The Clinical Guideline for the Prevention of Unplanned Periorative
Hypothermia
Vallire
Hooper, MSN, RN, CPAN
Clinical Nurse Specialist
American Society of Perianesthesia Nurses
Problem
Meta- analysis demonstrates
that perioperative hypothermia adversely affects patient
outcomes and increases hospital costs. Yet despite the availability
of preventative technology, it remains a common problem.
Evidence
The adverse effects
of perioperative hypothermia and effective treatment modalities
are well documented (see bibliography list). A multidisciplinary,
multispeciality panel convened to evaluate current practice
and literature with the goal of developing an evidence-based
guideline for perioperative hypothermia prevention and treatment.
Strategy
The evidence was evaluated
with 3 goals in mind:
1. Develop a definition for normothermia and hypothermia.
2. Establish the importance of maintaining perioperative
normothermia.
3. Ascertain effective management strategies for perioperative
hypothermia.
Practice change
The guideline
was developed by the panel and peer-reviewed by individuals
with expertise in perioperative hypothermia. It was then
pilot tested in 6 healthcare facilities of varying sizes
and locations.
Evaluation
Pilot test results
showed that the guideline was easy to use and follow, and
improved patient care and patient satisfaction.
Recommendations
The guideline
has been disseminated to both professional and practice
settings. It continues to gain endorsement from major
healthcare organizations involved in the care of the perioperative
patient. Future research should be focused on the effects
of guideline implementation on patient outcomes and healthcare
costs.
Bibliography
ASPAN. Clinical Guideline for the Prevention of Unplanned Perioperative Hypothermia. Available at:
http://www.aspan.org/hypothermia.htm. Accessed January 2003.
Sessler, DI. Current concepts: mild intraoperative hypothermia. N Eng J Med 1997;336:1730-1737.
Schmeid H, Kurz A, et al. Mild hypothermia increases blood loss and transfusion requirements during
total hip arthroplasty. Lancet 1995;347(1997) 289-292.
Bennett J, Ramachandra V, Webster J, Carli F. Prevention of hypothermia during hip surgery: effect of
passive compared with active skin surface warming. Br K Anaest 1994;73:A433.
Kelley SD, Prager MC, Sessler DI, Robers JP, Ascher, NL. Forced air warming minimizes hypothermia
during orthotopic liver transplantation. Anesth 1990;73:A433.
Russell SH, Freeman JW. Prevention of hypothermia during orthotopic liver transplantation; comparison
of three different intraoperative warming methods. Brit J Anaesth 1995;74:415-418.
Stapelfeldt WH, Polarski J, Janowitz M, et al. Determinants of transfusion requirements during
orthotopic liver transplantation: role of severity and cumulative duration of hypothermic episodes.
Anesth 1996;85(3A):A67.
Frank SM, Beattie C, Christopherson R, et al. Epidural versus general anesthesia, ambient operating
room temperature, and patient age as predictors of inadvertent hypothermia. Anesth 1992;77:252-7.
Carli F, Emery P, Freemantle C. Effect of intraoperative normothermia on postoperative protein
metabolism in elderly patients undergoing hip arthroplasty. Br J Anaest 1989;63:276-282.
Mahoney C, Odom J, Maintaining intraoperative normothermia: a meta-analysis of outcomes with costs.
AANA Journal 1999; 67: 155-164.
Frank S, Srinivasa N. Raja, Bulaco, C, Goldstein, D, relative contributions of core and cutaneous
temperature to thermal comfort and autonomic responses in humans. J Appl Physiol 1999
May;86950; 1588-93.
Krenzischek, D, Frank, S, Kelly, S, forced air warming vs routine thermal care and core temperature
measurement sites. JOPAN 1995; 10(2):69-77.
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