Modeling iatrogenic intraoperative hyperthermia from external warming in children: A pooled analysis from two prospective observational studies.
Paediatr Anaesth
; 33(2): 114-122, 2023 02.
Article
em En
| MEDLINE
| ID: mdl-36268791
ABSTRACT
BACKGROUND:
Maintenance of normothermia is an important quality metric in pediatric anesthesia. While inadvertent hypothermia is effectively prevented by forced-air warming, this therapeutic approach can lead to iatrogenic hyperthermia in young children.AIMS:
To estimate the influence of external warming by forced air on the development of intraoperative hyperthermia in anesthetized children aged 6 years or younger.METHODS:
We pooled data from two previous clinical studies. Primary outcome was the course of core temperature over time analyzed by a quadratic regression model. Secondary outcomes were the incidence of hyperthermia (body core temperature >38°C), the probability of hyperthermia over the duration of warming in relation to age and surface-area-to-weight ratio, respectively, analyzed by multiple logistic regression models. The influence of baseline temperature on hyperthermia was estimated using a Cox proportional hazards model.RESULTS:
Two hundred children (55 female) with a median age of 2.1 [1st -3rd quartile 1-4.2] years were analyzed. Mean temperature increased by 0.43°C after 1 h, 0.64°C after 2 h, and reached a peak of 0.66°C at 147 min. Overall, 33 children were hyperthermic at at least one measurement point. The odds ratios of hyperthermia were 1.14 (95%-CI 1.07-1.22) or 1.13 (95%-CI 1.06-1.21) for every 10 min of warming therapy in a model with age or surface-area-to weight ratio (ceteris paribus), respectively. Odds ratio was 1.33 (95%-CI 1.07-1.71) for a decrease of 1 year in age and 1.63 (95%-CI 0.93-2.83) for an increase of 0.01 in the surface-to-weight-area ratio (ceteris paribus). An increase of 0.1°C in baseline temperature increased the hazard of becoming hyperthermic by a factor of 1.33 (95%-CI 1.23-1.43).CONCLUSIONS:
In children, external warming by forced-air needs to be closely monitored and adjusted in a timely manner to avoid iatrogenic hyperthermia especially during long procedures, in young age, higher surface-area-to-weight ratio, and higher baseline temperature.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Hipertermia Induzida
/
Hipotermia
Tipo de estudo:
Observational_studies
/
Prognostic_studies
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Risk_factors_studies
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Systematic_reviews
Idioma:
En
Revista:
Paediatr Anaesth
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Alemanha