Rohrer Benjamin, Penick Emily, Zahedi Farhad, Tighiouart Hocine, Kelly Brian, Cobey Frederick, Ianchulev Stefan
Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, United States of America.
Tufts Clinical and Translational Science Institute, Boston, MA, United States of America.
PLoS One. 2017 Jun 2;12(6):e0178600. doi: 10.1371/journal.pone.0178600. eCollection 2017.
Transcatheter Aortic Valve Replacement (TAVR) procedures at our institution were complicated by perioperative hypothermia despite use of the standard of care forced-air convective warming device (the BairHugger, Augustine Medical Inc, Eden Prairie, MN, USA). To remedy this problem, we initiated a quality improvement process that investigated the use of a conductive warm water-circulating device (the Allon ThermoWrap, Menen Medical Corporation, Trevose, PA, USA), and hypothesized that it would decrease the incidence of perioperative hypothermia.
We compared two different intraoperative warming devices using a historic control. We retrospectively reviewed intraoperative records of 80 TAVRs between 6/2013 and 6/2015, 46 and 34 of which were done with the forced-air and water-circulating devices, respectively. Continuous temperature data obtained from pulmonary artery catheter, temperature upon arrival to cardiothoracic ICU (CTU), age, BSA, height, and BMI were compared.
Patients warmed with both devices were similar in terms of demographic characteristics. First recorded intraoperative temperature (mean 36.26 ± SD 0.61 vs. 35.95 ± 0.46°C, p = 0.02), lowest intraoperative temperature (36.01 ± 0.58 vs. 34.89 ± 0.76°C, p<0.001), temperature at the end of the procedure (36.47 ± 0.51 vs. 35.17 ± 0.75°C, p<0.001), and temperature upon arrival to the CTU (36.35 ± 0.44 vs. 35.07 ± 0.78°C, p<0.001) were significantly higher in the water-circulating group as compared to the forced-air group.
A quality improvement process led to selection of a new warming device that virtually eliminated perioperative hypothermia at our institution. Patients warmed with the new device were significantly less likely to experience intraoperative hypothermia and were significantly more likely to be normothermic upon arrival to the CTU.
尽管我们机构在经导管主动脉瓣置换术（TAVR）过程中使用了标准的强制空气对流加热设备（美国明尼苏达州伊甸草原市奥古斯汀医疗公司的BairHugger），但围手术期低温仍是一个复杂问题。为解决这一问题，我们启动了一项质量改进流程，研究使用传导式温水循环设备（美国宾夕法尼亚州特雷沃斯市梅嫩医疗公司的Allon ThermoWrap），并假设该设备会降低围手术期低温的发生率。
我们使用历史对照比较了两种不同的术中加热设备。我们回顾性分析了2013年6月至2015年6月期间80例TAVR手术的术中记录，其中分别有46例和34例使用了强制空气设备和温水循环设备。比较了从肺动脉导管获得的连续温度数据、到达心胸重症监护病房（CTU）时的体温、年龄、体表面积、身高和体重指数。
使用这两种设备加热的患者在人口统计学特征方面相似。与强制空气组相比，温水循环组首次记录的术中温度（平均36.26±标准差0.61 vs. 35.95±0.46°C，p = 0.02）、最低术中温度（36.01±0.58 vs. 34.89±0.76°C，p<0.001）、手术结束时的温度（36.47±0.51 vs. 35.17±0.75°C，p<0.001）以及到达CTU时的温度（36.35±0.44 vs. 35.07±0.78°C，p<0.001）均显著更高。
一项质量改进流程促使我们选择了一种新的加热设备，该设备几乎消除了我们机构的围手术期低温。使用新设备加热的患者术中发生低温的可能性显著降低，到达CTU时体温正常的可能性显著增加。
