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Reducing the Risk

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Forced-air warming is the gold standard

20/10/2013

Forced-air warming is the gold standard of care for managing inadvertent perioperative hypothermia in operating rooms throughout the world1,8-12 and can also help reduce surgical site infections and keep patients comfortable.

More than 100 scientific studies have been written about the benefits of forced-air warming, showing it to be the most effective warming method for preventing and treating inadvertent perioperative hypothermia.1-7

For example, a study by Aki Tominaga et al found that forced-air warming using an underbody blanket may prevent the initial temperature decrease caused by redistribution temperature drop4 and was more effective at preventing hypothermia during abdominal surgery compared with water mattresses.4

In addition, forced-air warming using under and over body blankets and gowns makes surgical patients feel comfortable, protects their modesty and can reduce anxiety. It is also cost effective compared to treating the complications of inadvertent perioperative hypothermia.

Maintaining normothermia is an important tool in the fight against surgical site infections (SSIs)14-16. Healthcare quality initiatives, including guidelines from the National Institute for Clinical Excellence (NICE) and the National Health Service (NHS) Saving Lives programme, note the importance of maintaining normothermia to reduce SSIs and several organisations specifically mention forced-air warming as a key method. In surgery, maintaining normothermia has also been shown to decrease length of stay in hospital and mortality rates.18 During the past 25 years, more than 165 million patients worldwide have been warmed perioperatively using Bair Hugger™ therapy forced-air warming from 3M.13 In that time, there has never been a report of a surgical site infection linked to Bair Hugger therapy use. This type of convective warming transfers heat from forced-air warming blankets or gowns by circulating warm air around the patient’s body. This warms a greater percentage of body surface area compared with conductive methods1 In addition, fluid outlets on the underbody blankets help to keep the patient dry and minimise the cooling effect of excess fluids and the potential for skin maceration. By contrast, conductive warming transfers heat from the heating source (mattress) through direct patient contact and warms the patient only where contact is made. Depending on the positioning of the patient, contact may be limited. Pressure points may also continue to be warmed, increasing the risk of thermal injury and there is the potential for fluids to pool on the surface of the mattress. Bair Hugger™ and Bair Paws™ therapy from 3M are a flexible range of overbody and underbody forced-air warming blankets and forced-air warming gowns that provide effective warming solutions for virtually any surgical procedure and patient. They can be used preoperatively, intraoperatively and postoperatively.

The Bair Hugger therapy blankets and Bair Paws warming gowns from 3M are single patient use - reducing the potential for cross-contamination when compared with reusable devices - and are convenient to use as no cleaning is required.

You can find out more about forced-air warming by visiting www.bairhugger.co.uk. 3M also offers E-Learning courses to health care professionals who would like to learn more about patient warming. For access log in and register at www.3m.co.uk/elearning.

References

1 Brauer, A., et al (2004), Conductive Heat Exchange with a Gel-Coated Circulating Water Mattress. Anaesthesia and Analgesia, Vol. 6, No. 99, pp. 1742-1746
2. Sessler, D.I, (1997), Current Concepts: mild perioperative hypothermia, New England Journal of Medicine, No. 336, pp. 1730-1737.
3. Karlnoski, R. et. al. Intraoperative Warming with vitalHEAT during Open Abdominal Surgery. ASA abstracts, 2010. A086. * vitalHEAT is a trademark of Dynatherm Medical, Inc.
4. Tominaga A, Koitabashi T, Ouchi T, Ban R, Takano E. Efficacy of an underbody forced-air warming blanket for the prevention of intraoperative hypothermia. Anesthesiology. Vol 1072007:A91.
5. Ouchi, T. et. al. Lithotomy Underbody Air Blanket Can Prevent Intraoperative Redistribution Hypothermia . ASA abstracts, 2010. A088.
6. Engelen, S, et al. (2010) A Comparison of Under-Body Forced Air and Resistive Heating during Hypothermic,on-pump cardiac surgery. Anaesthesia, Vol.66, No.2 , pp.104-110.
7. Roder, G. eta al (2011), Intra-operative rewarming with Hot Dog(Resistered symbol R in circle) resistive heating and forced-air heating: a trial of lower -body warming, Anaesthesia, Vol 66, No. 8, pp. 667-674.
8. Sessler DI, Moayeri A. (1990), Skin-surface warming: heat flux and central temperature. Anesthesiology, No.73, pp. 218–24.
9. Giesbrecht GG, Ducharme MB, McGuire JP. (1994), Comparison of forced-air patient warming systems for perioperative use. Anesthesiology, No.80, pp.671–9.
10. Hynson JM, Sessler DI. (1992), Intraoperative warming therapies: a comparison of three devices. Journal of Clinical Anesthesia, No. 4, pp. 194–9.
11. Kurz A, Kurz M, Poeschl G, Faryniak B, Redl G, Hackl W. (1993), Forced-air warming maintains intraoperative normothermia better than circulating-water mattresses. Anesthesia Analgesia , No. 77, pp. 89–95.
12. Borms SF, Englelen SL, Himpe DG, Suy MR, Theunissen WJ. (1994), Bair Hugger forced-air warming maintains normothermia more effectively than thermo-lite insulation. Journal of Clinical Anesthesia, No. 6, pp.303–7.
13. Data on file at 3M US, based on internal sales data from Arizant USA, a 3M company 2012.
14. Zink RS, Iaizzo PA, (1993), Conductive warming therapy does not increase the risk of wound contamination in the operating room. Anesthesia Analgesia, No. 76, pp.50-3.
15. Huang JK, Shah EF, Vinodkumar N, Hegarty MA, Greatorex RA, (2003), The Bair Hugger patient warming system in prolonged vascular surgery: an infection risk? Critical Care No. 7, R13–R16
16. Kurz A., Sessler D.I., Lenhardt R.L. (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. New England Journal of Medicine No. 334, Vol. 19, pp. 1209-1215
17. Sessler DI, Olmsted RN, Kuelpmann R. Forced-air warming does not worsen air quality in laminar flow operating rooms. Anesthesia & Analgesia, No. 113, pp. 1416-21
18. Mahoney CB, Odom J. (1999), Maintaining intraoperative normothermia: A meta-analysis of outcomes with costs. AANA Journal. No. 67, pp. 155-163.

3M is a trademark of 3M Company.
Bair Hugger and Bair Paws are trademarks of Arizant Healthcare Inc.


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