PATIENT CARE


Patient warming: improving outcomes


Research shows that addressing the issue of inadvertent hypothermia can have a significant impact – reducing mortality and morbidity in patients with trauma, as well as those undergoing surgery. LOUISE FRAMPTON reports.


Hypothermia is a condition in which core temperature drops below the required temperature for normal metabolism and body functions, which is defined as 35˚C (95˚F). The very young and the very old are more susceptible to hypothermia, while certain medical conditions can also affect patients’ thermoregulation. Trauma patients are particularly at risk and studies have shown that there are serious consequences associated with injured patients who are hypothermic (<35˚C), including coagulopathy, acidosis, decreased myocardial contractility and increased risk of mortality. Addressing the risk of hypothermia,


even before the patient arrives at hospital, is critical, therefore. A French study, recently published in the journal Critical Care (July 2012), found that patients who suffered a traumatic injury were at greater risk of mortality from hypothermia. The researchers advised that patients receiving emergency medical services should remain clothed when possible and temperatures of IV fluids and ambulances should be controlled.1 The researchers analysed cases of


adults with traumatic injuries who received pre-hospital care before being taken by ambulance to one of eight hospitals included in the study. The patients’ body temperatures were monitored continuously using an infrared tympanic thermometer – 14% of patients had hypothermia by the time they arrived at the hospital. “As expected, the severity of


hypothermia was linked to the severity of injury,” said Dr. Frederic Lapostolle, of


NOVEMBER 2012 THE CLINICAL SERVICES JOURNAL 55


‘Seriously injured patients with accidental hypothermia have a higher mortality independent of measured risk factors.’


Avicenne Hospital in Bobigny. “Blood loss and spine or head injury impair body temperature regulation, and, in our study, we found that head injury and intubation to aid breathing were independently associated with hypothermia.” Although the temperature outside had


little effect on patients’ risk for hypothermia, the temperature of the IV fluids they were given and temperatures inside their ambulance were significant


The Medi-Therm Hyper/Hypothermia system fromStryker helps regulate patient temperature through a microprocessor control. Separate heating and cooling reservoirs deliver rapid thermal response. The rate-controlled warming option allows caregivers to progressively increase temperature and reliably stabilise patient temperature at a selected set point.


risk factors for the condition. “The temperature of infused fluid for


75% of our patients was below [70˚F] and usually at ambient air temperature,” Dr Lapostolle added. “We suggest that, to reduce the incidence of hypothermia, the temperature of infusion fluids needs to be controlled, and that as small a volume as possible is used. Temperature of infusion fluids can be easily and rapidly measured in pre-hospital settings.” “We also recommend that ambulances


be heated and that, as much as possible, the patient should remain clothed, because attempting to warm the patients did not compensate for the effect of them being undressed even if it can make examination more difficult,” he concluded. The need for improved temperature management for trauma patients was also highlighted by the findings of an earlier study on ‘The incidence and significance of accidental hypothermia in major trauma’ – conducted by Ireland et al, in Melbourne, Australia.2 A review of 732 medical records of


major trauma patients presenting to an adult major trauma centre was undertaken between January and December 2008. Overall mortality was


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