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Talhaoğlu D, Başer M, Özgün MT. The Effects of Actively Warming the Patient on Maternal and Infant Well-Being in a Cesarean Section Operation. J Perianesth Nurs 2024; 39:366-374. [PMID: 38219080 DOI: 10.1016/j.jopan.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 07/16/2023] [Accepted: 08/23/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE Intraoperative warming is recommended for surgical patients under anesthesia, but there are insufficient studies on this topic in cesarean delivery patients under spinal anesthesia. The purpose of this study was to determine the effects of active warming on the mother and newborn during elective cesarean section. DESIGN This research was carried out in an experimental design with a pretest-posttest randomized intervention and control group. METHODS The research was conducted with 34 women (17 intervention and 17 control), who gave birth by cesarean section. The study examined outcomes for both mother and newborn. Women in the intervention group were heated by both active (warmed with carbon fiber resistive underbody heaters during surgery) and passive heating (preoperative- socks, nonelectrified wool blankets, etc). Only passive heating methods were applied to the women in the control group (preoperative). Neonatal Activity - Pulse - Grimace - Appearence - Respiration (APGAR) score, body temperature, cortisol, and blood glucose levels in the intervention and control groups were evaluated, while body temperature and shivering conditions were evaluated in the mother. FINDINGS Body temperature and first minute APGAR score of the infants in the intervention and control groups after cesarean section were 36.88 ± 0.27, 36.52 ± 0.32 (P = .002); 7.00 ± 0.36, 7.47 ± 0.64 (P = .009), respectively. Cortisol and blood glucose levels in the intervention and control groups were 3.55 ± 1.09, 4.51 ± 0.70 (P = .010), 77.94 ± 7.07, 72.47 ± 10.24 (P > .05), respectively. The body temperatures of the women in the intervention and control groups at 15, 30, and 45 minutes were significantly different (P < .05), while they were similar (P > .05) at 60 minutes. Oxygen saturation measured at 30 minutes during the operation was 97.10 ± 1.41 in the intervention group and 95.20 ± 1.78 in the control group (P < .05). CONCLUSIONS Active warming before, during, and after cesarean section affected body temperature, pulse, respiration, blood pressure, and oxygen saturation of women, and while it increased the body temperature and APGAR score of newborns, it decreased cortisol level.
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Affiliation(s)
- Dilek Talhaoğlu
- Osmaniye Korkut Ata University, Vocational School of Health Services, Osmaniye, Turkey.
| | - Mürüvvet Başer
- Department of Gynecology and Obstetrics Nursing, Erciyes University, Faculty of Health Sciences, Kayseri, Turkey
| | - Mahmut Tuncay Özgün
- Department of Surgical Medical Science, Erciyes University, Medical School, Kayseri, Turkey
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Uçak A, Tat Çatal A, Karadağ E, Cebeci F. The Effect of Prewarming on Perioperative Hypothermia: A Systematic Review and Meta-analysis of Randomized Controlled Studies. J Perianesth Nurs 2024:S1089-9472(23)01046-8. [PMID: 38340096 DOI: 10.1016/j.jopan.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/03/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE One of the methods for maintaining perioperative normothermia is prewarming. This study was conducted to investigate the effect of a preoperative prewarming intervention on perioperative body temperature. DESIGN Systematic review and meta-analysis. METHODS A literature review was conducted using PubMed, CINAHL, Cochrane Central, Science Direct, Springer Link, Scopus, Web of Science, and Ovid databases. Randomized controlled trials that investigate the effect of prewarming on body temperature in the prevention of perioperative hypothermia were included. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. Methodological quality was assessed using the Cochrane Collaboration "risk of bias" tool. Meta-analysis was performed with Comprehensive Meta-Analysis, version 2. Moderator analysis and publication bias assessment were performed. Funnel plots were analyzed using Orwin's fail-safe N, Trim, and Fill test method to investigate the source of heterogeneity. FINDINGS A total of 907 studies were found. The systematic review included 27 studies. Of these, 23 were included in the intraoperative meta-analysis, and 16 were included in the postoperative meta-analysis. According to the meta-analysis results, the prewarming intervention was effective in maintaining normothermia in the intraoperative (Hedge's g = 0.972, 95% confidence intervaI = 0.674 to 1.270) and postoperative (Hedge's g = 0.818, 95% confidence intervaI = 0.520 to 1.114) periods. CONCLUSIONS The findings of this systematic review and meta-analysis showed that preoperative prewarming played a significant role in providing and maintaining perioperative normothermia.
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Affiliation(s)
- Ayşe Uçak
- Faculty of Health Sciences, Department of Nursing, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Arzu Tat Çatal
- Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Engin Karadağ
- Faculty of Education, Akdeniz University, Antalya, Turkey
| | - Fatma Cebeci
- Faculty of Nursing, Head of the Surgical Nursing Department, Akdeniz University, Antalya, Turkey
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Rogers A, Ho G, Mosa A, Cartotto R. Ambient Room Temperatures in a Burn Intensive Care Unit-A Quality Improvement Project. Plast Surg (Oakv) 2023; 31:358-365. [PMID: 37915353 PMCID: PMC10617462 DOI: 10.1177/22925503221078689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/03/2023] Open
Abstract
Introduction: Patients with major burn injuries are particularly susceptible to hypothermia. The ability to maintain and rapidly increase ambient temperatures may reduce the impact of hypothermia and the hypermetabolic response. The purpose of this study was to determine ambient patient room temperatures in a burn intensive care unit (ICU) and to evaluate our ability to adjust these temperatures. Methods: The ambient temperatures of 9 burn ICU patient rooms were recorded hourly over a 6-month period in an American Burn Association-verified burn centre. Temperatures were recorded using wall-mounted smart sensors, transmitted to a mobile smartphone application via Bluetooth, and then exported to Excel for analysis. On 2 predetermined dates, thermostats in all rooms were simultaneously set to maximum, and monitored over 3 h. This represented a sound change initiative, and replicated a medical order to increase the ambient temperature during critical stages of patient care. Results: We recorded 4394 individual hourly temperature measurements for each of the 9 rooms. The mean ambient temperature was 23.5 ± 0.3 °C (range 22.8-24). After intervention 1, ambient temperatures increased <2 °C in 7 rooms and by only 2 °C-3 °C in the other 2 rooms. The overall mean increase in temperature over 3 h across all rooms was 1.03 °C ± 1.19 °C (range -0.88 to 3.26). Following intervention 2, temperatures could be increased by ≥2 °C in only 2 rooms with an overall mean increase in temperature of only 0.76 °C ± 0.99 °C (range -0.29 to 2.43) across all rooms. Conclusions: The burn ICU rooms were relatively cool and our ability locally to adjust ambient temperatures quickly was limited. Burn centres should have regular facility assessments to assess whether ambient temperatures can be adjusted expeditiously when required.
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Affiliation(s)
- Alan Rogers
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, Division of Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, ON, Canada
| | - George Ho
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, Division of Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, ON, Canada
| | - Adam Mosa
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, Division of Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, ON, Canada
| | - Robert Cartotto
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, Division of Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, ON, Canada
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Calderwood MS, Anderson DJ, Bratzler DW, Dellinger EP, Garcia-Houchins S, Maragakis LL, Nyquist AC, Perkins KM, Preas MA, Saiman L, Schaffzin JK, Schweizer M, Yokoe DS, Kaye KS. Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:695-720. [PMID: 37137483 PMCID: PMC10867741 DOI: 10.1017/ice.2023.67] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing their surgical-site infection (SSI) prevention efforts. This document updates the Strategies to Prevent Surgical Site Infections in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Affiliation(s)
| | - Deverick J. Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina, United States
| | - Dale W. Bratzler
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | | | | | - Lisa L. Maragakis
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Ann-Christine Nyquist
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Kiran M. Perkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Michael Anne Preas
- University of Maryland Medical System, Baltimore, Maryland, United States
| | - Lisa Saiman
- Columbia University Irving Medical Center and NewYork–Presbyterian Hospital, New York, New York, United States
| | - Joshua K. Schaffzin
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Marin Schweizer
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, University of Iowa, Iowa City, Iowa
| | - Deborah S. Yokoe
- University of California-San Francisco, San Francisco, California, United States
| | - Keith S. Kaye
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
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Deng X, Yan J, Wang S, Li Y, Shi Y. Clinical Survey of Current Perioperative Body Temperature Management: What Major Factors Influence Effective Hypothermia Prevention Practice? J Multidiscip Healthc 2022; 15:1689-1696. [PMID: 35965636 PMCID: PMC9374200 DOI: 10.2147/jmdh.s376423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Inadvertent intraoperative hypothermia (IIH) is generally associated with several postoperative complications. Inspite of the existing guidelines, the global incidence of IIH remains unacceptably high. Understanding the conditions that influence temperature management is critical for developing future interventions to improve the postoperative patient outcomes. This study aimed to identify the major factors that hinder the implementation of IIH prevention practices. Methods Through a literature research, pilot small-sample investigation, and expert suggestions, 11 factors that may hinder the implementation of IIH prevention practices were identified. A questionnaire was developed, and each question was used to assess each factor. After approval by the Research Ethics Board, the questionnaires were sent to the staff anaesthesiologists at two academic hospitals via WeChat. Each answer was coded according to the degree to which the factor was affected, as anticipated. Finally, the answers were analysed based on the 80/20 rule to identify the major barriers to effective temperature management. Results We included 195 participants. Knowledge, memory, attention and decision processes, beliefs about consequences, and environmental context and resources were the major factors, with cumulative composition ratios of 24%, 43.4%, 57.7%, and 70.7%, respectively. Meanwhile, behavioural regulation and social influence were the secondary factors, with cumulative composition ratios of 80.4% and 87.5%, respectively. Reinforcement, confidence in capacity, duty realisation, skills, and intention were the general factors with cumulative composition ratios of 94.3%, 99.8%, 100%, 100%, and 100%, respectively. Conclusion Four factors-knowledge, memory, attention and decision process, beliefs about consequences, and environmental context and resources-were the major factors that influence the effective hypothermia prevention practice. Relevance to Clinical Practice These major factors will be used in further studies as a basis to develop the corresponding solutions and improve the patient outcomes in clinical practice.
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Affiliation(s)
- Xiaoqian Deng
- Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, People's Republic of China
| | - Junyu Yan
- Department of Anesthesiology, Karamay Hospital of Integrated Traditional Chinese and Western Medicine, Karamay, People's Republic of China
| | - Shaungwen Wang
- West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Yifan Li
- West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Yun Shi
- Department of Anesthesiology, Children's Hospital of Fudan University, Fudan University, Shanghai, People's Republic of China
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Drewry AM, Mohr NM, Ablordeppey EA, Dalton CM, Doctor RJ, Fuller B, Kollef MH, Hotchkiss RS. Therapeutic Hyperthermia Is Associated With Improved Survival in Afebrile Critically Ill Patients With Sepsis: A Pilot Randomized Trial. Crit Care Med 2022; 50:924-934. [PMID: 35120040 PMCID: PMC9133030 DOI: 10.1097/ccm.0000000000005470] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To test the hypothesis that forced-air warming of critically ill afebrile sepsis patients improves immune function compared to standard temperature management. DESIGN Single-center, prospective, open-label, randomized controlled trial. SETTING One thousand two hundred-bed academic medical center. PATIENTS Eligible patients were mechanically ventilated septic adults with: 1) a diagnosis of sepsis within 48 hours of enrollment; 2) anticipated need for mechanical ventilation of greater than 48 hours; and 3) a maximum temperature less than 38.3°C within the 24 hours prior to enrollment. Primary exclusion criteria included: immunologic diseases, immune-suppressing medications, and any existing condition sensitive to therapeutic hyperthermia (e.g., brain injury). The primary outcome was monocyte human leukocyte antigen (HLA)-DR expression, with secondary outcomes of CD3/CD28-induced interferon gamma (IFN-γ) production, mortality, and 28-day hospital-free days. INTERVENTIONS External warming using a forced-air warming blanket for 48 hours, with a goal temperature 1.5°C above the lowest temperature documented in the previous 24 hours. MEASUREMENTS AND MAIN RESULTS We enrolled 56 participants in the study. No differences were observed between the groups in HLA-DR expression (692 vs 2,002; p = 0.396) or IFN-γ production (31 vs 69; p = 0.678). Participants allocated to external warming had lower 28-day mortality (18% vs 43%; absolute risk reduction, 25%; 95% CI, 2-48%) and more 28-day hospital-free days (difference, 2.6 d; 95% CI, 0-11.6). CONCLUSIONS Participants randomized to external forced-air warming did not have a difference in HLA-DR expression or IFN-γ production. In this pilot study, however, 28-day mortality was lower in the intervention group. Future research should seek to better elucidate the impact of temperature modulation on immune and nonimmune organ failure pathways in sepsis.
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Affiliation(s)
- Anne M. Drewry
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Nicholas M. Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Epidemiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Enyo A. Ablordeppey
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Catherine M. Dalton
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Rebecca J. Doctor
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Brian Fuller
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Marin H. Kollef
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Richard S. Hotchkiss
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Aggarwal G, Scott M, Peden CJ. Emergency Laparotomy. Anesthesiol Clin 2022; 40:199-211. [PMID: 35236580 DOI: 10.1016/j.anclin.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Emergency laparotomy is a high-risk surgical procedure with mortality and morbidity up to 10 times higher than for a similar procedure performed electively. An enhanced recovery approach has been shown to improve outcomes. A focus on rapid correction of underlying deranged acute physiology and proactive management of conditions associated with aging such as frailty and delirium are key. Patients are at high risk of complications and prevention and avoidance of failure to rescue are essential to improve outcomes. Other enhanced recovery components such as opioid-sparing analgesia and early postoperative mobilization are beneficial.
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Affiliation(s)
- Geeta Aggarwal
- Royal Surrey Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX, UK.
| | - Michael Scott
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Surgical Outcomes Research Centre, University College London, London, UK
| | - Carol J Peden
- Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Clinical Quality the Blue Cross Blue Shield Association, Chicago, IL 60601, USA
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8
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Ribeiro BB, Pereira RD, Vaz R, Carvalho B, Pereira NR. Nonemergent craniotomy surgical site infection: a retrospective cohort study. Porto Biomed J 2022; 7:e152. [PMID: 38304161 PMCID: PMC10830068 DOI: 10.1097/j.pbj.0000000000000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background The incidence of surgical site infection after craniotomy (SSI-CRAN) varies widely and is associated with major consequences. The aim of this study is to estimate the SSI-CRAN rate at the neurosurgery department of a tertiary center and to establish its risk factors. Methods All consecutive adult patients who underwent elective craniotomy for tumor resection at a tertiary center from January 2018 to October 2019 were retrospectively assessed. Demographic, clinical, and surgical data were collected. The main outcome of our study was the development of SSI within 30days postsurgery, as defined by the European Centre for Disease Prevention and Control guidelines. Univariate and multivariate analyses were performed to establish risk factors for SSI-CRAN. Results From the 271 patients enrolled in this study, 15 (5.5%) developed SSI-CRAN within 30days postsurgery, 11 (73.3%) of which were organ-space. The most common causative microorganisms isolated were gram-positive cocci, particularly Staphylococcus epidermidis (n = 4, 66.7%). In the univariate analysis, absence of normothermia and cerebrospinal fluid (CSF) leak were associated with SSI-CRAN. In the multivariate analysis, normothermia was the only protective factor and CSF leak was the only independent risk factor for SSI-CRAN. Conclusion The cumulative incidence of SSI-CRAN within 30days postsurgery was 5.5%. CSF leak and the absence of normothermia were the only independent risk factors for SSI-CRAN. The data provided in this study should be considered in the design of preventive strategies aimed to reduce the incidence of SSI.
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Affiliation(s)
| | - Raquel Duro Pereira
- Antimicrobial Resistance and Infection Prevention and Control Unit, Epidemiology Centre, Centro Hospitalar Universitário São João
- Infectious Diseases Department, Centro Hospitalar Universitário São João
| | - Rui Vaz
- Faculty of Medicine, University of Porto
- Neurosurgery Department, Centro Hospitalar Universitário São João
- Neurosciences Centre, CUF Hospital
| | - Bruno Carvalho
- Faculty of Medicine, University of Porto
- Neurosurgery Department, Centro Hospitalar Universitário São João
| | - Nuno Rocha Pereira
- Antimicrobial Resistance and Infection Prevention and Control Unit, Epidemiology Centre, Centro Hospitalar Universitário São João
- Infectious Diseases Department, Centro Hospitalar Universitário São João
- Medicine Department, Faculty of Medicine, University of Porto, Porto, Portugal
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9
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Hu QL, Ko CY. Prevention of Perioperative Surgical Site Infection. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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10
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Leisy PJ, Barnes RD, Weavind LM. Are Surgical Site Infections an Anesthesiologist's Problem? Adv Anesth 2021; 39:1-15. [PMID: 34715969 DOI: 10.1016/j.aan.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Philip J Leisy
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, 422 MAB, Nashville, TN 37212, USA.
| | - Robert D Barnes
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, 422 MAB, Nashville, TN 37212, USA
| | - Liza M Weavind
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, 422 MAB, Nashville, TN 37212, USA
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11
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Kümin M, Jones CI, Woods A, Bremner S, Reed M, Scarborough M, Harper CM. Resistant fabric warming is a viable alternative to forced-air warming to prevent inadvertent perioperative hypothermia during hemiarthroplasty in the elderly. J Hosp Infect 2021; 118:79-86. [PMID: 34637849 DOI: 10.1016/j.jhin.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is associated with inadvertent perioperative hypothermia (IPH). This can be prevented by active patient warming. However, results from comparisons of warming techniques are conflicting. They are based mostly on elective surgery, are from small numbers of patients, and are dominated by the market leader, forced-air warming (FAW). Furthermore, the definition of hypothermia is debatable and systematic reviews of warming systems conclude that a stricter control of temperature is required to study the benefits of warming. AIM To analyse core temperatures in detail in a large subset of elderly patients who took part in a randomized trial of patient warming following hemiarthroplasty who had received constant zero-flux thermometry to record their temperature. METHODS Regression models with a fixed effect for warming group and covariates related to temperature were compared for 257 participants randomized to FAW or resistant fabric warming (RFW) from a prior clinical trial. FINDINGS Those in the RFW group were -0.08°C cooler and had a cumulative hypothermia score -1.87 lower than those in the FAW group. There was no difference in the proportion of hypothermic patients at either <36.5°C or <36.0°C. CONCLUSIONS This is the first study to provide accurate temperature measurements in patients undergoing a procedure predominantly under regional rather than general anaesthetic. It shows that RFW is a viable alternative to FAW for preventing IPH during hemiarthroplasty. Further studies are needed to measure the benefits of patient warming in terms of clinically important outcomes.
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Affiliation(s)
- M Kümin
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - C I Jones
- Brighton and Sussex Medical School, Brighton, UK
| | - A Woods
- Milton Keynes University Hospitals NHS Foundation Trust, Milton Keynes, UK
| | - S Bremner
- Brighton and Sussex Medical School, Brighton, UK
| | - M Reed
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - M Scarborough
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C M Harper
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
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12
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Rauch S, Miller C, Bräuer A, Wallner B, Bock M, Paal P. Perioperative Hypothermia-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8749. [PMID: 34444504 PMCID: PMC8394549 DOI: 10.3390/ijerph18168749] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/25/2022]
Abstract
Unintentional hypothermia (core temperature < 36 °C) is a common side effect in patients undergoing surgery. Several patient-centred and external factors, e.g., drugs, comorbidities, trauma, environmental temperature, type of anaesthesia, as well as extent and duration of surgery, influence core temperature. Perioperative hypothermia has negative effects on coagulation, blood loss and transfusion requirements, metabolization of drugs, surgical site infections, and discharge from the post-anaesthesia care unit. Therefore, active temperature management is required in the pre-, intra-, and postoperative period to diminish the risks of perioperative hypothermia. Temperature measurement should be done with accurate and continuous probes. Perioperative temperature management includes a bundle of warming tools adapted to individual needs and local circumstances. Warming blankets and mattresses as well as the administration of properly warmed infusions via dedicated devices are important for this purpose. Temperature management should follow checklists and be individualized to the patient's requirements and the local possibilities.
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Affiliation(s)
- Simon Rauch
- Department of Anaesthesiology and Intensive Care Medicine, “F. Tappeiner” Hospital, 39012 Merano, Italy;
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy
| | - Clemens Miller
- Department of Anaesthesiology, University Medical Centre Goettingen, 37075 Goettingen, Germany; (C.M.); (A.B.)
| | - Anselm Bräuer
- Department of Anaesthesiology, University Medical Centre Goettingen, 37075 Goettingen, Germany; (C.M.); (A.B.)
| | - Bernd Wallner
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Matthias Bock
- Department of Anaesthesiology and Intensive Care Medicine, “F. Tappeiner” Hospital, 39012 Merano, Italy;
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, 5010 Salzburg, Austria;
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13
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Effect of an Insulation Device in Preventing Hypothermia during Magnetic Resonance Imaging Examinations for Dogs and Cats under General Anesthesia. Animals (Basel) 2021; 11:ani11082378. [PMID: 34438834 PMCID: PMC8388625 DOI: 10.3390/ani11082378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Magnetic resonance imaging examinations require general anesthesia, and it is difficult to prevent a decrease in body temperature because a machine for warming the body cannot be placed in the magnetic resonance imaging room, which must have a low room temperature. In this study, we created a heat insulating device that does not affect magnetic resonance imaging and examined the effectiveness of this device for dogs and cats undergoing magnetic resonance imaging examinations. In the dogs and cats wearing bubble wrap and down cloth blanket, the decrease in body temperature was minimal. The heat insulating device developed in this study protected the animals from the cold air and prevented heat loss from the body surface, minimizing a decrease in body temperature. The results obtained in this study suggest that dogs and cats requiring magnetic resonance imaging can be protected from hypothermia due to general anesthesia without the need for special machinery. Abstract Dogs and cats under general anesthesia may develop hypothermia. When performing a magnetic resonance imaging (MRI) examination, it is not possible to place a magnetic material in the MRI room, and MRI equipment requires a low room temperature. This study investigated the effectiveness of a heat insulating device that prevented hypothermia during MRI examinations in dogs and cats. The animals that underwent MRI examinations under general anesthesia were divided into control groups (no covering) and heat insulating groups (wearing bubble wrap and down cloth blankets), and their body temperatures were measured before and after the MRI examinations. The changes in body temperatures were as follows: control dogs (n = 17), median of −1.0 (from −2.5 to 0.3) °C; heat insulated dogs (n = 7), −0.3 (from −0.8 to 0.2) °C; control cats (n = 14), −1.85 (from −2.7 to −0.6) °C; and heat insulated cats (n = 12), −0.8 (from −1.5 to −0.1) °C. These results revealed that the bubble wrap and down cloth blanket significantly prevented hypothermia and heat loss from the body surface during MRI examinations of dogs and cats.
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Sherer EL, Erickson EC, Holland MH. Enhanced Recovery After Surgery. PHYSICIAN ASSISTANT CLINICS 2021. [DOI: 10.1016/j.cpha.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Xiao Y, Zhang R, Lv N, Hou C, Ren C, Xu H. Effects of a preoperative forced-air warming system for patients undergoing video-assisted thoracic surgery: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e23424. [PMID: 33235123 PMCID: PMC7710179 DOI: 10.1097/md.0000000000023424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The incidence of intraoperative hypothermia is still high despite the proposal of different preventive measures during thoracoscopic surgery. This randomized control study evaluated the effects of 30-minute prewarming combined with a forced-air warming system during surgery to prevent intraoperative hypothermia in patients undergoing video-assisted thoracic surgery under general anesthesia combined with erector spinae nerve block. METHODS Ninety-eight patients were randomly and equally allocated to prewarming or warming groups (n = 49 each). The primary outcome was the incidence of intraoperative hypothermia. Secondary outcomes were core temperature, irrigation and infused fluid, estimated blood loss, urine output, type of surgery, intraoperative anesthetic dosage, hemodynamics, recovery time, the incidence of postoperative shivering, thermal comfort, postoperative sufentanil consumption and pain intensity, patient satisfaction, and adverse events. RESULTS The incidence of intraoperative hypothermia was significantly lower in the prewarming group than the warming group (12.24% vs 32.65%, P = .015). Core temperature showed the highest decrease 30 minutes after surgery start in both groups; however, the rate was lower in the prewarming than in the warming group (0.31 ± 0.04°C vs 0.42 ± 0.06°C, P < .05). Compared with the warming group, higher core temperatures were recorded for patients in the prewarming group from T1 to T6 (P < .05). Significantly fewer patients with mild hypothermia were in the prewarming group (5 vs 13, P = .037) and recovery time was significantly reduced in the prewarming group (P < .05). Although the incidence of postoperative shivering was lower in the prewarming group, it was not statistically significant (6.12% vs 18.37%, P = .064). Likewise, the shivering severity was similar for both groups. Thermal comfort was significantly increased in the prewarming group, although patient satisfaction was comparable between the 2 groups (P > .05). No adverse events occurred associated with the forced-air warming system. Both groups shared similar baseline demographics, type of surgery, total irrigation fluid, total infused fluid, estimated blood loss, urine output, intraoperative anesthetic dosage, hemodynamics, duration of anesthesia and operation time, postoperative sufentanil consumption, and pain intensity. CONCLUSION In patients undergoing video-assisted thoracic surgery, prewarming for 30 minutes before the induction of anesthesia combined with a forced-air warming system may improve perioperative core temperature and the thermal comfort, although the incidence of postoperative shivering and severity did not improve.
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Affiliation(s)
| | | | - Na Lv
- Department of Operation Room
| | | | - Chunguang Ren
- Department of Anaesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Huiying Xu
- Department of Anaesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
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Rove KO, Strine AC, Wilcox DT, Vricella GJ, Welch TP, VanderBrink B, Chu DI, Chaudhry R, Zee RS, Brockel MA. Design and development of the Pediatric Urology Recovery After Surgery Endeavor (PURSUE) multicentre pilot and exploratory study. BMJ Open 2020; 10:e039035. [PMID: 33234633 PMCID: PMC7684811 DOI: 10.1136/bmjopen-2020-039035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Lower urinary tract reconstruction in paediatric urology represents a physiologically stressful event that is associated with high complication rates, including readmissions and emergency room visits. Enhanced recovery after surgery (ERAS) protocol is a set of multidisciplinary, perioperative strategies designed to expedite surgical recovery without adversely impacting readmission or reoperation rates. Early paediatric urology data demonstrated ERAS reduced complications in this population. METHODS AND ANALYSIS In 2016, a working group of paediatric urologists and anaesthesiologists convened to develop an ERAS protocol suitable for patients undergoing lower urinary tract reconstruction and define study process measures, patient-reported outcomes and clinically relevant outcomes in paediatric and adolescent/young adult patients. A multicentre, prospective, propensity-matched, case-control study design was chosen. Each centre will enrol five pilot patients to verify implementation. Subsequent enrolled patients will be propensity matched to historical controls. Eligible patients must be aged 4-25 years and undergoing planned operations (bladder augmentation, continent ileovesicostomy or appendicovesicostomy, or urinary diversion). 64 ERAS patients and 128 controls will be needed to detect a decrease in mean length of stay by 2 days. Pilot phase outcomes include attainment of ≥70% mean protocol adherence per patient and reasons for protocol deviations. Exploratory phase primary outcome is ERAS protocol adherence, with secondary outcomes including length of stay, readmissions, reoperations, emergency room visits, 90-day complications, pain scores, opioid usage and differences in Quality of Recovery 9 scores. ETHICS AND DISSEMINATION This study has been registered with authors' respective institution review boards and will be published in peer-reviewed journals. It will provide robust insight into the feasibility of ERAS in paediatric urology, determine patient outcomes and allow for iteration of ERAS implementations as new best practices and evidence for paediatric surgical care arise. We anticipate this study will take 4 years to fully accrue with completed follow-up. TRIAL REGISTRATION NUMBER NCT03245242; Pre-results.
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Affiliation(s)
- Kyle O Rove
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Urology, Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Andrew C Strine
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Duncan T Wilcox
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Urology, Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Gino J Vricella
- Division of Pediatric Urology, St Louis Children's Hospital, St Louis, Missouri, USA
- Division of Urology, Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Timothy P Welch
- Division of Urology, Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
- Department of Anesthesiology, St Louis Children's Hospital, St Louis, Missouri, USA
| | - Brian VanderBrink
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - David I Chu
- Division of Urology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Rajeev Chaudhry
- Division of Pediatric Urology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rebecca S Zee
- Division of Urology, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA
| | - Megan A Brockel
- Department of Anesthesiology, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Anesthesiology, University of Colorado, Aurora, Colorado, USA
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Enhanced recovery after surgery (ERAS) in gynecology oncology. Eur J Surg Oncol 2020; 47:952-959. [PMID: 33139130 DOI: 10.1016/j.ejso.2020.10.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022] Open
Abstract
The Enhanced Recovery After Surgery (ERAS) is a pathway designed to achieve early recovery for patients undergoing major surgery. The ERAS pathway included three important components preoperative, intraoperative, postoperative program. Pre-habilitation and re-habilitation are of paramount importance to improve patients' care. The ERAS is based on evidence-based medicine. Accumulating evidence highlighted that adopting ERAS resulted in lower complication rate, and shorter length of hospital stay in comparison to standard protocols of care. The adoption of the ERAS resulted in a significant improvement of patients' outcomes and a reduction of the overall cost of care. In the present review, we summarized current evidence on ERAS, focusing on the steps useful for its adoption into clinical practice.
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Poveda VDB, Oliveira RA, Galvão CM. Perioperative body temperature maintenance and occurrence of surgical site infection: A systematic review with meta-analysis. Am J Infect Control 2020; 48:1248-1254. [PMID: 32057511 DOI: 10.1016/j.ajic.2020.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Current guidelines recommend perioperative warming as one of the strategies to prevent surgical site infection, although there are gaps in the knowledge produced on this issue. AIM Assess the efficacy of active warming methods to maintain perioperative patients' body temperature and its effect on the occurrence of surgical site infection. METHODS A systematic review with meta-analysis was carried out. PubMed, CINAHL, LiLACS, CENTRAL, and EMBASE databases were searched. FINDINGS Of the 956 publications identified, 9 studies were selected for quantitative synthesis and 6 for the meta-analysis. The forced-air warming system was investigated in 8 studies. The generated evidence indicated that the use of an active warming method could maintain higher average body temperature as well as could decrease the surgical site infection incidence. Exposure of the patient to temperatures below 36°C in the perioperative period increased the chances of developing this type of infection. The meta-analysis indicated that the association between perioperative active warming methods compared with others to reduce the chances of developing surgical site infection remains unclear (odds ratio = e-3.59 = 2.718-0.59 = 0.552, 95% confidence interval (odds ratio) = (0.269-1.135), P = 0.106 I2 = 54.34%). CONCLUSIONS The employment of an active warming method is effective to maintain higher averages of body temperature. However, more randomized clinical trials are needed to assess the efficacy of that intervention to prevent surgical site infection.
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Affiliation(s)
- Vanessa de Brito Poveda
- Department of Medical-Surgical Nursing, Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil
| | - Ramon Antônio Oliveira
- Department of Medical-Surgical Nursing, Graduate Program in Adult Health Nursing, Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil.
| | - Cristina Maria Galvão
- Department of General and Specialized Nursing, Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brazil
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Okada N, Fujita T, Kanamori J, Sato A, Kurita D, Horikiri Y, Sato T, Fujiwara H, Yamamoto H, Daiko H. Efficacy of prewarming prophylaxis method for intraoperative hypothermia during thoracoscopic esophagectomy. Esophagus 2020; 17:385-391. [PMID: 32385752 DOI: 10.1007/s10388-020-00743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/26/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study was performed to elucidate the clinical efficacy of the prewarming prophylaxis method for intraoperative hypothermia during thoracoscopic esophagectomy for esophageal cancer. METHODS We enrolled 100 consecutive patients with esophageal cancer. Two patients in the prewarming group could not undergo thoracoscopic esophagectomy because of conversion to thoracotomy. The intraoperative core temperature was measured in 50 and 48 patients classified into the control and prewarming groups, respectively. Patients in the prewarming group wore a Bair Hugger warming gown (3 M, Maplewood, MN, USA) in the ward for 30 min before entering the operation room. The primary outcome measure was the difference in the intraoperative body core temperature between the control and prewarming groups, and the secondary outcome measure was the difference in postoperative infectious complications between the control and prewarming groups. RESULTS The intraoperative core temperature was significantly different between the two groups at each 30-min time point from the starting of operation to the ending of the thoracic procedure (P < 0.001). The incidence of infectious surgical complications was not significantly different between the control and prewarming groups (30.0% vs. 14.6%, respectively; P = 0.11). CONCLUSION The prewarming prophylaxis method was effective for maintaining normothermia during thoracoscopic esophagectomy.
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Affiliation(s)
- Naoya Okada
- Esophageal Surgery Division, Department of Gastrointestinal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takeo Fujita
- Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Jun Kanamori
- Esophageal Surgery Division, Department of Gastrointestinal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Ataru Sato
- Esophageal Surgery Division, Department of Gastrointestinal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Daisuke Kurita
- Esophageal Surgery Division, Department of Gastrointestinal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yasumasa Horikiri
- Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takuji Sato
- Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hisashi Fujiwara
- Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hiroyuki Yamamoto
- Division of Anesthesiology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hiroyuki Daiko
- Esophageal Surgery Division, Department of Gastrointestinal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. .,Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
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Matsuzaki S, Bonnin M, Fournet-Fayard A, Bazin JE, Botchorishvili R. Effects of Low Intraperitoneal Pressure on Quality of Postoperative Recovery after Laparoscopic Surgery for Genital Prolapse in Elderly Patients Aged 75 Years or Older. J Minim Invasive Gynecol 2020; 28:1072-1078.e3. [PMID: 32979535 DOI: 10.1016/j.jmig.2020.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/04/2020] [Accepted: 09/19/2020] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE Previous clinical trials for laparoscopic surgery have included few elderly patients aged ≥75 years. We aimed to evaluate the quality of postoperative recovery after laparoscopic surgery using low intraperitoneal pressure (IPP) (6 mm Hg) and warmed, humidified carbon dioxide gas for genital prolapse in elderly patients aged ≥75 years. DESIGN Prospective consecutive case series. SETTING University hospital. PATIENTS Consecutive patients (n = 30) aged ≥75 years planning to undergo laparoscopic surgery for genital prolapse by the same surgeon were recruited from October 2016 through December 2019. INTERVENTIONS Laparoscopic promontofixation for the treatment of genital prolapse was performed using low IPP and warmed, humidified carbon dioxide gas. When a promontory could not be easily identified, laparoscopic pectopexy was alternatively performed. MEASUREMENTS AND MAIN RESULTS The primary outcome was the Quality of Recovery-40 (QoR-40) score at 24 hours postoperatively. The secondary outcomes were postoperative pain using a 100-mm visual analog scale and the length of hospital stay after surgery (LHSS). For the global QoR-40 score and for 4 dimensions of the QoR-40, "emotional state," "physical comfort," "psychologic support," and "pain," no differences were observed between the baseline score and the score at 24 hours. The score for the "physical independence" dimension at 24 hours was significantly lower than the baseline score (p <.001). No patient had visual analog scale pain scores >30 out of 100 at 12 hours or later. LHSS was <48 hours in 22 patients (73.3%) and <72 hours in 8 patients (26.7%). Multivariable analysis showed that the odds of an LHSS >48 hours were more than 8 times higher in patients who were discharged from the operating room in the afternoon compared with those with a morning discharge. CONCLUSION The use of a low IPP is feasible, safe, and has clinical benefits for elderly patients aged ≥75 years who undergo laparoscopic surgery for genital prolapse.
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Affiliation(s)
- Sachiko Matsuzaki
- Department of Gynecologic Surgery, CHU Clermont-Ferrand (Drs. Matsuzaki and Botchorishvili); UMR6602, CNRS/UCA/SIGMA, Institute Pascal, University of Clermont Auvergne (Drs. Matsuzaki and Botchorishvili).
| | - Martine Bonnin
- Department of Perioperative Medicine, CHU Clermont-Ferrand (Drs. Bonnin, Fournet-Fayard, and Bazin), Clermont-Ferrand, France
| | - Aurelie Fournet-Fayard
- Department of Perioperative Medicine, CHU Clermont-Ferrand (Drs. Bonnin, Fournet-Fayard, and Bazin), Clermont-Ferrand, France
| | - Jean-Etienne Bazin
- Department of Perioperative Medicine, CHU Clermont-Ferrand (Drs. Bonnin, Fournet-Fayard, and Bazin), Clermont-Ferrand, France
| | - Revaz Botchorishvili
- Department of Gynecologic Surgery, CHU Clermont-Ferrand (Drs. Matsuzaki and Botchorishvili); UMR6602, CNRS/UCA/SIGMA, Institute Pascal, University of Clermont Auvergne (Drs. Matsuzaki and Botchorishvili)
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Pennington Z, Ehresman J, Westbroek EM, Lubelski D, Cottrill E, Sciubba DM. Interventions to minimize blood loss and transfusion risk in spine surgery: A narrative review. Clin Neurol Neurosurg 2020; 196:106004. [DOI: 10.1016/j.clineuro.2020.106004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 12/26/2022]
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Zhang Z, Inman C, Waters D, Dee P. Effectiveness of application of carbon-fibre polymer-fabric resistive heating compared with forced-air warming to prevent unintentional intraoperative hypothermia in patients undergoing elective abdominal operations: A systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 2020; 29:4429-4439. [PMID: 32841437 DOI: 10.1111/jocn.15463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Unintentional intraoperative hypothermia was regarded as a common intraoperative symptom with serious complications. The active warming strategies of forced-air warming (FAW) and carbon-fibre polymer-fabric resistive heating were considered to be effective interventions for preventing hypothermia. However, the effectiveness of them was not reported consistently. AIM To evaluate the effectiveness of carbon-fibre polymer-fabric resistive heating compared with FAW in preventing hypothermia in patients undergoing elective surgeries. DESIGN Systematic review and meta-analysis. METHODS A rigorous systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting checklist. Searching strategy was undertaken on the electronic databases of Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, EMBASE and Medical Literature Retrieval Service. The assessment of study quality was performed through risk of bias of Cochrane handbook of systematic review of interventions. Data synthesis was conducted through meta-analysis with sensitive analysis. The quality of evidence was graded using Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS A total of five randomised controlled trials with 282 patients undergoing elective surgeries were included in the quantitative synthesis. Four studies concluded that FAW was as effective as carbon-fibre polymer-fabric resistive heating in preventing hypothermia. However, one study yielded a different conclusion that the efficacy of FAW was superior to carbon-fibre polymer-fabric resistive heating with small incidence of hypothermia. Meta-analysis found that FAW was more effective than carbon-fibre polymer-fabric resistive heating in preventing hypothermia. CONCLUSIONS In the elective abdominal surgery, carbon-fibre polymer-fabric resistive heating was less effective than FAW on the prevention of hypothermia. However, hypothermia still occurred in the FAW group. It was more objective to assess the efficacy of warming technology combining the incidence of hypothermia and the core body temperature together, which was suggested for further research.
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Affiliation(s)
- Zhihui Zhang
- Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | | | | | - Philip Dee
- Birmingham City University, Birmingham, UK
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de Jonge SW, Wolfhagen N, Boldingh QJ, Bom WJ, Posthuma LM, Scheijmans JC, van der Leeuw BM, van der Hoeven JA, Hering JP, Sonneveld DJ, van Geffen OE, Hendriks ER, Kluyver EB, Demirkiran A, van Lonkhuijzen LR, Slotema T, Draaisma WA, Koopman SJ, van Rossem CC, Over LM, van Duijvendijk P, Dijkgraaf MG, Hollmann MW, Boermeester MA. Enhanced PeriOperative Care and Health protection programme for the prevention of surgical site infections after elective abdominal surgery (EPOCH): study protocol of a randomised controlled, multicentre, superiority trial. BMJ Open 2020; 10:e038196. [PMID: 32457082 PMCID: PMC7252990 DOI: 10.1136/bmjopen-2020-038196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Surgical site infections (SSI) are a common postoperative complication. During the development of the new WHO guidelines on SSI prevention, also in the Netherlands was concluded that perioperative care could be optimised beyond the current standard practice. We selected a limited set of readily available, cheap and evidence-based interventions from these new guidelines that are not part of standard practice in the Netherlands and formulated an Enhanced PeriOperative Care and Health bundle (EPOCH). Here, we describe the protocol for an open-label, randomised controlled, parallel-group, superiority trial to test the effect of the EPOCH bundle added to (national) standard care in comparison to standard care alone on the incidence of SSI. METHODS AND ANALYSIS EPOCH consists of intraoperative high fractional inspired oxygen (0.80); goal-directed fluid therapy; active preoperative, intraoperative and postoperative warming; perioperative glucose control and treatment of severe hyperglycaemia (>10 mmoll-1) and standardised surgical site handling. Patients scheduled for elective abdominal surgery with an incision larger than 5 cm are eligible for inclusion. Participants are randomised daily, 1:1 according to variable block sizes, and stratified per participating centre to either EPOCH added to standard care or standard care only. The primary endpoint will be SSI incidence according to the Centers for Disease Control and Prevention (CDC) definition within 30 days as part of routine clinical follow-up. Four additional questionnaires will be sent out over the course of 90 days to capture disability and costs. Other secondary endpoints include anastomotic leakage, incidence of incisional hernia, serious adverse events, hospital readmissions, length of stay and cost effectiveness. Analysis of the primary endpoint will be on an intention-to-treat basis. ETHICS AND DISSEMINATION Ethics approval is granted by the Amsterdam UMC Medical Ethics Committee (reference 2015_121). Results will be disseminated through peer-reviewed journals and summaries shared with stakeholders. This protocol is published before analysis of the results. TRIAL REGISTRATION NUMBER Registered in the Dutch Trial Register: NL5572.
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Affiliation(s)
- Stijn W de Jonge
- Department of Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Niels Wolfhagen
- Department of Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Quirine Jj Boldingh
- Department of Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Wouter J Bom
- Department of Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Linda M Posthuma
- Department of Anesthesiology, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Jochem Cg Scheijmans
- Department of Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Bart Mf van der Leeuw
- Department of Anesthesiology, Albert Schweitzer Hospital, Dordrecht, Noord-Holland, Netherlands
| | | | - Jens Peter Hering
- Anesthesiology, Dijklander Ziekenhuis, Hoorn, Noord-Holland, Netherlands
| | - Dirk Ja Sonneveld
- Department of Surgery, Dijklander Ziekenhuis, Hoorn, Noord-Holland, Netherlands
| | - Otto E van Geffen
- Department of Anesthesiology, Tergooiziekenhuizen, Hilversum, Noord-Holland, Netherlands
| | - Eduard R Hendriks
- Department of Surgery, Tergooiziekenhuizen, Hilversum, Noord-Holland, Netherlands
| | - Ewoud B Kluyver
- Department of Anesthesiology, Rode Kruis Ziekenhuis, Beverwijk, Noord-Holland, Netherlands
| | - Ahmet Demirkiran
- Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, Noord-Holland, Netherlands
| | - Luc Rcw van Lonkhuijzen
- Department of Gynaecologic Oncology, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Thomas Slotema
- Department of Anesthesiology, Jeroen Bosch Hospital, 's-Hertogenbosch, Noord-Brabant, Netherlands
| | - Werner A Draaisma
- Department of Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, Noord-Brabant, Netherlands
| | - Seppe Jsha Koopman
- Department of Anesthesiology, Maasstad Ziekenhuis, Rotterdam, Zuid-Holland, Netherlands
| | - Charles C van Rossem
- Department of Surgery, Maasstad Ziekenhuis, Rotterdam, Zuid-Holland, Netherlands
| | - Linda M Over
- Department of Anesthesiology, Gelre Ziekenhuizen, Apeldoorn, Gelderland, Netherlands
| | | | - Marcel Gw Dijkgraaf
- Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
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Özsaban A, Acaroğlu R. The Effect of Active Warming on Postoperative Hypothermia on Body Temperature and Thermal Comfort: A Randomized Controlled Trial. J Perianesth Nurs 2020; 35:423-429. [PMID: 32360129 DOI: 10.1016/j.jopan.2019.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/16/2019] [Accepted: 12/27/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to determine the effect of active warming method in temperature control and thermal comfort in hypothermia after surgery. DESIGN A randomized controlled trial. METHODS The study sample consisted of 64 male and female postanesthesia care unit and intensive care unit neurosurgery postoperative inpatients. The experimental group was warmed using the active warming method, and the control group's routine care was continued via a cotton blanket. Patients were warmed until their tympanic body temperature reached 37°C. FINDINGS The time needed to adequately warm patients was approximately twice as short in those who received active warming as compared with the control group. The perception of thermal comfort was significantly higher in the first hour in patients who received the active warming method (P < .05). CONCLUSIONS The active warming method resulted in a shorter time to warming in hypothermia after surgery and an increase in the perception of thermal comfort and body temperature.
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Affiliation(s)
- Aysel Özsaban
- Department of Nursing, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey.
| | - Rengin Acaroğlu
- Department of Fundamentals of Nursing, Florence Nightingale Faculty of Nursing, İstanbul University-Cerrahpaşa, Istanbul, Turkey
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BİRİCİK E, GÜNEŞ Y. Nörocerrahi ve Eras (Enhanced Recovery After Surgery). ARŞIV KAYNAK TARAMA DERGISI 2020. [DOI: 10.17827/aktd.604717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Odor PM, Bampoe S, Gilhooly D, Creagh-Brown B, Moonesinghe SR. Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. BMJ 2020; 368:m540. [PMID: 32161042 PMCID: PMC7190038 DOI: 10.1136/bmj.m540] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To identify, appraise, and synthesise the best available evidence on the efficacy of perioperative interventions to reduce postoperative pulmonary complications (PPCs) in adult patients undergoing non-cardiac surgery. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase, CINHAL, and CENTRAL from January 1990 to December 2017. ELIGIBILITY CRITERIA Randomised controlled trials investigating short term, protocolised medical interventions conducted before, during, or after non-cardiac surgery were included. Trials with clinical diagnostic criteria for PPC outcomes were included. Studies of surgical technique or physiological or biochemical outcomes were excluded. DATA EXTRACTION AND SYNTHESIS Reviewers independently identified studies, extracted data, and assessed the quality of evidence. Meta-analyses were conducted to calculate risk ratios with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methods. The primary outcome was the incidence of PPCs. Secondary outcomes were respiratory infection, atelectasis, length of hospital stay, and mortality. Trial sequential analysis was used to investigate the reliability and conclusiveness of available evidence. Adverse effects of interventions were not measured or compared. RESULTS 117 trials enrolled 21 940 participants, investigating 11 categories of intervention. 95 randomised controlled trials enrolling 18 062 participants were included in meta-analysis; 22 trials were excluded from meta-analysis because the interventions were not sufficiently similar to be pooled. No high quality evidence was found for interventions to reduce the primary outcome (incidence of PPCs). Seven interventions had low or moderate quality evidence with confidence intervals indicating a probable reduction in PPCs: enhanced recovery pathways (risk ratio 0.35, 95% confidence interval 0.21 to 0.58), prophylactic mucolytics (0.40, 0.23 to 0.67), postoperative continuous positive airway pressure ventilation (0.49, 0.24 to 0.99), lung protective intraoperative ventilation (0.52, 0.30 to 0.88), prophylactic respiratory physiotherapy (0.55, 0.32 to 0.93), epidural analgesia (0.77, 0.65 to 0.92), and goal directed haemodynamic therapy (0.87, 0.77 to 0.98). Moderate quality evidence showed no benefit for incentive spirometry in preventing PPCs. Trial sequential analysis adjustment confidently supported a relative risk reduction of 25% in PPCs for prophylactic respiratory physiotherapy, epidural analgesia, enhanced recovery pathways, and goal directed haemodynamic therapies. Insufficient data were available to support or refute equivalent relative risk reductions for other interventions. CONCLUSIONS Predominantly low quality evidence favours multiple perioperative PPC reduction strategies. Clinicians may choose to reassess their perioperative care pathways, but the results indicate that new trials with a low risk of bias are needed to obtain conclusive evidence of efficacy for many of these interventions. STUDY REGISTRATION Prospero CRD42016035662.
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Affiliation(s)
- Peter M Odor
- Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK
| | - Sohail Bampoe
- Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK
| | - David Gilhooly
- Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK
| | - Benedict Creagh-Brown
- Surrey Perioperative Anaesthesia Critical care collaborative Research (SPACeR) Group, Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - S Ramani Moonesinghe
- Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK
- UCL/UCLH Surgical Outcomes Research Centre, UCL Centre for Perioperative Medicine, Research Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK
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Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019. World J Surg 2020; 44:2056-2084. [DOI: 10.1007/s00268-020-05462-w] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Mutchnick I, Thatikunta M, Braun J, Bohn M, Polivka B, Daniels MW, Vickers-Smith R, Gump W, Moriarty T. Protocol-driven prevention of perioperative hypothermia in the pediatric neurosurgical population. J Neurosurg Pediatr 2020; 25:548-554. [PMID: 32059179 DOI: 10.3171/2019.12.peds1980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 12/02/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Perioperative hypothermia (PH) is a preventable, pathological, and iatrogenic state that has been shown to result in increased surgical blood loss, increased surgical site infections, increased hospital length of stay, and patient discomfort. Maintenance of normothermia is recommended by multiple surgical quality organizations; however, no group yet provides an ergonomic, evidence-based protocol to reduce PH for pediatric neurosurgery patients. The authors' aim was to evaluate the efficacy of a PH prevention protocol in the pediatric neurosurgery population. METHODS A prospective, nonrandomized study of 120 pediatric neurosurgery patients was performed. Thirty-eight patients received targeted warming interventions throughout their perioperative phases of care (warming group-WG). The remaining 82 patients received no extra warming care during their perioperative period (control group-CG). Patients were well matched for age, sex, and preparation time intraoperatively. Hypothermia was defined as < 36°C. The primary outcome of the study was maintenance of normothermia preoperatively, intraoperatively, and postoperatively. RESULTS WG patients were significantly warmer on arrival to the operating room (OR) and were 60% less likely to develop PH (p < 0.001). Preoperative forced air warmer use both reduced the risk of PH at time 0 intraoperatively and significantly reduced the risk of any PH intraoperatively (p < 0.001). All patients, regardless of group, experienced a drop in core temperature until a nadir occurred at 30 minutes intraoperatively for the WG and 45 minutes for the CG. At every time interval, from preoperatively to 120 minutes intraoperatively, CG patients were between 2 and 3 times more likely to experience PH (p < 0.001). All patients were warm on arrival to the postanesthesia care unit regardless of patient group. CONCLUSIONS Preoperative forced air warmer use significantly increases the average intraoperative time 0 temperature, helping to prevent a fall into PH at the intraoperative nadir. Intraoperatively, a strictly and consistently applied warming protocol made intraoperative hypothermia significantly less likely as well as less severe when it did occur. Implementation of a warming protocol necessitated only limited resources and an OR culture change, and was well tolerated by OR staff.
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Affiliation(s)
- Ian Mutchnick
- 1Division of Pediatric Neurosurgery, Norton Children's Hospital/Norton Neuroscience Institute, Louisville
- 2Department of Neurosurgery, University of Louisville
| | | | - Julianne Braun
- 1Division of Pediatric Neurosurgery, Norton Children's Hospital/Norton Neuroscience Institute, Louisville
| | - Martha Bohn
- 3Division of Operative Services, Norton Children's Hospital, Louisville, Kentucky
| | - Barbara Polivka
- 4University of Kansas School of Nursing, Kansas City, Kansas
| | - Michael W Daniels
- 5Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville; and
| | | | - William Gump
- 1Division of Pediatric Neurosurgery, Norton Children's Hospital/Norton Neuroscience Institute, Louisville
- 2Department of Neurosurgery, University of Louisville
| | - Thomas Moriarty
- 1Division of Pediatric Neurosurgery, Norton Children's Hospital/Norton Neuroscience Institute, Louisville
- 2Department of Neurosurgery, University of Louisville
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Stryja J, Sandy-Hodgetts K, Collier M, Moser C, Ousey K, Probst S, Wilson J, Xuereb D. PREVENTION AND MANAGEMENT ACROSS HEALTH-CARE SECTORS. J Wound Care 2020; 29:S1-S72. [DOI: 10.12968/jowc.2020.29.sup2b.s1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jan Stryja
- Vascular Surgeon, Centre of vascular and miniinvasive surgery, Hospital Podlesi, Trinec, The Czech Republic. Salvatella Ltd., Centre of non-healing wounds treatment, Podiatric outpatients’ department, Trinec, The Czech Republic
| | - Kylie Sandy-Hodgetts
- Senior Research Fellow – Senior Lecturer, Faculty of Medicine, School of Biomedical Sciences, University of Western Australia, Director, Skin Integrity Clinical Trials Unit, University of Western Australia
| | - Mark Collier
- Nurse Consultant and Associate Lecturer – Tissue Viability, Independent – formerly at the United Lincolnshire Hospitals NHS Trust, c/o Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire, PE21 9Q
| | - Claus Moser
- Clinical microbiologist, Rigshospitalet, Department of Clinical Microbiology, Copenhagen, Denmark
| | - Karen Ousey
- Professor of Skin Integrity, University of Huddersfield. Institute of Skin Integrity and Infection Prevention, Huddersfield, UK
| | - Sebastian Probst
- Professor of wound care, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Jennie Wilson
- Professor of Healthcare Epidemiology, University of West London, College of Nursing, Midwifery and Healthcare, London, UK
| | - Deborah Xuereb
- Senior Infection Prevention & infection Control Nurse, Mater Dei Hospital, Msida, Malta
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Altman AD, Helpman L, McGee J, Samouëlian V, Auclair MH, Brar H, Nelson GS. Enhanced recovery after surgery: implementing a new standard of surgical care. CMAJ 2020; 191:E469-E475. [PMID: 31036609 DOI: 10.1503/cmaj.180635] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta.
| | - Limor Helpman
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Jacob McGee
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Vanessa Samouëlian
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Marie-Hélène Auclair
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Harinder Brar
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Gregg S Nelson
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
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Lupo BL, Collins SB, Hewer I, Hooper VD. Comparing Forced-Air to Resistive-Polymer Warming for Perioperative Temperature Management: A Retrospective Study. J Perianesth Nurs 2019; 35:178-184. [PMID: 31859207 DOI: 10.1016/j.jopan.2019.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 08/06/2019] [Accepted: 08/19/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Compare perioperative temperature management between forced-air warming (FAW) and resistive-polymer heating blankets (RHBs). DESIGN A retrospective, quasi-experimental study. METHODS Retrospective data analysis of nonspine orthopedic cases (N = 426) over a one-year period including FAW (n = 119) and RHBs (n = 307). FINDINGS FAW was associated with a significantly higher final intraoperative temperature (P = .001, d = 0.46) than the RHB. The incidence of hypothermia was not found to be significantly different at the end (P = .102) or anytime throughout surgery (P = .270). Of all patients who started hypothermic, the FAW group had a lower incidence of hypothermia at the end of surgery (P = .023). CONCLUSIONS FAW was associated with higher final temperatures and a greater number of normothermic patients than RHBs. However, no causal relationship between a warming device and hypothermia incidence should be assumed.
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Affiliation(s)
| | | | - Ian Hewer
- Western Carolina University, School of Nursing, Asheville, NC
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D’Souza K, Choi JI, Wootton J, Wallace T. Impact of sequential implementation of multimodal perioperative care pathways on colorectal surgical outcomes. Can J Surg 2019; 62:25-32. [PMID: 30693743 DOI: 10.1503/cjs.015617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Standardized care protocols offer the potential to reduce postoperative complication rates. The purpose of this study was to determine whether there was an additive benefit associated with the sequential implementation of the evidence-based surgical site infection bundle (SSIB) and enhanced recovery after surgery (ERAS) protocols for patients undergoing colorectal surgery in a community hospital. Methods Patients at a single institution who underwent elective colorectal surgery between Apr. 1, 2011, and Dec. 31, 2015, were identified by means of American College of Surgeons National Surgical Quality Improvement Program data. Patients were stratified into 3 groups according to the protocol implementation dates: pre-SSIB/pre-ERAS (control), post-SSIB/pre-ERAS and post-SSIB/post-ERAS. Primary outcomes assessed were length of stay and wound complication rates. We used inverse proportional weighting to control for possible differences between the groups. Results There were 368 patients included: 94 in the control group, 95 in the post-SSIB/pre-ERAS group and 179 in the post-SSIB/post-ERAS group. In the adjusted analyses, mean length of stay (control group 7.6 d, post-SSIB/post-ERAS group 5.5 d, p = 0.04) and overall wound complication rates (14.7% and 6.5%, respectively, p = 0.049) were reduced after sequential implementation of the protocols. Conclusion Sequential implementation of quality-improvement initiatives yielded additive benefit for patients undergoing colorectal surgery in a community hospital, with a decrease in length of stay and wound complication rates. The amount of improvement attributable to either initiative is difficult to define as they were implemented sequentially. The improved outcomes were realized after the introduction of the ERAS protocol in adjusted analyses.
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Affiliation(s)
- Karan D’Souza
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (D’Souza, Choi, Wallace); the Interior Health Authority Quality, Risk, and Accreditation, Royal Inland Hospital, Kamloops, BC (Wootton, Wallace); and the Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (Wallace)
| | - Jung-In Choi
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (D’Souza, Choi, Wallace); the Interior Health Authority Quality, Risk, and Accreditation, Royal Inland Hospital, Kamloops, BC (Wootton, Wallace); and the Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (Wallace)
| | - Julie Wootton
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (D’Souza, Choi, Wallace); the Interior Health Authority Quality, Risk, and Accreditation, Royal Inland Hospital, Kamloops, BC (Wootton, Wallace); and the Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (Wallace)
| | - Thomas Wallace
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (D’Souza, Choi, Wallace); the Interior Health Authority Quality, Risk, and Accreditation, Royal Inland Hospital, Kamloops, BC (Wootton, Wallace); and the Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (Wallace)
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Usuki H, Kitamura H, Ando Y, Suto H, Asano E, Ohshima M, Kishino T, Kumamoto K, Okano K, Suzuki Y. New Concept Air Conditioning System for the Operating Room to Minimize Patient Cooling and Surgeon Heating: A Historical Control Cohort Study. World J Surg 2019; 44:45-52. [PMID: 31602521 DOI: 10.1007/s00268-019-05203-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intraoperative hypothermia is a common adverse event. For avoiding the complication due to hypothermia, many warming devices and methods have been used in perioperative period. It has been reported that more patients undergoing laparoscopic surgery tend to have hypothermia than with open surgery. To avoid intraoperative hypothermia, many kinds of warming tools have been used. But, it was also reported that some warming methods increased perceptions of distraction and physical demand. METHODS To achieve both patients' normothermia and surgeons' comfort, new air conditioning (AC) system was designed with considering the characteristics of laparoscopic surgery. The temperature of the airflows to the patient and to the surgeons can be adjusted independently in this new system. The new system has two parts. One controls the temperature of the central area over the operation table. The air from this part falls on the patients. The other part is the lateral area beside the operating table; the air from this part falls on the surgeons. The subjects of this study were 160 gastric cancer patients and 316 colorectal cancer patients undergoing laparoscopic surgery. The temperature of the central flow was set 23.5 °C, and the temperature of the lateral flow was set 22 °C just after the anesthesia. The number of timepoints the patient spent in hypothermic state, defined as a temperature cooler by 0.5 °C or more than that at the starting point of surgery, was determined in each patient. RESULTS In the results, the rate of hypothermic state in old operation rooms was 23.8% and that in new operation rooms was 2.7% in male gastric cancer patients (p < 0.01). And those were 37.1% in old operation rooms and 0.9% in new operation rooms in female gastric cancer patients (p < 0.01). The rate of hypothermic state in old operation rooms was 30.0% and that in new operation rooms was 9.5% in male colorectal cancer patients (p < 0.01). And those were 41.6% in old operation rooms and 8.9% in new operation rooms in female colorectal cancer patients (p < 0.01). The similar results were showed in the study, which subjects were limited the patients undergoing surgery in 2015 and 2016; which were the last year the old operation rooms were used and the first year the new operation rooms were used. CONCLUSIONS Thus, the usefulness of the new air conditioning system for achieving both patients' normothermia and comfort of surgeons could be verified in this study.
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Affiliation(s)
- Hisashi Usuki
- Surgical Center, Kagawa University Hospital, Ikenobe 1750-1, Miki, Kita, Kagawa, Japan.
- Department of Gastroenterological Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Miki, Kita, Kagawa, Japan.
| | - Hiroaki Kitamura
- Surgical Center, Kagawa University Hospital, Ikenobe 1750-1, Miki, Kita, Kagawa, Japan
| | - Yasuhisa Ando
- Department of Gastroenterological Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Miki, Kita, Kagawa, Japan
| | - Hironobu Suto
- Department of Gastroenterological Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Miki, Kita, Kagawa, Japan
| | - Eisuke Asano
- Department of Gastroenterological Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Miki, Kita, Kagawa, Japan
| | - Minoru Ohshima
- Department of Gastroenterological Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Miki, Kita, Kagawa, Japan
| | - Takayoshi Kishino
- Department of Gastroenterological Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Miki, Kita, Kagawa, Japan
| | - Kensuke Kumamoto
- Department of Gastroenterological Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Miki, Kita, Kagawa, Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Miki, Kita, Kagawa, Japan
| | - Yasuyuki Suzuki
- Department of Gastroenterological Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Miki, Kita, Kagawa, Japan
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Kaufner L, Niggemann P, Baum T, Casu S, Sehouli J, Bietenbeck A, Boschmann M, Spies CD, Henkelmann A, von Heymann C. Impact of brief prewarming on anesthesia-related core-temperature drop, hemodynamics, microperfusion and postoperative ventilation in cytoreductive surgery of ovarian cancer: a randomized trial. BMC Anesthesiol 2019; 19:161. [PMID: 31438849 PMCID: PMC6706928 DOI: 10.1186/s12871-019-0828-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/07/2019] [Indexed: 11/14/2022] Open
Abstract
Background General (GA)- and epidural-anesthesia may cause a drop in body-core-temperature (BCTdrop), and hypothermia, which may alter tissue oxygenation (StO2) and microperfusion after cytoreductive surgery for ovarian cancer. Cell metabolism of subcutaneous fat- or skeletal muscle cells, measured in microdialysis, may be affected. We hypothesized that forced-air prewarming during epidural catheter placement and induction of GA maintains normothermia and improves microperfusion. Methods After ethics approval 47 women scheduled for cytoreductive surgery were prospectively enrolled. Women in the study group were treated with a prewarming of 43 °C during epidural catheter placement. BCT (Spot on®, 3 M) was measured before (T1), after induction of GA (T2) at 15 min (T3) after start of surgery, and until 2 h after ICU admission (TICU2h). Primary endpoint was BCTdrop between T1 and T2. Microperfusion-, hemodynamic- and clinical outcomes were defined as secondary outcomes. Statistical analysis used the Mann-Whitney-U- and non-parametric-longitudinal tests. Results BCTdrop was 0.35 °C with prewarming and 0.9 °C without prewarming (p < 0.005) and BCT remained higher over the observation period (ΔT4 = 0.9 °C up to ΔT7 = 0.95 °C, p < 0.001). No significant differences in hemodynamic parameters, transfusion, arterial lactate and dCO2 were measured. In microdialysis the ethanol ratio was temporarily, but not significantly, reduced after prewarming. Lactate, glucose and glycerol after PW tended to be more constant over the entire period. Postoperatively, six women without prewarming, but none after prewarming were mechanical ventilated (p < 0.001). Conclusion Prewarming at 43 °C reduces the BCTdrop and maintains normothermia without impeding the perioperative routine patient flow. Microdialysis indicate better preserved parameters of microperfusion. Trial registration ClinicalTrials.gov; ID: NCT02364219; Date of registration: 18-febr-2015.
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Affiliation(s)
- L Kaufner
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - P Niggemann
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - T Baum
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Casu
- Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - J Sehouli
- Department of Gynaecology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - A Bietenbeck
- Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - M Boschmann
- Experimental & Clinical Research Center, ECRC, Charité-Universitätsmedizin Berlin CCB, Berlin, Germany
| | - C D Spies
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Henkelmann
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C von Heymann
- Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany
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An Overview of Surgical Site Infection in Low- and Middle-Income Countries: the Role of Recent Guidelines, Limitations, and Possible Solutions. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2019. [DOI: 10.1007/s40506-019-00198-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Affiliation(s)
- John Stephenson
- Senior Lecturer in Biomedical Statistics at the University of Huddersfield
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Gómez-Romero F, Fernández-Prada M, Fernández-Suárez F, Gutiérrez-González C, Estrada-Martínez M, Cachero-Martínez D, Suárez-Fernández S, García-González N, Picatto-Hernández M, Martínez-Ortega C, Navarro-Gracia J. Intra-operative temperature monitoring with two non-invasive devices (3M Spoton® and Dräger Tcore®) in comparison with the Swan-Ganz catheter. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2019.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Nelson G, Bakkum-Gamez J, Kalogera E, Glaser G, Altman A, Meyer LA, Taylor JS, Iniesta M, Lasala J, Mena G, Scott M, Gillis C, Elias K, Wijk L, Huang J, Nygren J, Ljungqvist O, Ramirez PT, Dowdy SC. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update. Int J Gynecol Cancer 2019; 29:651-668. [PMID: 30877144 DOI: 10.1136/ijgc-2019-000356] [Citation(s) in RCA: 376] [Impact Index Per Article: 75.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/18/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery. METHODS A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. CONCLUSIONS The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.
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Affiliation(s)
- Gregg Nelson
- Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jamie Bakkum-Gamez
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Eleftheria Kalogera
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Gretchen Glaser
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Alon Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jolyn S Taylor
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria Iniesta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Javier Lasala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel Mena
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Scott
- Department of Anesthesia, Virginia Commonwealth University Hospital, Richmond, Virginia, USA
| | - Chelsia Gillis
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Elias
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Lena Wijk
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jeffrey Huang
- Department of Anesthesiology, Oak Hill Hospital, Brooksville, Florida, USA
| | - Jonas Nygren
- Departments of Surgery and Clinical Sciences, Ersta Hospital and Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sean C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Freundlich RE, Nelson SE, Qiu Y, Ehrenfeld JM, Sandberg WS, Wanderer JP. A retrospective evaluation of the risk of bias in perioperative temperature metrics. J Clin Monit Comput 2018; 33:911-916. [PMID: 30536125 DOI: 10.1007/s10877-018-0233-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/05/2018] [Indexed: 11/30/2022]
Abstract
The prevention and treatment of hypothermia is an important part of routine anesthesia care. Avoidance of perioperative hypothermia was introduced as a quality metric in 2010. We sought to assess the integrity of the perioperative hypothermia metric in routine care at a single large center. Perioperative temperatures from all anesthetics of at least 60 min duration between January 2012 and 2017 were eligible for inclusion in analysis. Temperatures were displayed graphically, assessed for normality, and analyzed using paired comparisons. Automatically-recorded temperatures were obtained from several monitoring sites. Provider-entered temperatures were non-normally distributed, exhibiting peaks at temperatures at multiples of 0.5 °C. Automatically-acquired temperatures, on the other hand, were more normally distributed, demonstrating smoother curves without peaks at multiples of 0.5 °C. Automatically-acquired median temperature was highest, 36.8 °C (SD = 0.8 °C), followed by the three manually acquired temperatures (nurse-documented postoperative temperature, 36.5 °C [SD = 0.6 °C]; intraoperative manual temperature, 36.5 °C [SD = 0.6 °C]; provider-documented postoperative temperature, 36.1 °C [SD = 0.6 °C]). Provider-entered temperatures exhibit values that are unlikely to represent a normal probability distribution around a central physiologic value. Manually-entered perioperative temperatures appear to cluster around salient anchoring values, either deliberately, or as an unintended result driven by cognitive bias. Automatically-acquired temperatures may be superior for quality metric purposes.
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Affiliation(s)
- Robert E Freundlich
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, MAB 422F, Nashville, TN, 37212, USA. .,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Sara E Nelson
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, MAB 422F, Nashville, TN, 37212, USA
| | - Yuxuan Qiu
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jesse M Ehrenfeld
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, MAB 422F, Nashville, TN, 37212, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Warren S Sandberg
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, MAB 422F, Nashville, TN, 37212, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan P Wanderer
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, MAB 422F, Nashville, TN, 37212, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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40
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Clinical practice guideline. Unintentional perioperative hypothermia. ACTA ACUST UNITED AC 2018; 65:564-588. [PMID: 30447894 DOI: 10.1016/j.redar.2018.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 02/01/2023]
Abstract
The importance of the safety of our patients in the surgical theatre, has driven many projects. The majority of them aimed at better control and clinical performance; mainly of the variables that intervene or modulate the results of surgical procedures, and have a direct relationship with them. The Spanish Society of Anesthesiology, Critical Care and Therapeutic Pain (SEDAR), maintains a constant concern for a variable that clearly determines the outcomes of our clinical processes, "unintentional hypothermia" that develops in all patients undergoing an anesthetic or surgical procedure. SEDAR has promoted, in collaboration with other scientific Societies and patient Associations, the elaboration of this clinical practice guideline, which aims to answer clinical questions not yet resolved and for which, up to now, there are no documents based in the best scientific evidence available. With GRADE methodology and technical assistance from the Ibero-American Cochrane Collaboration office, this clinical practice guideline presents three recommendations (weak in favor) for active heating methods for the prevention of hypothermia (skin, fluid or gas); three for the prioritization of strategies for the prevention of hypothermia (too weak in favor and one strongly in favor); two of preheating strategies prior to anesthetic induction (both weak in favor); and two for research.
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41
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Rogers A, Saggaf M, Ziolkowski N. A quality improvement project incorporating preoperative warming to prevent perioperative hypothermia in major burns. Burns 2018. [DOI: 10.1016/j.burns.2018.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Effect of preoperative warming on intraoperative hypothermia: a randomized-controlled trial. Can J Anaesth 2018; 65:1029-1040. [DOI: 10.1007/s12630-018-1161-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 10/14/2022] Open
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43
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O'Hara LM, Thom KA, Preas MA. Update to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infection (2017): A summary, review, and strategies for implementation. Am J Infect Control 2018. [PMID: 29525367 DOI: 10.1016/j.ajic.2018.01.018] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Surgical site infections remain a common cause of morbidity, mortality, and increased length of stay and cost amongst hospitalized patients in the United States. This article summarizes the evidence used to inform the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infection (2017), and highlights key updates and new recommendations. We also present specific suggestions for how infection preventionists can play a central role in guideline implementation by translating these recommendations into evidence-based policies and practices in their facility.
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Affiliation(s)
| | - Kerri A Thom
- University of Maryland School of Medicine, Baltimore, MD
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44
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The Effect of Operating Room Temperature on the Performance of Clinical and Cognitive Tasks. Pediatr Qual Saf 2018; 3:e069. [PMID: 30280125 PMCID: PMC6132757 DOI: 10.1097/pq9.0000000000000069] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 02/12/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction: Operating room (OR) temperature may impact the performance of health care providers. This study assesses whether hot or cold room temperature diminishes the performance of OR personnel measured by psychomotor vigilance testing (PVT) and self-report scales. Methods: This prospective observational study enrolled surgical/anesthesia trainees, student registered nurse anesthetists, and certified registered nurse anesthetists. Each provider participated in a test of psychomotor function and a questionnaire using a self-report scale of personal comfort and well-being. The PVT and questionnaires were completed after 30 minutes of exposure to 3 different conditions (temperature of 21°C, 23°C, and 26°C). Results: The cohort of 22 personnel included 9 certified registered nurse anesthetists, 7 anesthesia/surgical trainees, and 6 student registered nurse anesthetists. Mean reaction time on the PVT was comparable among baseline (280 ± 47 ms), hot (286 ± 55 ms; P = 0.171), and cold (303 ± 114 ms; P = 0.378) conditions. On the self-report score (range, 1–21), there was no difference in the self-rated subjective performance between baseline and cold conditions. However, the self-rated subjective performance scale was lower (12 ± 6, P = 0.003) during hot conditions. Discussion: No difference was noted in reaction time depending on the temperature; however, excessive heat in the OR environment was associated with worse self-rated subjective performance among health care providers. Particularly, self-rated subjective physical demand and frustration were greater under hot condition.
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Prävention postoperativer Wundinfektionen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:448-473. [PMID: 29589090 DOI: 10.1007/s00103-018-2706-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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46
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Sandy-Hodgetts K, Carville K, Leslie GD. Surgical wound dehiscence: a conceptual framework for patient assessment. J Wound Care 2018; 27:119-126. [DOI: 10.12968/jowc.2018.27.3.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kylie Sandy-Hodgetts
- Clinical Trials Coordinator, Joondalup Health Campus, Adjunct Research Fellow, School of Anatomy, Physiology and Human Biology, University of Western Australia
| | - Keryln Carville
- Professor, Primary Health Care and Community, School of Nursing and Midwifery, Curtin University, Silver Chain Group
| | - Gavin D. Leslie
- Professor, Director of Research Training, School of Nursing and Midwifery, Curtin University
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Ardò NP, Loizzi D, Panariti S, Piccinin I, Sollitto F. Enhanced recovery pathways in thoracic surgery from Italian VATS group: nursing care program. J Thorac Dis 2018; 10:S529-S534. [PMID: 29629199 DOI: 10.21037/jtd.2017.12.85] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Enhanced recovery after surgery (ERAS) is an interprofessional program that can lead to hastened patient recovery and reduced time in hospital. Nursing staff play a key role in the implementation of enhanced recovery protocols. This issue focalizes the role of nurses in ERAS program for patients submitted to Thoracic Surgery, in particular for cases of major lung resection performed by a minimally invasive surgical approach (VATS, video assisted thoracic surgery).
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Affiliation(s)
- Nicoletta Pia Ardò
- Thoracic Surgery Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Domenico Loizzi
- Thoracic Surgery Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Ivana Piccinin
- Thoracic Surgery Unit, Ospedale San Raffaele, Milano, Italy
| | - Francesco Sollitto
- Thoracic Surgery Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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48
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Ousey K, Edward KL, Lui S, Stephenson J, Walker K, Duff J, Leaper D. Perioperative, local and systemic warming in surgical site infection: a systematic review and meta-analysis. J Wound Care 2017; 26:614-624. [DOI: 10.12968/jowc.2017.26.11.614] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- K. Ousey
- Professor, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - K-L. Edward
- Professor of Nursing and Practice-based Research, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - S. Lui
- Senior Lecturer, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - J. Stephenson
- Senior Lecturer Biomedical Statistics, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - K. Walker
- Professor, School of Health Sciences, University of Tasmania, Darlinghurst, Australia
| | - J. Duff
- Associate Professor, School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
| | - D. Leaper
- Emeritus Professor, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
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Itani KMF, Dellinger EP, Mazuski J, Solomkin J, Allen G, Blanchard JC, Kelz R, Berríos-Torres SI. Surgical Site Infection Research Opportunities. Surg Infect (Larchmt) 2017; 18:401-408. [PMID: 28541807 DOI: 10.1089/sur.2017.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Much has been done to identify measures and modify risk factors to decrease the rate of surgical site infection (SSI). Development of the Centers for Disease Control and Prevention (CDC) Core recommendations for the prevention of SSI revealed evidence gaps in six areas: Parenteral antimicrobial prophylaxis, glycemic control, normothermia, oxygenation, antiseptic prophylaxis, and non-parenteral antimicrobial prophylaxis. Using a modified Delphi process, seven SSI content experts identified nutritional status, smoking, obesity, surgical technique, and anemia as additional areas for SSI prevention research. Post-modified Delphi process Staphylococcus aureus colonization and SSI definition and surveillance were also deemed important topic areas for inclusion. For each topic, research questions were developed, and 10 were selected as the final SSI research questions.
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Affiliation(s)
- Kamal M F Itani
- 1 VA Boston Health Care System, Boston University and Harvard Medical School , Boston, Massachusetts
| | - E Patchen Dellinger
- 2 Department of Surgery, Division of General Surgery, University of Washington , Seattle, Washington
| | - John Mazuski
- 3 Section of Acute and Critical Care Surgery, Department of Surgery, Washington University School of Medicine , St. Louis, Missouri
| | - Joseph Solomkin
- 4 Department of Surgery, University of Cincinnati , Cincinnati, Ohio
| | - George Allen
- 5 Downstate Medical Center and SUNY College of Health Related Professions , Brooklyn, New York
| | - Joan C Blanchard
- 6 Association of periOperative Registered Nurses, Inc. , Denver, Colorado
| | - Rachel Kelz
- 7 Department of Surgery, Perelman School of Medicine, Leonard Davis Institute of Healthcare Economics, Wharton School, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Sandra I Berríos-Torres
- 8 Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia
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50
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Establishment and Validation of a Prediction Equation to Estimate Risk of Intraoperative Hypothermia in Patients Receiving General Anesthesia. Sci Rep 2017; 7:13927. [PMID: 29066717 PMCID: PMC5654776 DOI: 10.1038/s41598-017-12997-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 09/13/2017] [Indexed: 11/30/2022] Open
Abstract
Inadvertent intraoperative hypothermia (core temperature <36 °C) is a frequent but preventable complication of general anesthesia. Accurate risk assessment of individual patients may help physicians identify patients at risk for hypothermia and apply preventive approaches, which include active intraoperative warming. This study aimed to develop and validate a risk-prediction model for intraoperative hypothermia. Two independent observational studies in China, the Beijing Regional Survey and the China National Survey, were conducted in 2013 and 2014, respectively, to determine the incidence of hypothermia and its underlying risk factors. In this study, using data from these two studies, we first derived a risk calculation equation, estimating the predictive risk of hypothermia using National Survey data (3132 patients), then validated the equation using the Beijing Regional Survey data (830 patients). Measures of accuracy, discrimination and calibration were calculated in the validation data set. Through validation, this model, named Predictors Score, had sound overall accuracy (Brier Score = 0.211), good discrimination (C-Statistic = 0.759) and excellent calibration (Hosmer-Lemeshow, P = 0.5611). We conclude that the Predictors Score is a valid predictor of the risk of operative hypothermia and can be used in deciding whether intraoperative warming is a cost-effective measure in preventing the hypothermia.
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