PATIENT WARMING
HumiGard, and 30 patients receiving standard room temperature, dry CO2
. The
primary outcome was shoulder tip pain at four hours after surgery. Secondary outcome measures were time in recovery room, nausea, post-operative temperature and pelvic pain. The results showed a significant difference in change in core temperature from theatre to recovery (p=0.027). Sammour et al18
randomised controlled trial that compared HumiGard with unwarmed, dry CO2
reported a double-blind gas in
patients having elective laparoscopic colonic resection. A total of 41 patients received warm (37˚C), humidified (98% humidity) CO2
with HumiGard, and 41 patients received room temperature, dry CO2
.
The primary outcome was total opiate analgesia used during inpatient stay. Secondary outcome measures were post- operative pain. Other secondary outcome measures were intra-operative core temperature, cytokine response and length of inpatient stay. The results showed that HumiGard had a significant effect on post- operative pain at rest on day 1 (p=0.01) and post-operative pain on moving on day 1 (p=0.018). The results showed no statistically significant difference in the other outcome measures specified in the scope. NICE also evaluated the evidence from a double-blind randomised controlled trial in children aged 8 to 14 years having an acute laparoscopic appendectomy. Conducted by Yu et al,19
the study randomised 95 patients to
receive warm (37˚C), humidified (98% humidity) CO2
with HumiGard, and 95
patients to receive room temperature, dry CO2
. The primary outcome was post-operative pain (analgesic use) in the recovery room and at days one and two after the operation. Secondary outcome measures were pain intensity scores, intra-operative core temperature and post-operative recovery and return to normal activities. The authors provided only graphical data for pain perceived at rest and on moving, but no differences were reported between the groups at any of the time points studied (0, 2, 4, 6, 8, 10, 12, 24 and 48 hours). Mason et al20
was a retrospective cohort
trial, performed in a single UK centre, including patients having laparoscopic colorectal resections. The trial included 246 consecutive patients (mean age 68 years) with equal numbers having HumiGard or standard care. Outcome measures included incidence of surgical site infections, incidence of post-operative pneumonia, perioperative hypothermia, number of bed days, length of time in theatre recovery and cost. Body temperature was routinely measured tympanically on arrival to the post-anaesthetic recovery suite. The measurement of temperature intraoperatively was not standardised and therefore could not be included in the analysis. The results showed significant differences in perioperative hypothermia (p≤0.001), post-operative hypothermia on arrival in the recovery suite
(p<0.001) and incidence of surgical site infections when hypothermic (p=0.02). There was a significant difference in overall incidence of surgical site infections (p=0.04) but not in length of hospital stay.
NICE recommendations
The NICE committee considered that the clinical evidence supported the effectiveness of HumiGard in reducing hypothermia during laparoscopic and open abdominal surgery, noting that the evidence base was more substantial for laparoscopic surgery than for open surgery. The committee also noted the lack of high quality direct comparisons supporting the use of HumiGard to avoid the adverse outcomes of hypothermia following surgery.
The committee added that only one of the included studies involved children, and that in this study outcomes did not improve. However, clinical experts advised that heat loss is partly determined by the ratio of body surface area to body mass. Because this is larger in children, overheating through the use of warming strategies can also be a concern. The committee concluded that there was insufficient evidence to recommend the use of HumiGard in children.
The committee heard that total length of hospital stay after abdominal surgery has been reduced through the implementation of enhanced recovery programmes. Historically, length of stay after colorectal surgery was 7 to 9 days but this has now been reduced
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