Animal Surgery, Cornell University College of Veterinary Medicine, Ithaca, New York
| | - Eureka Ma
- College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Rory J Todhunter
- Section of Small Animal Surgery, Cornell University College of Veterinary Medicine, Ithaca, New York
| |
Collapse
|
|
10
|
Munday J, Delaforce A, Forbes G, Keogh S. Barriers and enablers to the implementation of perioperative hypothermia prevention practices from the perspectives of the multidisciplinary team: a qualitative study using the Theoretical Domains Framework. J Multidiscip Healthc 2019; 12:395-417. [PMID: 31239694 PMCID: PMC6551587 DOI: 10.2147/jmdh.s209687] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/05/2019] [Indexed: 12/29/2022] Open
Abstract
Purpose: Inadvertent perioperative hypothermia is a significant problem for surgical patients globally, and is associated with many detrimental side-effects. Despite the availability of rigorously developed international evidence-based guidelines for prevention, a high incidence of this complication persists. This qualitative study aims to identify and examine the domains which act as barriers and enablers to perioperative hypothermia prevention practices, from the perspectives of the key healthcare professionals involved with perioperative temperature management. Methods: A qualitative study employing semi-structured interviews was utilized. A purposive sample of key stakeholders involved in perioperative temperature management, including perioperative nurses, anesthetists, surgeons, and perioperative managers, were recruited via email. The interview guide was developed in reference to the Theoretical Domains Framework. All interviews were recorded, de-identified, transcribed, and coded. Belief statements were generated within each domain, and a frequency score generated for each belief. Finally, the domains were mapped to the COM-B model of the Behavior Change Wheel to develop recommendations for future interventions. Results: Twelve participants were included including eight nurses, two surgeons, and two anesthetists. Eleven key theoretical domains that influence the uptake of perioperative hypothermia practices were identified: knowledge; skills; social/professional role and identity; beliefs about capabilities; optimism; beliefs about consequences; reinforcement; goals; memory, attention, and decision processes; environmental context and resources; social influence. Suggested intervention strategies include training, reminder systems, audit, and feedback, organizational support to resolve lack of control of ambient temperature, as well as provision of accurate temperature measurement devices. Conclusion: Future interventions to address the key behavioral domains and improve perioperative hypothermia prevention need to be evaluated in the context of feasibility, effectiveness, safety, acceptability, and cost by the target users. All suggested intervention strategies need to take a team-based, multi-modal approach, as this is most likely to facilitate improvements in perioperative hypothermia prevention.
Collapse
Affiliation(s)
- Judy Munday
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD4059, Australia
- Department of Health and Nursing Science, University of Agder, Grimstad, Norway
| | - Alana Delaforce
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD4059, Australia
- Clinical Governance Unit, Mater Health, South Brisbane, QLD4101, Australia
| | - Gillian Forbes
- Department of Clinical, Educational and Health Psychology, UCL Centre for Behaviour Change, LondonWC1E 6BT, UK
| | - Samantha Keogh
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD4059, Australia
| |
Collapse
|
|
11
|
Shajahan A, Culp CH, Williamson B. Effects of indoor environmental parameters related to building heating, ventilation, and air conditioning systems on patients' medical outcomes: A review of scientific research on hospital buildings. INDOOR AIR 2019; 29:161-176. [PMID: 30588679 PMCID: PMC7165615 DOI: 10.1111/ina.12531] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/10/2018] [Accepted: 12/21/2018] [Indexed: 05/04/2023]
Abstract
The indoor environment of a mechanically ventilated hospital building controls infection rates as well as influences patients' healing processes and overall medical outcomes. This review covers the scientific research that has assessed patients' medical outcomes concerning at least one indoor environmental parameter related to building heating, ventilation, and air conditioning (HVAC) systems, such as indoor air temperature, relative humidity, and indoor air ventilation parameters. Research related to the naturally ventilated hospital buildings was outside the scope of this review article. After 1998, a total of 899 papers were identified that fit the inclusion criteria of this study. Of these, 176 papers have been included in this review to understand the relationship between the health outcomes of a patient and the indoor environment of a mechanically ventilated hospital building. The purpose of this literature review was to summarize how indoor environmental parameters related to mechanical ventilation systems of a hospital building are impacting patients. This review suggests that there is a need for future interdisciplinary collaborative research to quantify the optimum range for HVAC parameters considering airborne exposures and patients' positive medical outcomes.
Collapse
Affiliation(s)
- Amreen Shajahan
- Energy Systems LaboratoryTexas A&M UniversityCollege StationTexas
- Department of ArchitectureTexas A&M UniversityCollege StationTexas
| | - Charles H. Culp
- Energy Systems LaboratoryTexas A&M UniversityCollege StationTexas
- Department of ArchitectureTexas A&M UniversityCollege StationTexas
| | | |
Collapse
|
|
12
|
Effect of Fluid Flow Rate on Efficacy of Fluid Warmer: An In Vitro Experimental Study. Anesthesiol Res Pract 2018; 2018:8792125. [PMID: 30073025 PMCID: PMC6057410 DOI: 10.1155/2018/8792125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 05/30/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction In patients who require a massive intraoperative transfusion, cold fluid or blood transfusion can cause hypothermia and potential adverse effects. One method by which to prevent hypothermia in these patients is to warm the intravenous fluid before infusion. The aim of this study was to determine the effect of the fluid flow rate on the efficacy of a fluid warmer. Methods The room air temperature was controlled at 24°C. Normal saline at room temperature was used for the experiment. The fluid was connected to an infusion pump and covered with a heater line, which constantly maintained the temperature at 42°C. The fluid temperature after warming was measured by an insulated thermistor at different fluid flow rates (100, 300, 600, 900, and 1200 mL/h) and compared with the fluid temperature before warming. Effective warming was defined as an outlet fluid temperature of >32°C. Results The room temperature was 23.6°C ± 0.9°C. The fluid temperature before warming was 24.95°C ± 0.5°C. The outlet temperature was significantly higher after warming at all flow rates (p < 0.001). The increases in temperature were 10.9°C ± 0.1°C, 11.5°C ± 0.1°C, 10.2°C ± 0.1°C, 10.1°C ± 0.7°C, and 8.4°C ± 0.2°C at flow rates of 100, 300, 600, 900, and 1200 mL/h, respectively. The changes in temperature among all different flow rates were statistically significant (p < 0.001). The outlet temperature was >32°C at all flow rates. Conclusions The efficacy of fluid warming was inversely associated with the increase in flow rate. The outlet temperature was <42°C at fluid flow rates of 100 to 1200 mL/h. However, all outlet temperatures reached >32°C, indicating effective maintenance of the core body temperature by infusion of warm fluid.
Collapse
|
|
13
|
Zhou B, Wang G, Yang S, He X, Liu Y. The effects of amino acid infusions on core body temperature during the perioperative period: a systematic review. J Perianesth Nurs 2014; 29:491-500. [PMID: 25458629 DOI: 10.1016/j.jopan.2014.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 03/09/2014] [Accepted: 04/07/2014] [Indexed: 11/29/2022]
Abstract
The aim of this systematic review was to determine the effect of amino acid infusions on core body temperature and shivering. We searched the PubMed, EMBASE, CINAHL, and Cochrane Register of Controlled Trials databases to identify randomized controlled trials that met the inclusion criteria. A total of 11 eligible trials involving 506 participants were identified. Amino acid infusions were associated with shorter periods of mechanical ventilation and hospitalization and less perioperative shivering, mechanical intubation, and hospitalization in surgical patients without hepatic, renal, or severe metabolic disorders. It is recommended that infusions are warmed before administration to avoid further decrease in core body temperature.
Collapse
|
|
14
|
Munday J, Hines S, Wallace K, Chang AM, Gibbons K, Yates P. A systematic review of the effectiveness of warming interventions for women undergoing cesarean section. Worldviews Evid Based Nurs 2014; 11:383-93. [PMID: 25269994 DOI: 10.1111/wvn.12067] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women undergoing cesarean section are vulnerable to adverse effects associated with inadvertent perioperative hypothermia, but there has been a lack of synthesized evidence for temperature management in this population. This systematic review aimed to synthesize the best available evidence in relation to preventing hypothermia in mothers undergoing cesarean section surgery. METHODS Randomized controlled trials meeting the inclusion criteria (adult patients of any ethnic background, with or without comorbidities, undergoing any mode of anesthesia for any type of cesarean section) were eligible for consideration. Active or passive warming interventions versus usual care or placebo, aiming to limit or manage core heat loss in women undergoing cesarean section were considered. The primary outcome was maternal core temperature. A comprehensive search with no language restrictions was undertaken of multiple databases from their inception until May 2012. Two independent reviewers using the standardized critical appraisal instrument for randomized controlled trials from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments (JBI-MASTARI) assessed retrieved papers for methodological quality and conducted data collection. Where possible, results were combined in a fixed effects meta-analysis using the Cochrane Collaboration Review Manager software. Due to heterogeneity for one outcome, random effects meta-analysis was also used. RESULTS A combined total of 719 participants from 12 studies were included. Intravenous fluid warming was found to be effective at maintaining maternal temperature and preventing shivering. Warming devices, including forced air warming and under-body carbon polymer mattresses, were effective at preventing hypothermia. However, effectiveness increased if the devices were applied preoperatively. Preoperative warming devices reduced shivering and improved neonatal temperatures at birth. Intravenous fluid warming did not improve neonatal temperature, and the effectiveness of warming interventions on umbilical pH remains unclear. LINKING EVIDENCE TO ACTION Intravenous fluid warming by any method improves maternal temperature and reduces shivering during and after cesarean section, as does preoperative body warming. Preoperative warming strategies should be utilized where possible. Preoperative or intraoperative warmed IV fluids should be standard practice. Warming strategies are less effective when intrathecal opioids are administered. Further research is needed to investigate interventions in emergency cesarean section surgery. Larger scale studies using standardized, clinically meaningful temperature measurement time points are required.
Collapse
Affiliation(s)
- Judy Munday
- Clinical Research Nurse, Nursing Research Centre, Queensland University of Technology, Kelvin Grove, ALD, Australia
| | | | | | | | | | | |
Collapse
|
|
15
|
De Mattia AL, Barbosa MH, de Freitas Filho JPA, Rocha ADM, Pereira NHC. Warmed intravenous infusion for controlling intraoperative hypothermia. Rev Lat Am Enfermagem 2014; 21:803-10. [PMID: 23918028 DOI: 10.1590/s0104-11692013000300021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 02/19/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to verify the effectiveness of warmed intravenous infusion for hypothermia prevention in patients during the intraoperative period. METHOD experimental, comparative, field, prospective and quantitative study undertaken at a federal public hospital. The sample was composed of 60 adults, included based on the criteria of axillary temperature between 36ºC and 37.1ºC and surgical abdominal access, divided into control and experimental groups, using the systematic probability sampling technique. RESULTS 22 patients (73.4%) from both groups left the operating room with hypothermia, that is, with temperatures below 36ºC (p=1.0000). The operating room temperature when patients arrived and patients' temperature when they arrived at the operating room were statistically significant to affect the occurrence of hypothermia. CONCLUSION the planning and implementation of nursing interventions carried out by baccalaureate nurses are essential for preventing hypothermia and maintaining perioperative normothermia.
Collapse
Affiliation(s)
- Ana Lúcia De Mattia
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil.
| | | | | | | | | |
Collapse
|
|
16
|
Mendoza IYQ, Peniche ADCG, Püschel VADA. Conhecimento sobre hipotermia dos profissionais de Enfermagem do Centro Cirúrgico. Rev Esc Enferm USP 2012; 46 Spec No:123-9. [DOI: 10.1590/s0080-62342012000700018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 05/18/2012] [Indexed: 11/22/2022] Open
Abstract
Objetivou-se identificar a diferença no conhecimento sobre hipotermia do auxiliar de enfermagem após a intervenção educativa. A base conceitual de educação fundamenta-se na perspectiva da aprendizagem significativa, aliada à construção de mapa conceitual e à realização de estudo de caso. Os dados foram coletados por meio de um questionário validado por especialistas. A média do conhecimento após a intervenção educativa teve aumento de 3,49 pontos. Não se verificou diferença significativa do conhecimento quando foi relacionado às variáveis sociais e de formação estudadas. Conclui-se que a intervenção educativa foi satisfatória na medida em que as informações sobre hipotermia foram ancoradas e modificadas na estrutura cognitiva dos auxiliares de enfermagem.
Collapse
|
|
17
|
De Mattia AL, Barbosa MH, Rocha ADM, Farias HL, Santos CA, Santos DM. Hipotermia em pacientes no período perioperatório. Rev Esc Enferm USP 2012; 46:60-6. [DOI: 10.1590/s0080-62342012000100008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 04/12/2011] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste estudo foi identificar os fatores que desencadeiam a hipotermia em pacientes em sala de operação e as manifestações em sala de recuperação anestésica. O estudo foi realizado em um hospital de grande porte da rede mista da cidade de Santos. A coleta de dados foi realizada em 30 pacientes adultos, com temperatura corpórea entre de 36ºC e 37,2ºC na entrada da sala de operações com procedimentos cirúrgicos eletivos e anestesia geral. Os resultados demonstraram que os métodos preventivos de hipotermia mais utilizados foram a infusão venosa aquecida e a manta térmica. Na saída da sala de operação e até 30 minutos na sala de recuperação anestésica, os pacientes permaneceram hipotérmicos. As manifestações de hipotermia foram demonstradas pela hipoxemia e por tremores. Neste estudo, evidenciou-se que a hipotermia no paciente é desencadeada na sala de operação pela falta de medidas preventivas adequadas, acarretando complicações em período de recuperação anestésica.
Collapse
|
|
18
|
Barringer LB, Evans CW, Ingram LL, Tisdale PP, Watson SP, Janken JK. Agreement between temporal artery, oral, and axillary temperature measurements in the perioperative period. J Perianesth Nurs 2011; 26:143-50. [PMID: 21641529 DOI: 10.1016/j.jopan.2011.03.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 03/12/2011] [Accepted: 03/28/2011] [Indexed: 11/19/2022]
Abstract
This study examined agreement in temperature readings preoperatively and postoperatively between temporal artery and electronic oral/axillary thermometers as well as the seconds required to obtain temperature readings across the three measuring modes. Using a repeated measures design, 86 adult subjects had temporal artery, oral, and axillary temperatures taken upon admission to the surgical area and upon admission to the PACU. Findings indicated best agreement both preoperatively and postoperatively between the oral mode of the electronic thermometer and the temporal artery thermometer, followed by agreement between oral and axillary modes of the electronic thermometer, and the least agreement between the temporal artery and axillary readings. Seconds to temperature measurement was significantly different both preoperatively and postoperatively, with temporal artery measurement the fastest, followed by oral and then axillary. Results support the use of the temporal artery thermometers as an alternative for perioperative noninvasive temperature monitoring.
Collapse
|
|
19
|
Poveda VDB, Galvão CM. Hipotermia no período intra-operatório: é possível evitá-la? Rev Esc Enferm USP 2011; 45:411-7. [DOI: 10.1590/s0080-62342011000200016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 09/06/2010] [Indexed: 11/22/2022] Open
Abstract
O estudo teve como objetivo identificar as medidas adotadas para a prevenção de hipotermia no período intra-operatório. Trata-se de um estudo com delineamento de pesquisa não experimental, tipo descritivo-exploratório, prospectivo. Para tal elaborou-se um instrumento de coleta de dados, o qual foi submetido à validação aparente e de conteúdo. A amostra foi constituída de 70 pacientes. A medida mais empregada na sala de operação foi o método passivo de aquecimento cutâneo como o uso de lençol de algodão (11,4%) e o enfaixamento dos membros inferiores (14,3%). A utilização de um método ativo de aquecimento cutâneo ocorreu uma única vez (1,4%). Os resultados evidenciados demonstraram a necessidade de implementação de intervenções eficazes para a prevenção da hipotermia e o enfermeiro tem papel importante neste contexto, uma vez que a segurança do paciente e a redução de complicações decorrentes do procedimento anestésico cirúrgico são metas do cuidado de enfermagem.
Collapse
|
|
20
|
Hooper VD, Chard R, Clifford T, Fetzer S, Fossum S, Godden B, Martinez EA, Noble KA, O’Brien D, Odom-Forren J, Peterson C, Ross J, Wilson L. ASPAN’s Evidence-Based Clinical Practice Guideline for the Promotion of Perioperative Normothermia: Second Edition. J Perianesth Nurs 2010; 25:346-65. [DOI: 10.1016/j.jopan.2010.10.006] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 10/14/2010] [Indexed: 01/27/2023]
|
|
21
|
Hooper VD, Chard R, Clifford T, Fetzer S, Fossum S, Godden B, Martinez EA, Noble KA, O'Brien D, Odom-Forren J, Peterson C, Ross J. ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia. J Perianesth Nurs 2010; 24:271-87. [PMID: 19853810 DOI: 10.1016/j.jopan.2009.09.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 09/03/2009] [Indexed: 11/24/2022]
|
|
22
|
de Brito Poveda V, Galvão CM, dos Santos CB. Factors associated to the development of hypothermia in the intraoperative period. Rev Lat Am Enfermagem 2009; 17:228-33. [PMID: 19551277 DOI: 10.1590/s0104-11692009000200014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 10/27/2008] [Indexed: 11/21/2022] Open
Abstract
This study aimed to assess factors associated to body temperature changes intraoperatively in patients undergoing elective surgery. A prospective study including 70 patients was carried out in a charity hospital. A data collection instrument was developed and its face and content validity was established. The variables measured were operating room temperature and humidity and patient body temperature at different times. In the multivariate linear regression, the variables type of anesthesia, duration of anesthesia, body mass index, and operating room temperature were directly associated to mean body temperature. Nurses are responsible for planning and implementing effective interventions that can contribute to minimize costs and most importantly reduce hypothermia complications.
Collapse
|
|
23
|
Yokoyama K, Suzuki M, Shimada Y, Matsushima T, Bito H, Sakamoto A. Effect of administration of pre-warmed intravenous fluids on the frequency of hypothermia following spinal anesthesia for Cesarean delivery. J Clin Anesth 2009; 21:242-8. [DOI: 10.1016/j.jclinane.2008.12.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 11/17/2008] [Accepted: 12/04/2008] [Indexed: 12/21/2022]
|
|
24
|
Poveda VDB, Galvão CM, Dantas RAS. Hipotermia no período intra-operatório em pacientes submetidos a cirurgias eletivas. ACTA PAUL ENFERM 2009. [DOI: 10.1590/s0103-21002009000400002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar a temperatura corporal do paciente submetido a cirurgia eletiva no período intra-operatório. MÉTODOS: Para a coleta de dados elaborou-se um instrumento que foi submetido à validação aparente e de conteúdo e a amostra foi constituída de 70 pacientes. As variáveis mensuradas foram: temperatura e umidade da sala de cirurgia e temperatura corporal do paciente em diferentes momentos do período intra-operatório. RESULTADOS: Em relação à temperatura corporal dos pacientes observou-se que no final do procedimento anestésico-cirúrgico a média foi de 33,6º C. A temperatura média da sala na chegada dos pacientes foi de 24,6º C e na quarta hora de procedimento anestésico-cirúrgico foi de 22,4ºC. Houve correlação estatisticamente significante e positiva entre as variáveis mensuradas. CONCLUSÃO: Os resultados apontaram a necessidade de implementação de intervenções efetivas para a prevenção da hipotermia e, neste cenário, a atuação do enfermeiro é crucial para a melhoria da assistência prestada ao paciente cirúrgico.
Collapse
|
|
25
|
|