Comparison of resistive heating and forced-air warming to prevent inadvertent perioperative hypothermia.

BACKGROUND: Forced-air warming is a commonly used warming modality, which has been shown to reduce the incidence of inadvertent perioperative hypothermia (<36°C). The reusable resistive heating mattresses offer a potentially cheaper alternative, however, and one of the research recommendations from the National Institute for Health and Care Excellence was to evaluate such devices formally. We conducted a randomized single-blinded study comparing perioperative hypothermia in patients receiving resistive heating or forced-air warming. METHODS: A total of 160 patients undergoing non-emergency surgery were recruited and randomly allocated to receive either forced-air warming (n=78) or resistive heating (n=82) in the perioperative period. Patient core temperatures were monitored after induction of anaesthesia until the end of surgery and in the recovery room. Our primary outcome measures included the final intraoperative temperature and incidence of hypothermia at the end of surgery. RESULTS: There was a significantly higher rate of hypothermia at the end of surgery in the resistive heating group compared with the forced-air warming group (P=0.017). Final intraoperative temperatures were also significantly lower in the resistive heating group (35.9 compared with 36.1°C, P=0.029). Hypothermia at the end of surgery in both warming groups was common (36% forced air warming, 54% resistive heating). CONCLUSION: Our results suggest that forced-air warming is more effective than resistive heating in preventing postoperative hypothermia. CLINICAL TRIAL REGISTRATION: NCT01056991.

Effect of forced-air warming on the performance of operating theatre laminar flow ventilation.

Forced-air warming exhaust may disrupt operating theatre airflows via formation of convection currents, which depends upon differences in exhaust and operating room air temperatures. We investigated whether the floor-to-ceiling temperatures around a draped manikin in a laminar-flow theatre differed when using three types of warming devices: a forced-air warming blanket (Bair Hugger™); an over-body conductive blanket (Hot Dog™); and an under-body resistive mattress (Inditherm™). With forced-air warming, mean (SD) temperatures were significantly elevated over the surgical site vs those measured with the conductive blanket (+2.73 (0.7) °C; p<0.001) or resistive mattress (+3.63 (0.7) °C; p<0.001). Air temperature differences were insignificant between devices at floor (p=0.339), knee (p=0.799) and head height levels (p=0.573). We conclude that forced-air warming generates convection current activity in the vicinity of the surgical site. The clinical concern is that these currents may disrupt ventilation airflows intended to clear airborne contaminants from the surgical site.