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1.
Medicine (Baltimore) ; 100(12): e25235, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761716

RESUMO

BACKGROUND: This study aimed to evaluate the efficacy of peri-induction forced air warming to prevent inadvertent perioperative hypothermia, defined as a reduction in body temperature to <36.0°C during the perioperative period, in intraoperatively warmed patients receiving major surgery lasting >120 minutes. METHODS: In total, 130 patients scheduled for elective surgery under general anesthesia lasting >120 minutes were divided into 2 groups: peri-induction warming (n = 65) and control (n = 65). Patients in the peri-induction warming group were warmed during the anesthetic induction period using a forced-air warmer set at 47°C, whereas patients in the control group were covered passively with a cotton blanket. All patients were warmed with a forced-air warmer during surgery. Body temperature was measured using a tympanic membrane thermometer in the pre- and postoperative periods and using a nasopharyngeal temperature probe during surgery. Patients were evaluated for shivering scale score, thermal comfort scale score, and satisfaction score in the post-anesthesia care unit. RESULTS: The incidence rates of intraoperative and postoperative hypothermia were lower in the peri-induction warming group than in the control group (19.0% vs 57.1%, P < .001; 3.3% vs 16.9%, P = .013, respectively). Body temperature was higher in the peri-induction warming group (P < .001). However, intraoperative blood loss, as well as postoperative thermal comfort scale score, shivering scale score, and patient satisfaction score, were similar between groups. Post-anesthesia care unit duration was also similar between groups. CONCLUSIONS: Peri-induction active forced air warming is an effective, simple, and convenient method to prevent inadvertent perioperative hypothermia in intraoperatively warmed patients undergoing major surgery lasting >120 minutes.


Assuntos
Anestesia Geral , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Calefação/métodos , Hipotermia , Complicações Pós-Operatórias , Termometria/métodos , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Temperatura Corporal , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Hipotermia/etiologia , Hipotermia/prevenção & controle , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Período Perioperatório/efeitos adversos , Período Perioperatório/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Resultado do Tratamento
2.
Isr Med Assoc J ; 9(22): 476-480, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32954692

RESUMO

BACKGROUND: Neonatal hypothermia (< 36°C) has been associated with both neonatal morbidity and mortality. OBJECTIVES: To develop a multifactorial approach to reduce the incidence of neonatal hypothermia at admission to the neonatal intensive care unit. METHODS: The approach involved a detailed quality improvement (QI) plan, which included the use of occlusive wrapping and exothermic mattresses as well as higher delivery and operating room environmental temperatures. The improvement plan was implemented over a 10-month period. Retrospective comparison to the same 10-month period during the previous year assessed the effectiveness of the approach in reducing the incidence of admission hypothermia. RESULTS: The QI project included 189 patients. These patients were compared to 180 patients during the control period. The characteristics of the patient groups were similar and included preterm infants, who were subsequently analyzed as a subgroup. We found a significant reduction in the incidence of hypothermia, which was most profound for the subgroup of premature infants born at < 32 weeks gestation. Neonatal hyperthermia was identified as an unintended consequence of the project, and subsequently improved after initiating simple preventive measures. CONCLUSIONS: Occlusive wrapping, exothermic mattresses, and higher delivery and operating room environmental temperature may be successful in reducing admission neonatal hypothermia.


Assuntos
Regulação da Temperatura Corporal/fisiologia , Hipotermia/prevenção & controle , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/métodos , Roupas de Cama, Mesa e Banho , Humanos , Hipotermia/epidemiologia , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Israel , Curativos Oclusivos , Salas Cirúrgicas , Melhoria de Qualidade , Temperatura
3.
J Spec Oper Med ; 20(3): 21-35, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32969001

RESUMO

As an outcome of combat injury and hemorrhagic shock, trauma-induced hypothermia (TIH) and the associated coagulopathy and acidosis result in significantly increased risk for death. In an effort to manage TIH, the Hypothermia Prevention and Management Kit™ (HPMK) was implemented in 2006 for battlefield casualties. Recent feedback from operational forces indicates that limitations exist in the HPMK to maintain thermal balance in cold environments, due to the lack of insulation. Consequently, based on lessons learned, some US Special Operations Forces are now upgrading the HPMK after short-term use (60 minutes) by adding insulation around the casualty during training in cold environments. Furthermore, new research indicates that the current HPMK, although better than no hypothermia protection, was ranked last in objective and subjective measures in volunteers when compared with commercial and user-assembled external warming enclosure systems. On the basis of these observations and research findings, the Committee on Tactical Combat Casualty Care decided to review the hypothermia prevention and management guidelines in 2018 and to update them on the basis of these facts and that no update has occurred in 14 years. Recommendations are made for minimal costs, low cube and weight solutions to create an insulated HPMK, or when the HPMK is not readily available, to create an improvised hypothermia (insulated) enclosure system.


Assuntos
Hipotermia , Humanos , Hipotermia/prevenção & controle , Medicina Militar , Choque Hemorrágico , Ferimentos e Lesões/terapia
4.
Int J Biometeorol ; 64(12): 2161-2169, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32869111

RESUMO

Mountain accident casualties are often exposed to cold and windy weather. This may induce post-traumatic hypothermia which increases mortality. The aim of this study was to assess the ability of warming systems to compensate for the victim's estimated heat loss in a simulated mountain rescue operation. We used thermal manikins and developed a thermodynamic model of a virtual patient. Manikins were placed on a mountain rescue stretcher and exposed to wind chill indices of 0 °C and - 20 °C in a climatic chamber. We calculated the heat balance for two simulated clinical scenarios with both a shivering and non-shivering victim and measured the heat gain from gel, electrical, and chemical warming systems for 3.5 h. The heat balance in the simulated shivering patient was positive. In the non-shivering patient, we found a negative heat balance for both simulated weather conditions (- 429.53 kJ at 0 °C and - 1469.78 kJ at - 20 °C). Each warming system delivered about 300 kJ. The efficacy of the gel and electrical systems was higher within the first hour than later (p < 0.001). We conclude that none of the tested warming systems is able to compensate for heat loss in a simulated model of a non-shivering patient whose physiological heat production is impaired during a prolonged mountain evacuation. Additional thermal insulation seems to be required in these settings.


Assuntos
Hipotermia , Manequins , Temperatura Corporal , Regulação da Temperatura Corporal , Temperatura Baixa , Humanos , Hipotermia/prevenção & controle , Reaquecimento , Tremor por Sensação de Frio
5.
J Plast Reconstr Aesthet Surg ; 73(9): 1645-1664, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32505626

RESUMO

BACKGROUND: Optimising patients pre-operatively reduces the chance of complications. This may be achieved by preconditioning. Thermal preconditioning refers to the supraphysiological heating of organisms or specific organs prior to an environmental insult. This review explores the current application and efficacy of thermal preconditioning for surgery. METHODS: A comprehensive search of Medline (via PubMed), Embase and the Cochrane library was performed. Only articles evaluating the use of supraphysiological heating prior to a surgical intervention were included. Qualitative syntheses of data were undertaken due to the heterogeneity of the studies. The quality of each article was appraised using risk of bias tools (Cochrane and SYRCLE). RESULTS: The primary literature search returned 3175 articles. After screening and reviewing reference lists, 28 papers met the inclusion criteria. The majority of studies were performed in animals, with only three clinical trials. Although there was broad coverage of different surgical techniques, flap transfer was the most commonly performed procedure. Most studies demonstrated a beneficial effect of thermal preconditioning, ranging from increased joint mobility to improved flap or organ transplant survival rates. The quality of evidence was variable, with experimental animal studies limited by a lack of methodological detail. CONCLUSIONS: Thermal preconditioning for surgery has been primarily investigated using animal models. A beneficial effect has been demonstrated in most cases, across specialties ranging from plastic to general surgery. Future studies should aim to assess the clinical significance through large multicentre randomised controlled trials.


Assuntos
Calefação , Cuidados Pré-Operatórios , Procedimentos Cirúrgicos Operatórios , Animais , Sobrevivência de Enxerto , Proteínas de Choque Térmico/metabolismo , Humanos , Hipotermia/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Retalhos Cirúrgicos
6.
Ann Afr Med ; 19(2): 137-143, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32499471

RESUMO

Objective: Administration of warm intravenous (IV) fluid infusion and use of forced air warmers is the most easy and physiologically viable method for maintaining normothermia during surgery and postsurgical periods This study was conducted to assess the effect of combination of active warming (AW) methods namely warm IV fluid infusion and forced air warming versus forced air warming only (WA) on maternal temperature during elective C-delivery under spinal anesthesia. Materials and Methods: A total of 100 patients scheduled for elective c-section were grouped into those who received both warmed IV fluid infusion and forced air warmer (Combination of active warming WI= 50) and those who received only forced air warmer (WA = 50). Core body temperature and shivering incidence were recorded using a tympanic thermometer from prespinal till the end of surgery every 10 min and in postanesthesia care unit (PACU) at 0, 15, and 30 min. Results: Core temperature showed statistically significant difference in 15, 35, 45, and 55 min between air warmer and warm infusion groups and in PACU at 0, 15, and 30 min, it was statistically significant (P = 0.000) among WI group (mean temperature = 36.79°C) when compared to WA group (mean temperature = 35.96°C). There was a lower incidence of shivering in WI compared to WA group, which is statistically significant. Conclusion: Combination of warm Intravenous fluid infusion and Forced air warming is better than forced air warming alone. In maintaining near normal maternal core body temperature during elective cesarean section following spinal anesthesia. Combined warming method also reduces shivering incidence.


Assuntos
Anestesia Obstétrica/métodos , Raquianestesia/efeitos adversos , Cesárea/efeitos adversos , Temperatura Alta/uso terapêutico , Hipotermia/prevenção & controle , Infusões Intravenosas/métodos , Cuidados Intraoperatórios/métodos , Administração Intravenosa , Adulto , Período de Recuperação da Anestesia , Anestesia Obstétrica/efeitos adversos , Raquianestesia/métodos , Regulação da Temperatura Corporal , Cesárea/métodos , Feminino , Humanos , Hipotermia/induzido quimicamente , Hipotermia/etiologia , Monitorização Intraoperatória/métodos , Gravidez , Tremor por Sensação de Frio/efeitos dos fármacos , Tremor por Sensação de Frio/fisiologia , Fatores de Tempo , Resultado do Tratamento
7.
Arch Dis Child Fetal Neonatal Ed ; 105(6): 675-679, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32350064

RESUMO

Some neural circuits within infants are not fully developed at birth, especially in preterm infants. Therefore, it is unclear whether reflexes that affect breathing may or may not be activated during the neonatal stabilisation at birth. Both sensory reflexes (eg, tactile stimulation) and non-invasive ventilation (NIV) can promote spontaneous breathing at birth, but the application of NIV can also compromise breathing by inducing facial reflexes that inhibit spontaneous breathing. Applying an interface could provoke the trigeminocardiac reflex (TCR) by stimulating the trigeminal nerve resulting in apnoea and a reduction in heart rate. Similarly, airflow within the nasopharynx can elicit the TCR and/or laryngeal chemoreflex (LCR), resulting in glottal closure and ineffective ventilation, whereas providing pressure via inflations could stimulate multiple receptors that affect breathing. Stimulating the fast adapting pulmonary receptors may activate Head's paradoxical reflex to stimulate spontaneous breathing. In contrast, stimulating the slow adapting pulmonary receptors or laryngeal receptors could induce the Hering-Breuer inflation reflex or LCR, respectively, and thereby inhibit spontaneous breathing. As clinicians are most often unaware that starting primary care might affect the breathing they intend to support, this narrative review summarises the currently available evidence on (vagally mediated) reflexes that might promote or inhibit spontaneous breathing at birth.


Assuntos
Recém-Nascido Prematuro/fisiologia , Reflexo , Respiração , Humanos , Hipotermia/prevenção & controle , Pulmão/fisiologia , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Estimulação Física , Atenção Primária à Saúde , Ventilação Pulmonar , Fatores de Risco , Sucção , Tato , Nervo Vago/fisiologia
8.
Niger J Clin Pract ; 23(5): 619-625, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32367867

RESUMO

Background: Shivering is a frequent undesirable event in patients undergoing cesarean delivery under spinal anesthesia. Postanesthetic shivering has a multitude of deleterious effects and different methods have been used to prevent it. We therefore compare the efficacy of ondansetron to that of tramadol in preventing postanesthetic shivering in women undergoing cesarean section under subarachnoid block. Aim: Comparison of the efficacy of ondansetron to that of tramadol in preventing postanesthetic shivering in women undergoing cesarean section under subarachnoid block. Subject and Methods: This is a prospective, double-blind, placebo-controlled, randomized study. The patients (n = 109) were randomly allocated to three groups according to the study drugs, namely tramadol 50 mg group (Group T), ondansetron 4 mg group (Group O), and saline 4 ml group (Group S) using envelope randomization. Statistical analyses were done using Statistical Package for Social Sciences 20.0. Results: A total of 100 patients completed the study (33 in Group S, 33 in Group T, and 34 in Group O). The three groups were comparable with respect to demographic characteristics. Shivering was observed in 16 (48.5%) of the patients in Group S; 13 (39.4%) patients in Group T, and in only 2 (5.9%) patients in Group O. The differences in incidence of shivering were statistically significant between Groups O and S (P = 0.000) and Groups O and T (P = 0.001) but not between Groups T and S (P = 0.460). The differences across the groups were not statistically significant in terms of incidence of intraoperative hypotension, bradycardia, and the cumulative amount of ephedrine consumed. Conclusion: This study demonstrated that ondansetron is superior to tramadol in preventing shivering under spinal anesthesia in women undergoing cesarean section.


Assuntos
Analgésicos Opioides/uso terapêutico , Raquianestesia/efeitos adversos , Cesárea , Hipotermia/prevenção & controle , Ondansetron/uso terapêutico , Antagonistas da Serotonina/uso terapêutico , Tremor por Sensação de Frio/efeitos dos fármacos , Tramadol/uso terapêutico , Adulto , Analgésicos Opioides/administração & dosagem , Anestesia Obstétrica/métodos , Raquianestesia/métodos , Método Duplo-Cego , Feminino , Humanos , Hipotermia/etiologia , Ondansetron/administração & dosagem , Gravidez , Estudos Prospectivos , Antagonistas da Serotonina/administração & dosagem , Tramadol/administração & dosagem , Resultado do Tratamento
9.
J Neuroimmunol ; 344: 577244, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32330748

RESUMO

Toll-like receptor 2 (TLR2) recognizes a wide range of microbial molecules and plays critical roles in the initiation of innate immune responses. In the present study, we aimed to investigate whether the depletion of microglia and macrophages with clodronate liposomes (Clod-Lips) attenuates the activation of mouse brain circuits for TLR2-mediated inflammation and hypothermia. The peripheral administration of the TLR2 agonist zymosan induced nuclear factor-κB activation in microglia and macrophages and Fos expression in astrocytes/tanycytes and neurons in the circumventricular organs (CVOs). The depletion of microglia and macrophages with Clod-Lips markedly decreased zymosan-induced Fos expression in astrocytes/tanycytes and neurons in the CVOs. The treatment with Clod-Lips significantly attenuated zymosan-induced hypothermia. These results indicate that microglia and macrophages in the CVOs participate in the initiation and transmission of inflammatory responses after the peripheral administration of zymosan.


Assuntos
Ácido Clodrônico/administração & dosagem , Hipotermia/metabolismo , Macrófagos/metabolismo , Microglia/metabolismo , Proteínas Proto-Oncogênicas c-fos/biossíntese , Zimosan/toxicidade , Fatores Etários , Animais , Conservadores da Densidade Óssea/administração & dosagem , Portadores de Fármacos/administração & dosagem , Expressão Gênica , Hipotermia/induzido quimicamente , Hipotermia/prevenção & controle , Lipossomos , Macrófagos/efeitos dos fármacos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microglia/efeitos dos fármacos , Proteínas Proto-Oncogênicas c-fos/genética , Receptor 2 Toll-Like/agonistas , Receptor 2 Toll-Like/metabolismo
10.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32193210

RESUMO

OBJECTIVES: Reduce postoperative hypothermia by up to 50% over a 12-month period in children's hospital NICUs and identify specific clinical practices that impact success. METHODS: Literature review, expert opinion, and benchmarking were used to develop clinical practice recommendations for maintaining perioperative euthermia that included the following: established euthermia before transport to the operating room (OR), standardized practice for maintaining euthermia on transport to and from the OR, and standardized practice to prevent intraoperative heat loss. Process measures were focused on maintaining euthermia during these time points. The outcome measure was the proportion of patients with postoperative hypothermia (temperature ≤36°C within 30 minutes of a return to the NICU or at the completion of a procedure in the NICU). Balancing measures were the proportion of patients with postoperative temperature >38°C or the presence of thermal burns. Multivariable logistic regression was used to identify key practices that improved outcome. RESULTS: Postoperative hypothermia decreased by 48%, from a baseline of 20.3% (January 2011 to September 2013) to 10.5% by June 2015. Strategies associated with decreased hypothermia include >90% compliance with patient euthermia (36.1-37.9°C) at times of OR arrival (odds ratio: 0.58; 95% confidence interval [CI]: 0.43-0.79; P < .001) and OR departure (odds ratio: 0.0.73; 95% CI: 0.56-0.95; P = .017) and prewarming the OR ambient temperature to >74°F (odds ratio: 0.78; 95% CI: 0.62-0.999; P = .05). Hyperthermia increased from a baseline of 1.1% to 2.2% during the project. No thermal burns were reported. CONCLUSIONS: Reducing postoperative hypothermia is possible. Key practices include prewarming the OR and compliance with strategies to maintain euthermia at select time points throughout the perioperative period.


Assuntos
Hipotermia/prevenção & controle , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Benchmarking , Temperatura Corporal/fisiologia , Regulação da Temperatura Corporal/fisiologia , Queimaduras/epidemiologia , Humanos , Hipotermia/epidemiologia , Lactente , Unidades de Terapia Intensiva Neonatal , Modelos Logísticos , Razão de Chances , Salas Cirúrgicas , Avaliação de Resultados em Cuidados de Saúde , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Desenvolvimento de Programas , Fatores de Tempo , Transporte de Pacientes
11.
Int J Surg ; 77: 40-47, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32198100

RESUMO

OBJECTIVE: To determine whether preoperative warming can reduce the risk of surgical site infection (SSI) after surgery. BACKGROUND: Intraoperative hypothermia is a risk factor for the occurrence of SSI in patients after surgery. However, the effectiveness of preoperative warming in reducing the incidence of the condition remains unclear. MATERIALS AND METHODS: A systematic review was conducted using Medline, EMBASE, and the Cochrane Library to identify randomized controlled trials (RCTs) that evaluated the risk of SSI after surgery with and without the use of a preoperative warming protocol. The primary outcome measure was the diagnosis of SSI within 10-90 days of surgery. The pooled risk ratio was estimated with a fixed-effect meta-analysis. Sensitivity analyses were performed to examine the impact of the structural design of preoperative warming on the pooled risk of SSI. RESULTS: Of the 249 studies identified, seven RCTs representing 1086 patients were included in the present meta-analysis. The use of preoperative warming was associated with a significant decrease in SSI (RR = 0.60, 95% CI 0.42-0.87, P = 0.072). Specifically, we defined patients who used forced-air warming (FAW) and integrated measures such as liquid heating and warming blankets as the MIX group and patients who used only FAW as the FAW group. Patients who used MIX methods (temperature set <43 °C and 30-min prewarming) before surgery benefited more from prewarming. CONCLUSIONS: The results of this study suggest that preoperative warming can reduce rates of SSI after surgery. We, therefore, recommend the application of MIX warming methods before surgery.


Assuntos
Hipotermia/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Cuidados Pré-Operatórios , Infecção da Ferida Cirúrgica/prevenção & controle , Temperatura Alta , Humanos
12.
Enferm. clín. (Ed. impr.) ; 30(supl.3): 92-94, mar. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-196119

RESUMO

OBJECTIVE: This study aims to determine the effectiveness of Therapy Hypothermia on hemodynamic status in acute myocardial infarction post cardiac arrest. METHOD: This study used a quasi-experiment, with a one-group pre-post test. Accidental sampling used with 12 participants. The study was conducted on patients who had just entered the Intensive Cardiovascular Care Unit (ICVCU) with acute myocardial infarction. Therapy Hypothermia was started used blanketrol set at 32-34°C for 24h, then level of consciousness, systolic, dyastolic, Mean Arterial Pressure (MAP), Heart Rate (HR), Respiratory Rate (RR), Temperature taken before and after intervention. Analysis used dependent T-test. RESULT: Showed effectiveness of hypothermia therapy on the hemodynamic status of acute myocardial infarction post cardiac arrest, which level of consciousness, Systolic, Dyastolic, MAP, HR, RR and Temperature obtained p value<0.05. CONCLUSION: Therapy hypotermia is one standardized to stabilized hemodynamic status of acute myocardial infarction post cardiac arrest


No disponible


Assuntos
Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Monitorização Hemodinâmica/métodos , Infarto do Miocárdio/terapia , Parada Cardíaca/complicações , Resultado do Tratamento , Hipotermia Induzida/métodos , Hipotermia/epidemiologia , Parada Cardíaca/terapia , Volume Sistólico , Hipotermia/prevenção & controle
13.
Can Assoc Radiol J ; 71(2): 238-243, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32063017

RESUMO

PURPOSE: Unintentional drop in body temperature in trauma victims is an independent risk factor for mortality. We aimed to assess the impact of thermal insulation on image quality and radiation dose in polytrauma computed tomography (CT). METHODS: Thirteen different insulating covers were used to wrap CT phantoms. Images were assessed subjectively at a radiological workstation and analyzed digitally with dedicated software evaluating the noise intensity, spatial resolution, and image homogeneity. The radiation dose was measured using a dosimeter. RESULTS: Most materials did not cause significant artifacts apart from 2 heating pads. Although the radiation dose was increased by the majority of insulating covers (up to 64.66%), certain covers decreased the absorbed radiation (up to -7.35%). CONCLUSIONS: The majority of insulating systems do not cause artifacts in CT scans. When using covers with self-heating warmers, removing the heating pad is suggested due to the risk of considerable artifacts appearing. Certain insulating covers may increase or decrease the radiation dose.


Assuntos
Doses de Radiação , Temperatura , Tomografia Computadorizada por Raios X/normas , Artefatos , Hipotermia/prevenção & controle , Traumatismo Múltiplo/diagnóstico por imagem , Imagens de Fantasmas , Estudos Prospectivos , Interpretação de Imagem Radiográfica Assistida por Computador
14.
MCN Am J Matern Child Nurs ; 45(2): 102-108, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32097222

RESUMO

PURPOSE: The purpose of this integrative review was to assess common warming measures used for prevention of hypothermia during the perioperative period for women having cesarean birth and to determine their efficacy. METHODS: A literature search was conducted via electronic databases EBSCO, PUBMED, Academic Search Premier, Google Scholar, and CINAHL using keyword search terms hypothermia, cesarean, and warming. Inclusion criteria were articles written in English and published between 2006 and 2018. RESULTS: Seventeen articles were included in the review, covering three common warming measures; intravenous (IV) fluid warming, forced-air warming, and combined IV fluid and forced-air warming. Several other warming modalities were noted including warming mattresses and various combinations of interventions. CLINICAL IMPLICATIONS: Maternal hypothermia risk is increased during the perioperative period for women having cesarean birth without use of warming measures. Warming modalities that are beneficial in preventing maternal hypothermia in women having cesarean birth are IV fluid warming, upper body force-air warming, ambient OR temperature, and warming mattresses. National standards and guidelines from the American Society of PeriAnesthesia Nurses, the Association of Perioperative Registered Nurses, and the Association of Women's Health, Obstetric, and Neonatal Nurses are consistent with current evidence and should be in place and followed in every maternity unit caring for women having cesarean birth.


Assuntos
Cesárea/efeitos adversos , Hipotermia/etiologia , Hipotermia/prevenção & controle , Adulto , Cesárea/métodos , Feminino , Hidratação/métodos , Humanos , Assistência Perioperatória/métodos , Gravidez
15.
Arthroscopy ; 36(2): 347-352, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31901395

RESUMO

PURPOSE: To determine if a clinically significant difference in the core body temperature (CBT) exists between the Bair Hugger (BH) and Inditherm (IT) warming devices in patients undergoing arthroscopic shoulder surgery. METHODS: This was a parallel, 2-treatment, prospective, randomized, controlled trial conducted in patients undergoing elective arthroscopic shoulder surgery in the beach-chair position using room-temperature irrigation fluid. The BH was used as the indicative forced-air warming device, whereas the IT served as the indicative resistive heating system. By use of a minimal clinically significant difference of 0.6°C and standard deviation of 0.6°C, a power analysis showed that a sample size of 90 patients (45 per group) would be required. Patients fulfilling the inclusion criteria were recruited from the clinics of the senior authors. Anesthetic and surgical protocols were standardized. The intraoperative CBT was recorded every 5 minutes using a nasopharyngeal thermistor probe. Demographic data as well as the volume of irrigation fluid used were also noted. RESULTS: A steady decline in the CBT was observed in both groups up to 30 minutes after induction of anesthesia. Beyond 30 minutes, the BH group showed a gradual increase in temperature whereas it continued to decline in the IT group. A statistically significant difference in the CBT was observed from 60 minutes onward (P = .025). This difference continued to increase up to 90 minutes (P < .001). At no time was a rise in the CBT observed in the IT group. At completion of the study and surgical procedure, 13 of 47 patients in the BH group and 32 of 44 patients in the IT group had hypothermia (P = .0002). CONCLUSIONS: The CBT was statistically significantly better with the use of the BH compared with the IT mattress. However, the differences in the CBT did not reach the level of clinical significance of 0.6°C. Far fewer patients in the BH group had hypothermia at the end of surgery. Therefore, this study supports the use of the BH in elective arthroscopic shoulder surgery for the prevention of hypothermia. LEVEL OF EVIDENCE: Level I.


Assuntos
Roupas de Cama, Mesa e Banho , Leitos , Regulação da Temperatura Corporal , Calefação/instrumentação , Hipotermia/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Assistência Perioperatória , Artroscopia , Procedimentos Cirúrgicos Eletivos , Humanos , Estudos Prospectivos , Articulação do Ombro/cirurgia
17.
Vet Surg ; 49(2): 256-264, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31617950

RESUMO

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.


Assuntos
Doenças do Gato/prevenção & controle , Doenças do Cão/prevenção & controle , Hipotermia/veterinária , Complicações Intraoperatórias/veterinária , Temperatura , Anestesia , Animais , Temperatura Corporal , Doenças do Gato/etiologia , Gatos , Doenças do Cão/etiologia , Cães , Feminino , Humanos , Hipotermia/etiologia , Hipotermia/prevenção & controle , Incidência , Complicações Intraoperatórias/epidemiologia , Monitorização Intraoperatória , Assistência Perioperatória , Fatores de Risco
18.
Urol J ; 17(1): 1-7, 2020 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-30882163

RESUMO

Purpose? Isothermic irrigation decreases the reduction in core temperature and shivering in patients undergoing transurethral resection of prostate gland but this effect has not been studied in patients undergoing endoscopic urethral stone treatment surgery. The current study is designed to study the effect of isothermic hydration on core temperature in patients scheduled for endoscopic urethral stone treatment surgery under spinal anesthesia. Materials and Methods? Sixty patients allocated randomly into two groups. In GroupW (n = 30) irrigation fluid at 37°C was used whereas at room temperature in GroupRT (n = 30). Spinal anesthesia was performed at L3-L4 interspace with 15mg of hyperbaric bupivacaine. Core temperature, shivering, and hemodynamic parameters were measured every minute until 10th minute and five minute intervals until the end of operation. Shivering and surgeon comfort was also recorded. The primary outcome was the core temperature at the end of surgery. Frequencies, means, standard deviations, percentages, chi-square tests, independent samples t-test, and Mann Whitney U tests were used where eligible for the statistical analysis.Results? Baseline core temperature was 36.6 ± 0.4°C in GroupW and 36.6 ± 0.5°C in GroupRT (P = .097) which decreased to 36.0 ± 0.5°C and 35.2 ± 0.7°C respectively (P = .018) at the end of operation.  Shivering was observed in 36.7% (n = 11) in GroupRT and 6.7% (n = 2) in GroupW (P = .012). Hemodynamic parameter changes and demographic data were not significant between groups.Conclusion? Isothermic irrigation decreases both the reduction in core temperature and the incidence of shivering while increasing the surgeon comfort.


Assuntos
Raquianestesia/efeitos adversos , Temperatura Corporal , Hipotermia/prevenção & controle , Doenças Uretrais/cirurgia , Cálculos Urinários/cirurgia , Adulto , Endoscopia , Hemodinâmica , Humanos , Hipotermia/etiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Tremor por Sensação de Frio , Temperatura , Irrigação Terapêutica/métodos
19.
J Trop Pediatr ; 66(2): 129-135, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31257430

RESUMO

BACKGROUND: Preterm constitutes a major part of neonatal mortality, particularly in India. Due to dermal immaturity, preterm neonates are susceptible to various complications like infection, hypothermia, etc. Emollient application is a traditional practice in our subcontinent. AIMS: To find out the efficacy of coconut oil application for skin maturity, prevention of sepsis, hypothermia and apnea, its effect on long-term neurodevelopment and adverse effect of it, if any. MATERIAL AND METHODS: A randomized controlled trial was conducted in the rural field practice area of Department of Community Medicine, Burdwan Medical College from March 2014 to August 2018. Preterm born in the study period was divided into Group A (received virgin coconut oil application) and Group B (received body massage without any application). Neonatal skin condition was assessed on 7th, 14th, 21st and 28th day of life. Neurodevelopmental status was assessed on 3rd, 6th and 12th months. RESULTS: A total of 2294 preterm were included in the study. Groups A and B consisted of 1146 and 1148 preterm infants, consecutively. Mean gestational age of the study population was 31.9 ± 3.4 weeks and 50.4% were male. Mean weight loss in first few days was less in group A but mean weight gain per day was higher in group B. Lesser incidences of hypothermia and apnea, and better skin maturity and neurodevelopmental outcome were noted in group A. No significant adverse effect was noted with coconut oil application. CONCLUSION: Use of coconut oil helps in dermal maturity and better neurodevelopmental outcome. Further studies are warranted for universal recommendation.


Assuntos
Apneia/prevenção & controle , Óleo de Coco/administração & dosagem , Emolientes/administração & dosagem , Hipotermia/prevenção & controle , Recém-Nascido Prematuro , Sepse/prevenção & controle , Pele/efeitos dos fármacos , Administração Cutânea , Óleo de Coco/uso terapêutico , Emolientes/uso terapêutico , Feminino , Humanos , Cuidado do Lactente/métodos , Recém-Nascido , Masculino , Avaliação de Resultados em Cuidados de Saúde , População Rural
20.
J Perinatol ; 40(3): 530-539, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31712659

RESUMO

BACKGROUND: Following delivery, extremely premature infants are vulnerable to rapid development of hypothermia and hypoglycemia. To reduce local rates of these morbidities, a multidisciplinary team developed a protocol standardizing evidence-based care practices during the first hour after birth. METHODS: Using quality improvement methodology, the Golden Hour protocol was implemented for all inborn infants <27 weeks' gestation. Data were collected (2012-2017) over three phases; pre-protocol (n = 80), Phase I (n = 42), and Phase II (n = 92). RESULTS: There were no significant differences in infant characteristics. Improvements in hypothermia (59% vs 26% vs 38%; p = 0.001), hypoglycemia (18% vs 7% vs 4%; p = 0.012), and minutes to completion of stabilization [median (Q1,Q3) 110 (89,138) vs 111 (94,135) vs 92 (74,129); p = 0.0035] were observed. CONCLUSIONS: Implementation of an evidence-based, Golden Hour protocol is an effective intervention for reducing hypothermia and hypoglycemia in extremely premature infants.


Assuntos
Hipoglicemia/prevenção & controle , Hipotermia/prevenção & controle , Lactente Extremamente Prematuro , Unidades de Terapia Intensiva Neonatal/organização & administração , Terapia Intensiva Neonatal/normas , Melhoria de Qualidade , Medicina Baseada em Evidências , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/normas , Masculino , Tempo para o Tratamento
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