Pearce Brett, Mattheyse Linda, Ellard Louise, Desmond Fiona, Pillai Param, Weinberg Laurence
North-Western Training Scheme, Victoria, Australia.
Department of Anaesthesia, Austin Hospital, Victoria, Australia.
Transplant Direct. 2018 Mar 20;4(4):e358. doi: 10.1097/TXD.0000000000000775. eCollection 2018 Apr.
The avoidance of hypothermia is vital during prolonged and open surgery to improve patient outcomes. Hypothermia is particularly common during orthotopic liver transplantation (OLT) and associated with undesirable physiological effects that can adversely impact on perioperative morbidity. The KanMed WarmCloud (Bromma, Sweden) is a revolutionary, closed-loop, warm-air heating mattress developed to maintain normothermia and prevent pressure sores during major surgery. The clinical effectiveness of the WarmCloud device during OLT is unknown. Therefore, we conducted a randomized controlled trial to determine whether the WarmCloud device reduces hypothermia and prevents pressure injuries compared with the Bair Hugger underbody warming device.
Patients were randomly allocated to receive either the WarmCloud or Bair Hugger warming device. Both groups also received other routine standardized multimodal thermoregulatory strategies. Temperatures were recorded by nasopharyngeal temperature probe at set time points during surgery. The primary endpoint was nasopharyngeal temperature recorded 5 minutes before reperfusion. Secondary endpoints included changes in temperature over the predefined intraoperative time points, number of patients whose nadir temperature was below 35.5°C and the development of pressure injuries during surgery.
Twenty-six patients were recruited with 13 patients randomized to each group. One patient from the WarmCloud group was excluded because of a protocol violation. Baseline characteristics were similar. The mean (standard deviation) temperature before reperfusion was 36.0°C (0.7) in the WarmCloud group versus 36.3°C (0.6) in the Bairhugger group ( = 0.25). There were no statistical differences between the groups for any of the secondary endpoints.
When combined with standardized multimodal thermoregulatory strategies, the WarmCloud device does not reduce hypothermia compared with the Bair Hugger device in patients undergoing OLT.
在长时间的开放性手术中，避免体温过低对于改善患者预后至关重要。体温过低在原位肝移植（OLT）过程中尤为常见，并且与不良生理效应相关，这些效应会对围手术期发病率产生不利影响。KanMed WarmCloud（瑞典布罗玛）是一种革命性的闭环暖空气加热床垫，旨在在大手术期间维持正常体温并预防压疮。WarmCloud设备在OLT期间的临床效果尚不清楚。因此，我们进行了一项随机对照试验，以确定与Bair Hugger下身保暖设备相比，WarmCloud设备是否能降低体温过低并预防压力性损伤。
患者被随机分配接受WarmCloud或Bair Hugger保暖设备。两组患者还接受了其他常规标准化的多模式体温调节策略。在手术期间的设定时间点，通过鼻咽温度探头记录体温。主要终点是再灌注前5分钟记录的鼻咽温度。次要终点包括在预定义的术中时间点的体温变化、最低体温低于35.5°C的患者数量以及手术期间压力性损伤的发生情况。
招募了26名患者，每组随机分配13名患者。WarmCloud组的一名患者因违反方案被排除。基线特征相似。WarmCloud组再灌注前的平均（标准差）体温为36.0°C（0.7），而Bairhugger组为36.3°C（0.6）（P = 0.25）。两组在任何次要终点方面均无统计学差异。
在接受OLT的患者中，当与标准化的多模式体温调节策略联合使用时，WarmCloud设备与Bair Hugger设备相比，并未降低体温过低的发生率。
