Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany.
Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany.
Paediatr Anaesth. 2023 Feb;33(2):114-122. doi: 10.1111/pan.14580. Epub 2022 Oct 30.
Maintenance of normothermia is an important quality metric in pediatric anesthesia. While inadvertent hypothermia is effectively prevented by forced-air warming, this therapeutic approach can lead to iatrogenic hyperthermia in young children.
To estimate the influence of external warming by forced air on the development of intraoperative hyperthermia in anesthetized children aged 6 years or younger.
We pooled data from two previous clinical studies. Primary outcome was the course of core temperature over time analyzed by a quadratic regression model. Secondary outcomes were the incidence of hyperthermia (body core temperature >38°C), the probability of hyperthermia over the duration of warming in relation to age and surface-area-to-weight ratio, respectively, analyzed by multiple logistic regression models. The influence of baseline temperature on hyperthermia was estimated using a Cox proportional hazards model.
Two hundred children (55 female) with a median age of 2.1 [1 -3 quartile 1-4.2] years were analyzed. Mean temperature increased by 0.43°C after 1 h, 0.64°C after 2 h, and reached a peak of 0.66°C at 147 min. Overall, 33 children were hyperthermic at at least one measurement point. The odds ratios of hyperthermia were 1.14 (95%-CI: 1.07-1.22) or 1.13 (95%-CI: 1.06-1.21) for every 10 min of warming therapy in a model with age or surface-area-to weight ratio (ceteris paribus), respectively. Odds ratio was 1.33 (95%-CI: 1.07-1.71) for a decrease of 1 year in age and 1.63 (95%-CI: 0.93-2.83) for an increase of 0.01 in the surface-to-weight-area ratio (ceteris paribus). An increase of 0.1°C in baseline temperature increased the hazard of becoming hyperthermic by a factor of 1.33 (95%-CI: 1.23-1.43).
In children, external warming by forced-air needs to be closely monitored and adjusted in a timely manner to avoid iatrogenic hyperthermia especially during long procedures, in young age, higher surface-area-to-weight ratio, and higher baseline temperature.
维持正常体温是小儿麻醉的一个重要质量指标。虽然强制空气加热有效地防止了意外低温，但这种治疗方法可能导致幼儿医源性发热。
估计在 6 岁或以下接受麻醉的儿童中，通过强制空气进行外部加热对术中发热发展的影响。
我们汇集了两项先前临床研究的数据。主要结果是通过二次回归模型分析核心温度随时间的变化过程。次要结果是通过多元逻辑回归模型分析与年龄和表面积与体重比分别相关的术中发热（核心体温>38°C）的发生率，以及发热的概率在与年龄和表面积与体重比分别相关的时间段内与年龄和表面积与体重比的关系。使用 Cox 比例风险模型估计基础体温对发热的影响。
分析了 200 名儿童（55 名女性）的中位数年龄为 2.1 [1-3 四分位距 1-4.2]岁。1 小时后平均温度升高 0.43°C，2 小时后升高 0.64°C，147 分钟时达到 0.66°C的峰值。总体而言，33 名儿童至少有一个测量点发热。在年龄或表面积与体重比的模型中，每 10 分钟加热治疗增加 1°C，发热的优势比分别为 1.14（95%CI：1.07-1.22）或 1.13（95%CI：1.06-1.21）（恒等）。年龄每减少 1 岁，优势比为 1.33（95%CI：1.07-1.71），表面积与体重比每增加 0.01，优势比为 1.63（95%CI：0.93-2.83）（恒等）。基础体温升高 0.1°C，发热的危险比增加 1.33（95%CI：1.23-1.43）。
在儿童中，通过强制空气进行外部加热需要密切监测并及时调整，以避免医源性发热，特别是在手术时间长、年龄较小、表面积与体重比较高、基础体温较高的情况下。
