Hypothermia Is Associated with Surgical Site Infection in Cytoreductive Surgery with Hyperthermic Intra-Peritoneal Chemotherapy

The Development of the Inadvertent Perioperative Hypothermia Knowledge Test (IPH-KT)

PURPOSE

This study aimed to develop the inadvertent perioperative hypothermia knowledge test (IPH-KT) for health care professionals and examine its validity and reliability.

DESIGN

The methodological and cross-sectional study design was used.

METHODS

The research was carried out with 326 nursing students in Turkey. Data for the study were collected using a demographic information form and the IPH-KT.

FINDINGS

The item difficulty index and item distinctiveness index of the questions included in the draft form of the 25-item test ranged from 0.03 to 0.81 and from 0.25 to 0.99, respectively. After the analyses, 8 items were excluded from the draft test, and the final version of the test consisted of 17 questions. The item difficulty index of the final test ranged from 0.30 to 0.96, and the item distinctiveness index ranged from 0.33 to 0.81. The reliability of the test was determined using the Kuder-Richardson formula 20 and found to be 0.72, indicating high internal consistency. Therefore, the IPH-KT was accepted as a reliable test.

CONCLUSIONS

The study revealed that the questions in the IPH-KT had varying difficulty levels and a high ability to discriminate between individuals with knowledge of IPH and those without. The results demonstrated that the test had good content and face validity and showed high reliability for measuring the IPH knowledge of nursing students.

Effects of Pre-warming and Co-warming in Preventing Intraoperative Hypothermia

BACKGROUND

 Hypothermia is a condition characterized by a decreased body temperature. It takes place when the body is exposed to cold weather or water for a longer period of time. Different types of hypothermia include acute hypothermia, exhaustion hypothermia, and chronic hypothermia. Excessive shivering, breathing difficulty, slurred speech, confusion, drowsiness, a weak pulse, and a loss of consciousness are the symptoms related to hypothermia.

AIMS

The aim of this study was to see how effective co-warming and pre-warming are at reducing the risk of intraoperative hypothermia.

MATERIALS AND METHODS

A randomized, prospective, comparative clinical study was conducted in a population of 60 participants. Participants were divided into two groups. Participants in group A received pre-warming for 30 minutes at 40°C before transport to the operation theater and also received co-warming before induction of anesthesia. Group B includes those who received co-warming at 40°C from the point of induction of anesthesia.

RESULTS

The mean age (years) of participants in groups A and B was identified as 43.3 ± 11.84 and 45.93 ± 15.87, respectively. The majority of the participants in the study population were males in groups A and B, with 66.67% and 73.33%, respectively. The medians of core temperature and peripheral temperature at the baseline were identified as 36.80 (36.20 to 37.12) and 32.55 (32.38 to 32.72) in group A. Similarly, it was observed as 36 (35.70 to 36.20) and 32 (31.60 to 32.02) in group B. The medians of core temperature and peripheral temperature after the surgery were identified as 34.50 (34.20 to 35) and 32.65 (31.95 to 33) in group A. Similarly, it was identified as 34 (33.80 to 34.25) and 32 (32.10 to 32.25) in group B.

CONCLUSION

 Our study concluded that it is important to prevent hypothermia in patients undergoing surgery under general anesthesia. Pre-operative and intraoperative warming showed a decrease in the rate of fall in core temperature. Hence, both techniques are effective in reducing hypothermia.

Side-effects of hyperthermic intraperitoneal chemotherapy in patients with gastrointestinal cancers

Background

Hyperthermic intraperitoneal chemotherapy (HIPEC) produces unwanted side-effects that are mainly caused by chemotherapeutic drugs in the treatment of gastrointestinal (GI) cancers, and these effects have not been systematically summarized. The aim of this article was to provide a comprehensive overview of the side-effects of HIPEC for GI cancers and propose practical strategies for adverse event management.

Methodology

PubMed, Web of Science, and the Cochrane Library were systematically searched for side-effects of HIPEC in GI cancers prior to October 20, 2022. A total of 79 articles were included in this review.

Results

Adverse events, such as enterocutaneous digestive fistulas, GI tract perforation, neutropenia, postoperative bleeding, ventricular tachycardia, hyperglycemia, hypocalcemia, renal impairment, encapsulating peritoneal sclerosis, scrotal ulceration, and sarcopenia were described, and their clinical management was discussed. These side-effects involve the digestive, hematopoietic, circulatory, metabolic, and urinary systems. Effective methods for adverse event management included an expert multidisciplinary team, replacing chemotherapy drugs, using Chinese medicine, and careful preoperative assessments.

Conclusion

The side-effects of HIPEC are frequent and can be minimized by several effective methods. This study proposes practical strategies for adverse event management of HIPEC to assist physicians in choosing the optimal treatment method.

The Role of Perioperative Hypothermia in the Development of Surgical Site Infection: A Systematic Review

Surgical patients may experience inadvertent perioperative hypothermia, a condition that can cause a variety of complications, including surgical site infection (SSI). The authors of this systematic review used the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines to examine the role of perioperative hypothermia in the development of SSI. The authors searched the PubMed, Cumulative Index Nursing and Allied Health Literature, Cochrane, and ScienceDirect databases for eligible articles published between January 2008 and November 2018 and identified seven studies that met the inclusion criteria. The results of this review indicate that the relationship between hypothermia and SSI is closely related to the type of the surgical intervention performed (eg, emergent, colorectal), and that severe hypothermia (eg, <35.0° C [95.0° F]) can increase the risk of developing an SSI. Perioperative nurses should monitor patients for inadvertent hypothermia and prevent its occurrence when possible.

Surgical Infection Society Research Priorities: A Narrative Review of Fourteen Years of Progress

Background: In 2006, the Surgical Infection Society (SIS) utilized a modified Delphi approach to define 15 specific priority research questions that remained unanswered in the field of surgical infections. The aim of the current study was to evaluate the scientific progress achieved during the ensuing period in answering each of the 15 research questions and to determine if additional research in these fields is warranted. Methods: For each of the questions, a literature search using the National Center for Biotechnology Information (NCBI) was performed by the Scientific Studies Committee of the SIS to identify studies that attempted to address each of the defined questions. This literature was analyzed and summarized. The data on each question were evaluated by a surgical infections expert to determine if the question was answered definitively or remains unanswered. Results: All 15 priority research questions were studied in the last 14 years; six questions (40%) were definitively answered and 9 questions (60%) remain unanswered in whole or in part, mainly because of the low quality of the studies available on this topic. Several of the 9 unanswered questions were deemed to remain research priorities in 2020 and warrant further investigation. These included, for example, the role of empiric antimicrobial agents in nosocomial infections, the use of inotropes/vasopressors versus volume loading to raise the mean arterial pressure, and the role of increased antimicrobial dosing and frequency in the obese patient. Conclusions: Several surgical infection-related research questions prioritized in 2006 remain unanswered. Further high-quality research is required to provide a definitive answer to many of these priority knowledge gaps. An updated research agenda by the SIS is warranted at this time to define research priorities for the future.