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would take a robust
randomized controlled
trial or a very large and
well-designed observa-
tional study comparing
the outcomes of
warmed and non-
warmed patients, while
also factoring in other
potential causes of
infection, to definitively
address the risk. That study hasn't yet been done, so let's look at what is known
about the warming methods that can lower the risk of post-op infection.
1. Why does warming matter?
Most of the evidence strongly suggests that preventing hypothermia will lead to
improved surgical outcomes. Coagulopathy and an inability to fight infection are
among the many detrimental effects of hypothermia. Patients might also suffer
increased myocardial oxygen demand, which can cause ischemia, especially in
shivering patients. But does hypothermia increase risk of surgical site infec-
tions? Not all studies show an association, but a vast majority do indicate that a
causal link exists, and there is a good theoretical basis for that link. When you
combine those two factors, the scale is certainly tilted toward hypothermia
causing post-op infections.
2. What's the best way to warm patients?
The most effective way to prevent hypothermia might be to use active and passive
methods in combination.
•
Fluid warming
can help maintain normothermia, but is most efficacious
when intravenous fluid, especially large amounts, is infused very rapidly.
• COMFORT MEASURE Warmed blankets might not be effective in preventing hypothermia,
but they sit atop the list of patient satisfiers.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
