Roxby David, Sobieraj-Teague Magdalena, von Wielligh Jacoba, Sinha Romi, Kuss Bryone, Smith Anne-Louise, McEwen Mark
College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
SA Pathology Transfusion Service, Flinders Medical Centre, Adelaide, South Australia, Australia.
Emerg Med Australas. 2020 Aug;32(4):604-610. doi: 10.1111/1742-6723.13471. Epub 2020 Feb 11.
Major trauma is associated with blood loss and hypothermia. It is common to replace lost fluid with red cells stored at 2-6°C, and/or colloid/crystalloid fluid stored at ambient temperature, thus increasing hypothermia risk. At trauma and medical retrieval sites, mains electricity powered fluid warmers cannot be generally used. Latent heat provides an alternate practical method of portable temperature-controlled intravenous fluid warming. This work investigates the safety and efficacy of a fluid warmer powered by latent heat.
Twenty-five haematology patients received red cell transfusions, one through a fluid warmer, using latent heat from a super-cooled liquid and one without warming. Temperature of donor red cell units was measured after passing through fluid warmers. Blood samples were collected from red cell units and patients, prior and after each transfusion. These were tested for haemolysis markers (plasma haemoglobin, potassium, lactate dehydrogenase, bilirubin) and for traces of super-cooled liquid. Patient physiological parameters (oxygen saturation, pulse, temperature, blood pressure, respiration) were monitored during each transfusion.
Patient's physiological signs remained stable and no transfusion reactions were observed during warm transfusions. Latent heat fluid warmers increased the temperature of red cell units to approximately 35°C. There were no significant differences in haemolysis markers following warmed and unwarmed transfusions, and no contamination of red cell units by super-cooled liquid was detected.
The latent heat fluid warmer was shown to safely warm transfused blood in a controlled clinical setting.
严重创伤与失血和体温过低相关。用储存在2-6°C的红细胞和/或储存在室温下的胶体/晶体液来补充丢失的液体很常见，从而增加了体温过低的风险。在创伤和医疗救援现场，通常无法使用市电驱动的液体加温器。潜热提供了一种便携式温度控制静脉输液加温的替代实用方法。这项工作研究了一种由潜热驱动的液体加温器的安全性和有效性。
25名血液学患者接受红细胞输血，其中1名通过使用过冷液体的潜热的液体加温器输血，另1名未加温输血。测量供体红细胞单位通过液体加温器后的温度。在每次输血前后，从红细胞单位和患者身上采集血样。检测这些样本的溶血标志物（血浆血红蛋白、钾、乳酸脱氢酶、胆红素）和过冷液体痕迹。在每次输血期间监测患者的生理参数（血氧饱和度、脉搏、体温、血压、呼吸）。
在加温输血过程中，患者的生理体征保持稳定，未观察到输血反应。潜热液体加温器将红细胞单位的温度提高到约35°C。加温输血和未加温输血后的溶血标志物无显著差异，未检测到红细胞单位被过冷液体污染。
在可控的临床环境中，潜热液体加温器被证明能安全地加温输血。
