Perspectives on Temperature Management

Effect of temperature maintenance by forced-air warming blankets of different temperatures on changes in inflammatory factors in children undergoing congenital hip dislocation surgery

Background

Hypothermia is associated with many adverse clinical outcomes in pediatric patients, and thus, it is important to find an effective and safe method for preventing peri-operative hypothermia and its associated adverse outcomes in pediatric patients. This study aimed to investigate the effect of forced-air warming blankets with different temperatures on changes in the transforming growth factor-β (TGF-β), tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-10 levels in children undergoing surgical treatment for developmental displacement of the hip (DDH).

Methods

The study included 123 children undergoing surgery for DDH under general anesthesia. The patients were randomly assigned to three groups, using a random number table: the 32, 38, and 43°C groups according to the temperature setting of the forced-air warming blankets. For each patient, body temperature was recorded immediately after anesthesia induction and intubation (T₀), at initial incision (T₁), at 1 h after incision (T₂), at 2 h after incision (T₃), at the end of surgery (T₄), immediately upon return to the ward after surgery (T₅), and then at 12 h (T₆), 24 h (T₇), 36 h (T₈), and 48 h (T₉) after the surgery. The serum levels of TGF-β, TNF-α, IL-1β, and IL-10 were measured at T₀ and T₄ for all groups.

Results

The number of patients with fever in the 38°C group was significantly less than those in the 32 and 43°C groups (χ² = 6.630, P = 0.036). At T₀, the body temperatures in the 38 and 43°C groups were significantly higher than that in the 32°C group (F = 17.992, P < 0.001). At T₂, the body temperature was significantly higher in the 43°C group than those in the 32 and 38°C groups (F = 12.776, P < 0.001). Moreover, at T₄, the serum levels of TGF-β (F = 3286.548, P < 0.001) and IL-10 (F = 4628.983, P < 0.001) were significantly increased in the 38°C group, and the serum levels of TNF-α (F = 911.415, P < 0.001) and IL-1β (F = 322.191, P < 0.001) were significantly decreased in the 38°C group, compared with the levels in the 32 and 43°C groups.

Conclusion

Force-air warming blankets set at 38°C maintained stable body temperature with less adverse outcome and effectively inhibited the inflammatory response in pediatric patients undergoing surgery for DDH.

Clinical trial registration

ChiCTR1800014820; http://www.chictr.org.cn/showproj.aspx?proj=25240.