Desai Ronak, Gosschalk Jason, van Helmond Noud, Mitrev Ludmil, Zhang Catherine, McEniry Brian, Hunter Krystal, Wallace Ernest, Mele Michele, Ocbo Jennifer, Trivedi Keyur, Hsu George, Krishnan Sandeep, Dibato John, Patel Kinjal
Cooper Medical School of Rowan University, Camden, New Jersey, United States of America.
Cooper University Hospital, Camden, New Jersey, United States of America.
PLoS One. 2025 Jun 12;20(6):e0325954. doi: 10.1371/journal.pone.0325954. eCollection 2025.
To mitigate perioperative hypothermia, patients can be warmed preoperatively and intraoperatively with forced-air warming (FAW) and conductive warming (CW) methods. We examined the association of four combinations of pre- and intraoperative CW and FAW with the magnitude of intraoperative hypothermia.
We conducted a prospective randomized trial at a tertiary healthcare center in the United States (trial registration number ISRCTN23065394). Patients were randomized to 4 arms based on the following pre/intraoperative warming combinations: (1) CW/CW, (2) FAW/FAW, (3) no active prewarming (NAPW)/CW, (4) NAPW/FAW. Body temperature was measured using an esophageal probe. The area under the temperature curve (AUC) below 36°C was calculated according to the trapezoidal rule and quantified intraoperative hypothermia. A mixed model was used to estimate differences in AUC between the 4 arms.
182 patients were analyzed. Patients in the NAPW/FAW arm had the highest AUC values while those in the CW/CW arm had the lowest. AUC values [median (Q1, Q3] were as follows: CW/CW = 4.7 (0, 26.6); FAW/FAW = 8.0 (0, 30.8); NAPW/CW = 7.4 (0, 27.1); NAPW/FAW = 19.9 (5.0, 44.3). Mixed model results showed significant lower AUC values in CW/CW and NAPW/CW when compared to NAPW/FAW. The ratio of mean AUC [95% CI] between CW/CW vs NAPW/FAW was 0.49 [0.24, 0.98], 51% lower, and between NAPW/CW and NAPW/FAW, 0.46 [0.23, 0.91], 54% lower. When the AUC was normalized to the duration of surgery (AUC/case duration in°C, or "relative AUC"), significant lower relative AUC values were observed between FAW/FAW vs NAPW/FAW (48% lower, p = 0.0419) and NAPW/CW vs NAPW/FAW (48% lower, p = 0.0407).
CW is more effective than FAW at reducing intraoperative hypothermia when FAW is used without prewarming. When patients are actively prewarmed, CW and FAW show no difference in their ability to maintain patient temperature.
为减轻围手术期体温过低，可在术前和术中采用强制空气加温（FAW）和传导加温（CW）方法对患者进行加温。我们研究了术前和术中CW与FAW的四种组合与术中体温过低程度之间的关联。
我们在美国一家三级医疗中心进行了一项前瞻性随机试验（试验注册号ISRCTN23065394）。根据以下术前/术中加温组合将患者随机分为4组：（1）CW/CW，（2）FAW/FAW，（3）无主动术前加温（NAPW）/CW，（4）NAPW/FAW。使用食管探头测量体温。根据梯形法则计算36°C以下温度曲线下的面积（AUC），并对术中体温过低进行量化。使用混合模型估计4组之间AUC的差异。
对182例患者进行了分析。NAPW/FAW组患者的AUC值最高，而CW/CW组患者的AUC值最低。AUC值[中位数（Q1，Q3）]如下：CW/CW = 4.7（0，26.6）；FAW/FAW = 8.0（0，30.8）；NAPW/CW = 7.4（0，27.1）；NAPW/FAW = 19.9（5.0，44.3）。混合模型结果显示，与NAPW/FAW相比，CW/CW和NAPW/CW组的AUC值显著更低。CW/CW与NAPW/FAW之间的平均AUC[95%CI]比值为0.49[0.24，0.98]，低51%，NAPW/CW与NAPW/FAW之间的比值为0.46[0.23，0.91]，低54%。当将AUC标准化为手术持续时间（AUC/手术持续时间，单位为°C，即“相对AUC”）时，FAW/FAW与NAPW/FAW之间（低48%，p = 0.0419）以及NAPW/CW与NAPW/FAW之间（低48%，p = 0.0407）观察到显著更低的相对AUC值。
在未进行术前加温而使用FAW时，CW在降低术中体温过低方面比FAW更有效。当患者进行主动术前加温时，CW和FAW在维持患者体温的能力上没有差异。
