Body temperature

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Background

Normal thermoregulation is disrupted during anaesthesia and surgery due to multiple factors.[1] Unintended perioperative hypothermia is common in surgical patients, and has been reported to be associated with platelet dysfunction, bleeding, wound infection, alterations of pharmacotherapeutic effects and shivering.[2]Back to top

Overview of evidence (non-systematic literature review)

No systematic reviews were undertaken for this topic. Practice points were based on selected published evidence. See Guidelines development process.

Effects of perioperative body temperature on wound site

One randomised controlled trial of 200 patients undergoing colorectal surgery reported that maintenance of a normal body temperature (near 36.5°C) during colorectal surgery using forced-air warming combined with fluid warming decreased the rate of surgical site infectionand reduced length of stay, compared with allowing body temperature to decrease to approximately 34.5°C.[3]

Subsequent observational cohort studies have not always supported the three-fold reduction in surgical site infection seen in the original study.[4][5]

Avoidance of hypothermia should be encouraged for its other benefits, which may include improved wound healing associated with a reduction in hospital stay.[3]Back to top

Strategies for maintaining perioperative body temperature

Strategies for maintaining perioperative body temperature include warming intravenous (IV) and irrigation fluids, the use of reflective blankets or clothing, and forced air warming, and prewarming.[6][7]

The use of warmed IV fluids has been shown to be effective in maintaining body temperature in adults.[7] Pre-warming for a minimum of 30 minutes may also reduce the risk of subsequent hypothermia.[6] There is no clear evidence that the use of reflective blankets or clothing increases body temperature, compared with usual care.[7]
Practice pointA recommendation on a subject that is outside the scope of the search strategy for the systematic review, based on expert opinion and formulated by a consensus process.Question mark transparent.png

Perioperative normothermia should ideally be maintained at or above 36.0˚C.

Practice pointA recommendation on a subject that is outside the scope of the search strategy for the systematic review, based on expert opinion and formulated by a consensus process.Question mark transparent.png

The use of warmed IV fluids and forced-air warming can be used to minimise perioperative hypothermia.


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References

  1. Sessler, DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology 2017 Nov 23;2008 Aug; 109(2): 318–338. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614355/.
  2. Joanna Briggs Institute. Strategies for the management and prevention of hypothermia within the adult perioperative environment Best Practice: evidence-based information sheets for health professionals. 2010; 14(13):1-4.; 2017 Nov 23.
  3. 3.03.1 Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 1996 May 9;334(19):1209-15 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/8606715.
  4. Baucom RB, Phillips SE, Ehrenfeld JM, Muldoon RL, Poulose BK, Herline AJ, et al. Association of Perioperative Hypothermia During Colectomy With Surgical Site Infection. JAMA Surg 2015 Jun;150(6):570-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25902410.
  5. Lehtinen SJ, Onicescu G, Kuhn KM, Cole DJ, Esnaola NF. Normothermia to prevent surgical site infections after gastrointestinal surgery: holy grail or false idol? Ann Surg 2010 Oct;252(4):696-704 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20881777.
  6. 6.06.1 Hart, SR; Bordes, B; Hart, J; Corsino, D; Harmon, D;. Unintended perioperative hypothermia. The Ochsner Journal 2017 Nov 23;2011;11(3):259-270.
  7. 7.07.17.2 National Collaborating Centre for Nursing and Supportive Care. National Institute for Health and Clinical Excellence (commissioner). The management of inadvertent perioperative hypothermia in adults. (NICE CG65). London: National Institute for Health and Clinical Excellence; 2008 Available from: https://www.nice.org.uk/guidance/cg65/evidence/cg65-perioperative-hypothermia-inadvertent-full-guideline2.
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