Prevention of peri-interventional hypothermia during endoscopic retrograde cholangiopancreatography using a forced-air heating system

Abstract

Background: Perioperative hypothermia is associated with significant complications, and can be prevented by forced-air heating systems (FAHS). If hypothermia occurs during prolonged endoscopic sedation is unclear and prevention measures are not addressed in endoscopic sedation guidelines. We hypothesized that hypothermia also occurs in a significant proportion of patients undergoing endoscopic interventions associated with longer sedation times such as endoscopic retrograde cholangiopancreaticography (ERCP), and that FAHS may prevent it. Methods: In this observational study, each patient received two consecutive ERCPs, the first ERCP following current standard of care without FAHS (SOC group) and a consecutive ERCP with FAHS (FAHS group). The primary endpoint was maximum body temperature difference during sedation. Results: 24 patients were included. Median (IQR) maximum body temperature difference was −0.9°C (−1.2; −0.4) in the SOC and −0.1°C (−0.2; 0) in the FAHS group (p < 0.001). Median body temperature was lower in the SOC compared with the FAHS group after 20, 30, 40 and 50 minutes of sedation. A reduction in body temperature of > 1°C (p < 0.001) and a reduction below 36°C (p = 0.01) occurred more often in the SOC than in the FAHS group. FAHS was independently associated with reduced risk of hypothermia (p=0.006). More patients experienced freezing in the SOC group (p = 0.004). Hemodynmaic and respiratory stability were comparable in both groups. Conclusions: Hypothermia occurred in the majority of patients undergoing prolonged endoscopic sedation without active temperature control. FAHS was associated with higher temperature stability during sedation and better patient comfort.