The optimal warming strategy to reduce perioperative hypothermia: A prospective randomized non-blinded clinical trial.

IF 2.9 3区综合性期刊 Q1 MULTIDISCIPLINARY SCIENCES

PLoS ONE Pub Date : 2025-06-12 eCollection Date: 2025-01-01 DOI:10.1371/journal.pone.0325954

Ronak Desai, Jason Gosschalk, Noud van Helmond, Ludmil Mitrev, Catherine Zhang, Brian McEniry, Krystal Hunter, Ernest Wallace, Michele Mele, Jennifer Ocbo, Keyur Trivedi, George Hsu, Sandeep Krishnan, John Dibato, Kinjal Patel

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Abstract

Background: To mitigate perioperative hypothermia, patients can be warmed preoperatively and intraoperatively with forced-air warming (FAW) and conductive warming (CW) methods. We examined the association of four combinations of pre- and intraoperative CW and FAW with the magnitude of intraoperative hypothermia.

Methods: We conducted a prospective randomized trial at a tertiary healthcare center in the United States (trial registration number ISRCTN23065394). Patients were randomized to 4 arms based on the following pre/intraoperative warming combinations: (1) CW/CW, (2) FAW/FAW, (3) no active prewarming (NAPW)/CW, (4) NAPW/FAW. Body temperature was measured using an esophageal probe. The area under the temperature curve (AUC) below 36°C was calculated according to the trapezoidal rule and quantified intraoperative hypothermia. A mixed model was used to estimate differences in AUC between the 4 arms.

Results: 182 patients were analyzed. Patients in the NAPW/FAW arm had the highest AUC values while those in the CW/CW arm had the lowest. AUC values [median (Q1, Q3] were as follows: CW/CW = 4.7 (0, 26.6); FAW/FAW = 8.0 (0, 30.8); NAPW/CW = 7.4 (0, 27.1); NAPW/FAW = 19.9 (5.0, 44.3). Mixed model results showed significant lower AUC values in CW/CW and NAPW/CW when compared to NAPW/FAW. The ratio of mean AUC [95% CI] between CW/CW vs NAPW/FAW was 0.49 [0.24, 0.98], 51% lower, and between NAPW/CW and NAPW/FAW, 0.46 [0.23, 0.91], 54% lower. When the AUC was normalized to the duration of surgery (AUC/case duration in°C, or "relative AUC"), significant lower relative AUC values were observed between FAW/FAW vs NAPW/FAW (48% lower, p = 0.0419) and NAPW/CW vs NAPW/FAW (48% lower, p = 0.0407).

Conclusions: CW is more effective than FAW at reducing intraoperative hypothermia when FAW is used without prewarming. When patients are actively prewarmed, CW and FAW show no difference in their ability to maintain patient temperature.

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减少围手术期低温的最佳加热策略：一项前瞻性随机非盲临床试验。

背景：为了减轻围手术期的低温，术前和术中可以采用强制空气加热（FAW）和传导加热（CW）方法对患者进行加热。我们检查了术前和术中CW和FAW的四种组合与术中低温程度的关系。方法：我们在美国一家三级医疗中心进行了一项前瞻性随机试验（试验注册号为ISRCTN23065394）。患者根据以下术前/术中预热组合随机分为4组：(1)CW/CW, (2) FAW/FAW,(3)无主动预热(NAPW)/CW, (4) NAPW/FAW。用食管探头测量体温。根据梯形法则计算36℃以下温度曲线下面积（AUC），并量化术中低温。采用混合模型估计4组间AUC的差异。结果：分析182例患者。NAPW/FAW组患者AUC值最高，而CW/CW组患者AUC值最低。AUC值[中位数（Q1, Q3）]如下：CW/CW = 4.7 (0,26.6)；Faw / Faw = 8.0 (0,30.8)；Napw / cw = 7.4 (0,27.1)；Napw / faw = 19.9（5.0, 44.3）。混合模型结果显示，与NAPW/FAW相比，CW/CW和NAPW/CW的AUC值显著降低。CW/CW与NAPW/FAW的平均AUC比值[95% CI]为0.49[0.24,0.98]，低51%；NAPW/CW与NAPW/FAW的平均AUC比值[0.46][0.23,0.91]，低54%。当AUC归一化到手术时间（°C下的AUC/病例持续时间，或“相对AUC”）时，FAW/FAW与NAPW/FAW之间的相对AUC值显著降低（低48%，p = 0.0419）， NAPW/CW与NAPW/FAW之间的相对AUC值显著降低（低48%，p = 0.0407）。结论：在不预热的情况下使用FAW时，CW比FAW更有效地降低术中低温。当患者积极预热时，CW和FAW在维持患者体温的能力上没有差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

PLoS ONE 生物-生物学

CiteScore

6.20

自引率

5.40%

发文量

14242

审稿时长

3.7 months

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