Mutchnick Ian, Thatikunta Meena, Braun Julianne, Bohn Martha, Polivka Barbara, Daniels Michael W, Vickers-Smith Rachel, Gump William, Moriarty Thomas
1Division of Pediatric Neurosurgery, Norton Children's Hospital/Norton Neuroscience Institute, Louisville.
2Department of Neurosurgery, University of Louisville.
J Neurosurg Pediatr. 2020 Feb 14;25(5):548-554. doi: 10.3171/2019.12.PEDS1980. Print 2020 May 1.
Perioperative hypothermia (PH) is a preventable, pathological, and iatrogenic state that has been shown to result in increased surgical blood loss, increased surgical site infections, increased hospital length of stay, and patient discomfort. Maintenance of normothermia is recommended by multiple surgical quality organizations; however, no group yet provides an ergonomic, evidence-based protocol to reduce PH for pediatric neurosurgery patients. The authors' aim was to evaluate the efficacy of a PH prevention protocol in the pediatric neurosurgery population.
A prospective, nonrandomized study of 120 pediatric neurosurgery patients was performed. Thirty-eight patients received targeted warming interventions throughout their perioperative phases of care (warming group-WG). The remaining 82 patients received no extra warming care during their perioperative period (control group-CG). Patients were well matched for age, sex, and preparation time intraoperatively. Hypothermia was defined as < 36°C. The primary outcome of the study was maintenance of normothermia preoperatively, intraoperatively, and postoperatively.
WG patients were significantly warmer on arrival to the operating room (OR) and were 60% less likely to develop PH (p < 0.001). Preoperative forced air warmer use both reduced the risk of PH at time 0 intraoperatively and significantly reduced the risk of any PH intraoperatively (p < 0.001). All patients, regardless of group, experienced a drop in core temperature until a nadir occurred at 30 minutes intraoperatively for the WG and 45 minutes for the CG. At every time interval, from preoperatively to 120 minutes intraoperatively, CG patients were between 2 and 3 times more likely to experience PH (p < 0.001). All patients were warm on arrival to the postanesthesia care unit regardless of patient group.
Preoperative forced air warmer use significantly increases the average intraoperative time 0 temperature, helping to prevent a fall into PH at the intraoperative nadir. Intraoperatively, a strictly and consistently applied warming protocol made intraoperative hypothermia significantly less likely as well as less severe when it did occur. Implementation of a warming protocol necessitated only limited resources and an OR culture change, and was well tolerated by OR staff.
围手术期体温过低（PH）是一种可预防的、病理性的医源性状态，已被证明会导致手术失血量增加、手术部位感染增加、住院时间延长以及患者不适。多个外科质量组织建议维持正常体温；然而，尚无团体提供一种符合人体工程学的、基于证据的方案来降低小儿神经外科患者的体温过低情况。作者的目的是评估一种预防体温过低方案在小儿神经外科患者中的疗效。
对120例小儿神经外科患者进行了一项前瞻性、非随机研究。38例患者在围手术期护理的各个阶段接受了目标性升温干预（升温组-WG）。其余82例患者在围手术期未接受额外的升温护理（对照组-CG）。患者在年龄、性别和术中准备时间方面匹配良好。体温过低定义为<36°C。该研究的主要结果是术前、术中和术后维持正常体温。
升温组患者到达手术室时体温明显更高，发生体温过低的可能性降低了60%（p<0.001）。术前使用强制空气升温器既降低了术中0时刻体温过低的风险，也显著降低了术中任何体温过低的风险（p<0.001）。所有患者，无论组别如何，核心体温均出现下降，升温组在术中30分钟时、对照组在术中45分钟时降至最低点。在从术前到术中120分钟的每个时间间隔，对照组患者发生体温过低的可能性比升温组高2至3倍（p<0.001）。无论患者组别如何，所有患者到达麻醉后护理单元时体温均正常。
术前使用强制空气升温器显著提高了术中0时刻的平均体温，有助于防止在术中最低点时出现体温过低。在术中，严格且持续应用的升温方案使术中体温过低的可能性显著降低，且在发生时程度也较轻。实施升温方案仅需要有限的资源和手术室文化的改变，并且手术室工作人员耐受性良好。
