Vorwärmung entsprechend der „S3 Leitlinie Vermeidung von unbeabsichtigter perioperativer Hypothermie 2014“

Zusammenfassung

Hintergrund

Die deutschsprachige „S3 Leitlinie Vermeidung unbeabsichtigter perioperativer Hypothermie 2014“ war die erste international publizierte Leitlinie, die explizit die Vorwärmung von chirurgischen Patienten empfiehlt. In der klinischen Routine ist die Vorwärmung im Gegensatz zur intraoperativen Wärmung allerdings noch nicht überall implementiert. Zudem fehlen Untersuchungen, die die Effektivität der Vorwärmung in der klinischen Routine evaluieren.

Ziel der Arbeit

Das Ziel der vorliegenden Untersuchung war es, die Frage zu beantworten, welche Hypothermieraten in der klinischen Routine erzielbar sind, wenn Vorwärmung im Anästhesieeinleitungsbereich zusätzlich zur intraoperativen Wärmung durchgeführt wird.

Material und Methoden

Konvektive Vorwärmung wurde zwischen Januar 2015 und Dezember 2016 im Anästhesieeinleitungsbereich bei 3899 Patienten im Rahmen eines standardisierten Wärmemanagements zusätzlich zur intraoperativen Wärmung durchgeführt. Die Ergebnisse wurden mit denen einer Kontrollgruppe von 3887 Patienten verglichen, die zwischen Juli 2012 und August 2014 keine Vorwärmung erhielten.

Ergebnisse

Patienten mit Vorwärmung wiesen eine intraoperative Hypothermierate von 15,8 % und eine postoperative Hypothermierate von 5,1 % auf. Verglichen mit der Kontrollgruppe ohne Vorwärmung bedeutet dies eine Reduktion der intraoperativen Hypothermierate von 52 % und der postoperativen Hypothermierate von 41 % (p < 0,0001).

Schlussfolgerung

Die in der S3-Leitlinie empfohlene Vorwärmung reduzierte die Hypothermieraten auch in der klinischen Routine signifikant und klinisch relevant. Intraoperative Hypothermieraten von 15,8 % und postoperative Hypothermieraten von 5,1 % sind im klinischen Alltag erreichbar, wenn eine Vorwärmung im Anästhesieeinleitungsbereich zusätzlich zur intraoperativen Wärmung durchgeführt wird.

Abstract

Background

Inadvertent perioperative hypothermia, which is defined as a core body temperature of less than 36.0 °C, can have serious consequences in surgery patients. These include cardiac complications, increased blood loss, wound infections and postoperative shivering; therefore, the scientific evidence that inadvertent perioperative hypothermia should be avoided is undisputed and several national guidelines have been published summarizing the scientific evidence and recommending specific procedures. The German AWMF guidelines were the first to emphasize the importance of prewarming for surgery patients to avoid inadvertant perioperative hypothermia; however, in contrast to intraoperative warming, prewarming is so far not sufficiently implemented in clinical practice in many hospitals. Furthermore, a recent study has questioned the effectiveness of prewarming.

Objective

The aim of this retrospective investigation was to evaluate the hypothermia rates that can be achieved when prewarming in the anesthesia induction room is introduced into the clinical practice and performed in addition to intraoperative warming.

Material and methods

The ethics committee of the Medical Faculty of the Martin Luther University Halle Wittenberg gave approval for data storage and retrospective data analysis from the anesthesia database. According to the existing local standard operating procedure, prewarming with forced air was performed in addition to intraoperative warming in the anesthesia induction room in 3899 patients receiving general anesthesia with a duration of 30 min or longer from January 2015 to December 2016. The results were compared with a control group of 3887 patients from July 2012 to August 2014 who received intraoperative warming but were not subjected to prewarming. Tracheal intubation was carried out in all patients and temperature measurements after the induction of anesthesia were performed using esophageal, urinary catheter or intra-arterial temperature probes.

Results

The mean duration of prewarming was 25 min in the treatment group. Patients subjected to prewarming showed an intraoperative hypothermia rate of 15.8% and a postoperative hypothermia rate of 5.1%. Patients without prewarming showed an intraoperative hypothermia rate of 30.4% and a postoperative hypothermia rate of 12.4%. This means a 52% reduction of the intraoperative hypothermia rate and a 41% reduction of the postoperative hypothermia rate for patients who received prewarmimg (p < 0.0001). Multivariate logistic regression revealed that the lack of prewarming was independently associated with intraoperative hypothermia with an odds ratio of 2.5 (95% confidence interval CI 2.250–2.841; p < 0.0001) and postoperative hypothermia with an odds ratio of 2.8 (95% CI 2.316–3.277; p < 0.0001).

Conclusion

Prewarming, as recommended in the AWMF guidelines, resulted in a significant and clinically relevant reduction in the incidence of inadvertent perioperative hypothermia; therefore, prewarming can still be regarded as an effective method to avoid perioperative hypothermia. Hypothermia rates of 15.8% intraoperatively and 5.1% postoperatively can be achieved in clinical practice, when prewarming is performed in addition to intraoperative warming in the anesthesia induction room directly before the start of surgical procedures.