An Overview of the Implications for Perianesthesia Nurses in terms of Intraoperative Changes in Temperature and Factors Associated with Unintentional Postoperative Hypothermia

Development and validation of a nomogram to predict hypothermia in adult burn patients during escharectomy under general anesthesia

BACKGROUND

It is very common for burn patients to have hypothermia during escharectomy under general anesthesia, which increases the blood transfusion demand of burn patients, and may lead to blood coagulation disorder or even increase the mortality of patients. It is important to predict the occurrence of hypothermia in advance, but we lack a prognostic prediction model. Our study aimed to develop a nomogram to predict the incidence of hypothermia in adult burn patients undergoing escharectomy under general anesthesia to intervention the hazards associated with hypothermia early.

METHODS

This retrospective study included 978 adult burn patients who underwent simple escharectomy under general anesthesia during hospitalization between January 2017 and December 2022, they were further divided into a training cohort and a validation cohort. The clinical data were recorded in electronic medical record system and a self-made collection table of intraoperative hypothermia. The preliminary predictive factors for hypothermia which undergoing simple escharectomy under general anesthesia in burn patients were determined using least absolute shrinkage and selection operator (LASSO) at first, then the final predictive factors determined using binary logistic regression analyses and a nomogram to predict the occurrence of hypothermia was established. The index of concordance(C-index), calibration curves, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used to evaluate the performance of the model.

RESULTS

A total of 211 patients with hypothermia and 767 patients without hypothermia were selected. Least absolute shrinkage and selection operator regression analysis and binary logistic regression results concluded that burn index, urinary volume, blood transfusion volume and irrigation volume were significantly associated with hypothermia in burn patients undergoing escharectomy under general anesthesia. The nomogram based on these four variables had good predictive efficiency for hypothermia in adult burn patients during escharectomy under general anesthesia, the C-index in the training cohort was 0.903, areas under the receiver operating characteristic curves (AUROC) of for the training cohort (95 % CI 0.877-0.920) and 0.875 for the validation cohort (95 % CI 0.852-0.897) indicated satisfactory discriminative ability of the nomogram, and the calibration curves for the training cohort and the validation cohort also fit as well, indicating that the nomogram had good clinical application value.

CONCLUSIONS

Hypothermia in burn patients during escharectomy under general anesthesia is associated with burn index, urinary volume, blood transfusion volume and irrigation volume. We successfully developed a practical nomogram to accurately predict hypothermia, which is a practical method helping clinicians rapidly and conveniently diagnose and guide the treatment of hypothermia in burn patients during escharectomy under general anesthesia.

Inadvertent Hypothermia in the Perspective of Operating Room Nurses: A Phenomenological Qualitative Study

PURPOSE

The aim of the study was to reveal the awareness and perceptions of operating room nurses concerning inadvertent hypothermia, as well as their experiences and recommendations for its prevention.

DESIGN

The study employed a phenomenological qualitative approach.

METHODS

This study was conducted with 17 nurses working in the operating room of a university hospital in Konya, Turkey. Data were collected face to face between 15 August and 30 September 2022 using the in-depth individual interview method. The data were subjected to inductive content analysis. Written permission was obtained from the hospital, the ethics committee, and the participants to conduct the study.

FINDINGS

The mean age of the nurses was 28.4 years and the majority were female. The nurses were graduates of a four-year health vocational high school, a two-year nursing associate degree program, or a four-year nursing bachelors' degree program. Their operating room experience ranged from 1 to 22 years. All the nurses were aware of inadvertent hypothermia, and all but one encountered hypothermia and applied preventive measures. The data analysis revealed 263 codes, 12 categories, and 4 themes on the awareness and perceptions of operating room nurses about inadvertent hypothermia and their experiences and recommendations for its prevention.

CONCLUSIONS

The findings showed that the majority of the participants were aware of inadvertent hypothermia and its risk factors, and frequently encountered inadvertent hypothermia despite implementing preventive measures.

Impact of Intraoperative Hypothermia on Incidence of Infection in Implant-Based Breast Reconstruction

BACKGROUND

Infection following implant-based breast reconstruction can lead to devastating complications. Risk factors for infection include smoking, diabetes, and obesity. Intraoperative hypothermia may represent another modifiable risk factor. This study analyzed the effect of hypothermia in postmastectomy immediate implant-based reconstruction on postoperative surgical-site infection (SSI).

METHODS

This was a retrospective review of 122 patients with intraoperative hypothermia, defined as less than 35.5°C, and 106 normothermic patients who underwent postmastectomy implant-based reconstruction between 2015 and 2021. Demographics, comorbidities, smoking status, hypothermia (and its duration), and length of surgery were collected. The primary outcome was SSI. Secondary outcomes included reoperation and delayed wound healing.

RESULTS

A total of 185 patients (81%) underwent staged reconstruction with tissue expander placement and 43 patients (18.9%) had a direct-to-implant procedure. Over half (53%) of the patients experienced intraoperative hypothermia. In the hypothermic group, a higher proportion of patients had SSIs (34.4% versus 17% of normothermic patients; P < 0.05) and wound healing complications (27.9% versus 16%; P < 0.05). Intraoperative hypothermia predicted SSI (OR, 2.567; 95% CI, 1.367 to 4.818; P < 0.05) and delayed wound healing (OR, 2.023; 95% CI, 1.053 to 3.884; P < 0.05). Longer duration of hypothermia significantly correlated with SSI, with an average 103 minutes versus 77 minutes ( P < 0.05).

CONCLUSIONS

This study demonstrates that intraoperative hypothermia is a significant risk factor for postoperative infection in postmastectomy implant-based breast reconstruction. Maintaining strict normothermia during implant-based breast reconstruction procedures may improve patient outcomes by reducing the risk of postoperative infection and delayed wound healing.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, II.

The Effect of Using a Normothermia Checklist on Awakening Time From Anesthesia and Coagulation Disorder: A Randomized Controlled Trial

BACKGROUND

Inadvertent perioperative hypothermia (IPH) is a common issue in surgical patients. To avoid this issue, the patient should be monitored continuously throughout the perioperative process. Evidence-based practices in line with relevant guidelines are necessary to maintain normothermia.

PURPOSE

This study was developed to determine the effect of using a control list developed for preventing IPH on time of awakening from anesthesia and coagulation disorder in surgical patients.

METHODS

In this randomized controlled study, nursing interventions were applied to patients in accordance with the normothermia checklist (NC) developed by the researchers to prevent IPH.

RESULTS

In this study, 30 patients were respectively assigned to the experimental and control groups. Conducting nursing interventions in accordance with the control checklist was found to be effective in preventing IPH. Moreover, time of awakening from anesthesia was significantly shorter in the experimental group (3.77 ± 1.10 minutes) than the control group (11.03 ± 2.51 minutes; p < .05). Furthermore, tendency to bleed was higher in the control group than the experimental group, and a statistically significant between-group difference in coagulation disorders was found ( p < .05).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The results of this evidence-based study indicate that implementing nursing interventions in line with the developed NC is effective in preventing IPH. Preventing IPH, which increases the risk of numerous complications in surgical patients, is an important responsibility of nurses. Nurses may employ the NC proposed in this study to better secure the safety and minimize the risk of complications in surgical patients.