Postoperative hypothermia—The chilling consequences

Abstract

UNPLANNED HYPOTHERMIA is commonly encountered in the perioperative period. Nursing has contributed to the literature on hypothermia with studies on shivering and treatment modalities; however, the direct physiological consequences of postoperative hypothermia have been reported mainly in the medical literature. RESEARCH ON THE PHYSIOLOGICAL effects of postoperative hypothermia offers nurses further evidence to support interventions for temperature correction in patients with hypothermia. Evidence indicates that forced‐air warming is the most effective method for warming hypothermic patients. THE ROY ADAPTATION MODEL is explained as a framework for nursing care of patients with hypothermia. Clinical practice guidelines for unplanned perioperative hypothermia also are provided. AORN J 83 (May 2006) 1055–1066.

Unintentional Hypothermia: Implications for Perianesthesia Nurses

“…The physiological effects reflect an overall depression of metabolism affecting all body systems (Table 2). 4,5,8,[10][11][12][13] In addition to the physiological effects of hypothermia, other potentially deleterious effects include alteration in wound healing, myocardial infarction, coagulopathy, increased infection rates, and prolonged emergence after anesthesia because of decreased drug metabolism, as well as psychological effects including pain, stress, and altered cognitive functioning (Table 3). 12 Although all patients are potentially affected by the adverse physiological responses associated with hypothermia, infants, the elderly and debilitated, patients with burns and trauma, and the malnourished represent patient categories at greatest risk for developing physiological alterations (Table 4).…”

“…12 Although all patients are potentially affected by the adverse physiological responses associated with hypothermia, infants, the elderly and debilitated, patients with burns and trauma, and the malnourished represent patient categories at greatest risk for developing physiological alterations (Table 4). 5,8 For example, research aimed at predictive factors for hypothermia found that patients older than 70 years were at greater risk for untoward sequelae associated with the development of perioperative hypothermia. 14…”

“…1,11 This type of radiation heat loss can be prevented by limiting skin exposure with warmed cotton blankets, socks, and head coverings. 5,18 Infants and children lose body heat primarily through the skin surface. 8,11 The infant's larger body surface area facilitates greater heat loss than adults.…”

“…[1][2][3][4][5][6][7] A generalized depression of metabolism is the hallmark of hypothermia, affecting all body systems. The incidence of hypothermia for surgical patients ranges from 50 % to 90%.…”

“…6,7 Significant physiological changes result, such as altered cardiac function, changes in level of consciousness, prolonged plasma half-lives of drugs, and shivering, which may increase oxygen demand as much as 500%. 5,8 Other adverse outcomes associated with hypothermia include increases in length of hospital stay, infection rates, and cardiac events. 9 Research shows that patients who remain normothermic throughout the surgical continuum acquired fewer infections (64%), exhibited 44% fewer cardiac events, and were 34% less likely to require postoperative mechanical ventilation.…”