Effects of intraoperative temperatures on postoperative infections in infants and neonates

Walker, Scott G.; Amin, Ruchi; Arca, Marjorie J.; Datta, Ankur

doi:10.1016/j.jpedsurg.2019.09.060

Cited by 9 publications

(10 citation statements)

References 22 publications

(30 reference statements)

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“…With the discrepancy of incidences in hypothermia and hyperthermia, our study remarkably underlines the risk of children becoming hyperthermic due to highly effective forced-air warming devices with the potential of overheating [ 3 ]. This can also lead to harm such as surgical site infection, thermal discomfort, or sweating in the postanesthetic care unit [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Neonates, infants, and young children are at increased risk of perioperative hypothermia due to their reduced weight-to-surface-area-ratio and limited subcutaneous fat stores [ 5 ]. Particularly in this age group, however, there is also a clear risk of overheating, which is associated with relevant complications such as surgical site infections [ 6 ]. Temperature management requires an accurate method to measure core temperature.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative zero-heat-flux thermometry overestimates esophageal temperature by 0.26 °C: an observational study in 100 infants and young children

Nemeth¹,

Lovric²,

Asendorf³

et al. 2020

J Clin Monit Comput

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In pediatric anesthesia, deviations from normothermia can lead to many complications, with infants and young children at the highest risk. A measurement method for core temperature must be clinically accurate, precise and should be minimally invasive. Zero-heat-flux (ZHF) temperature measurements have been evaluated in several studies in adults. We assessed the agreement between the 3M Bair Hugger™ temperature measurement sensor (TZHF) and esophageal temperature (TEso) in children up to and including 6 years undergoing surgery with general anesthesia. Data were recorded in 5 min-intervals. We investigated the accuracy of the ZHF sensor overall and in subgroups of different age, ASA classification, and temperature ranges by Bland–Altman comparisons of differences with multiple measurements. Change over time was assessed by a linear mixed model regression. Data were collected in 100 children with a median (1st–3rd quartile) age of 1.7 (1–3.9) years resulting in 1254 data pairs. Compared to TEso (range from 35.3 to 39.3 °C; median 37.2 °C), TZHF resulted in a mean bias of +0.26 °C (95% confidence interval +0.22 to +0.29 °C; 95% limits of agreement −0.11 to +0.62 °C). Lin’s concordance correlation coefficient was 0.89. There was no significant or relevant change of temperature over time (0.006 °C per hour measurement interval, p = 0.199) and no relevant differences in the subgroups. Due to the mean bias of +0.26 °C in TZHF, the risk of hypothermia may be underestimated, while the risk of hyperthermia may be overestimated. Nevertheless, because of its high precision, we consider ZHF valuable for intraoperative temperature monitoring in children and infants.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intraoperative zero-heat-flux thermometry overestimates esophageal temperature by 0.26 °C: an observational study in 100 infants and young children

Nemeth¹,

Lovric²,

Asendorf³

et al. 2020

J Clin Monit Comput

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“…This is true for increased blood loss, transfusion [ 9 , 55 ], and impaired wound healing [ 8 ]. Reports about SSI are conflicting [ 56 , 57 ].…”

Section: Adverse Eventsmentioning

confidence: 99%

“…Especially during longer-lasting operations in small children, forced-air warming can lead to overheating [ 17 , 81 , 82 , 88 , 112 ]. Intraoperative hyperthermia has been associated with SSI in neonates and infants [ 57 ] and is generally undesirable. Therefore, it is imperative to monitor core temperature in children.…”

Section: Risks Of Active Warming Therapymentioning

confidence: 99%

Perioperative Hypothermia in Children

Nemeth

Miller

Bräuer

2021

IJERPH

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Background: First described by paediatric anaesthesiologists, perioperative hypothermia is one of the earliest reported side effects of general anaesthesia. Deviations from normothermia are associated with numerous complications and adverse outcomes, with infants and small children at the highest risk. Nowadays, maintenance of normothermia is an important quality metric in paediatric anaesthesia. Methods: This review is based on our collection of publications regarding perioperative hypothermia and was supplemented with pertinent publications from a MEDLINE literature search. Results: We provide an overview on perioperative hypothermia in the paediatric patient, including definition, history, incidence, development, monitoring, risk factors, and adverse events, and provide management recommendations for its prevention. We also summarize the side effects and complications of perioperative temperature management. Conclusions: Perioperative hypothermia is still common in paediatric patients and may be attributed to their vulnerable physiology, but also may result from insufficient perioperative warming. An effective perioperative warming strategy incorporates the maintenance of normothermia during transportation, active warming before induction of anaesthesia, active warming during anaesthesia and surgery, and accurate measurement of core temperature. Perioperative temperature management must also prevent hyperthermia in children.

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“…4 Possible reasons for intraoperative hyperthermia include sepsis, iatrogenic passive overheating, inadequate heat loss, and allergic reactions. 4,5 Hyperthermia is associated with postoperative infections, 6 and in severe cases it can be life-threatening. 7 Therefore, continuous core body temperature monitoring is necessary to maintain normothermia during pediatric surgery.…”

mentioning

confidence: 99%

The Accuracy of a Wireless Axillary Thermometer for Core Temperature Monitoring in Pediatric Patients Having Noncardiac Surgery: An Observational Study

Ding

Han

et al. 2021

Journal of PeriAnesthesia Nursing

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A wireless and wearable axillary thermometer (iThermonitor) has been validated for perioperative core temperature monitoring in adults. The purpose of this study was to evaluate its accuracy in pediatrics having non−cardiac surgery. Design: Prospective observational study. Methods: From January 2019 to December 2019, 70 children aged younger than 14 years undergoing surgery in a tertiary hospital were selected. Pairs of esophageal temperatures (T Eso ), rectal temperatures (T Rec ), and axillary temperatures monitored by the iThermonitor (T iTh ) were collected every 5 min during surgery. Taking T Eso as reference, the bias between T Eso and T iTh and the proportion of bias within §0.5°C were calculated. Bland-Altman method was used to analyze the 95% of limits of agreement (LOA) between T iTh and T Eso . The same analyses were done for T Rec. Findings: A total of 2232 pairs of temperatures were collected. The bias (mean § SD) between T iTh and T Eso was -0.07°C § 0.25°C, and 95% LOA was -0.07°C § 0.50°C. The proportion of bias within §0.5°C accounted for 96% (95% Confidence Interval [CI], 92-98%). Higher bias and 95% LOA, and lower proportion of bias within § 0.5°C were found between T Rec and T Eso than those between T iTh and T Eso . Conclusion: During pediatric non−cardiac surgery, axillary temperature derived from iThermonitor is in good agreement with esophageal temperature and can be used as an alternative to core temperature.

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Effects of intraoperative temperatures on postoperative infections in infants and neonates

Cited by 9 publications

References 22 publications

Intraoperative zero-heat-flux thermometry overestimates esophageal temperature by 0.26 °C: an observational study in 100 infants and young children

Intraoperative zero-heat-flux thermometry overestimates esophageal temperature by 0.26 °C: an observational study in 100 infants and young children

Perioperative Hypothermia in Children

The Accuracy of a Wireless Axillary Thermometer for Core Temperature Monitoring in Pediatric Patients Having Noncardiac Surgery: An Observational Study

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