The objective of this work was to evaluate the efficacy of an induced normothermia protocol by comparing patient mortality and outcomes in patients treated at Boston Medical Center (BMC) before and after the implementation of the protocol. The controls (regular fever management) and the cases (induced normothermia) were demographically similar, except there were more whites (p = 0.01) in the control group and more of the patients in the control group were transferred to BMC from outside hospitals (p = 0.006), although there was not a higher incidence of death among patients who were transferred from outside hospitals (p = 0.55). The patients in the case group were kept normothermic throughout the first 7 days of their hospital stay more effectively than those in the control group (p = 0.0001). Average intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were not different between the two groups, although mean arterial pressure (MAP) was (p = 0.84; p = 0.08; p = 0.02, respectively). Mortality was lower in the case group by hospital discharge (p = 0.007) and patients in the case group were more likely to achieve a positive functional outcome (p = 0.03). In light of these findings, there is a need for high-quality prospective trials to assess the efficacy of induced normothermia compared to regular fever management.

Perioperative hypothermia, defined as a core body temperature lower than 36řC, is associated with increased perioperative complications and prolonged hospitalization. The aim of this thesis is to analyze measures that are taken to prevent perioperative hypothermia at the Orthopedic Clinic of one Czech hospital and compare them with the current recommendations of the American Society of PeriAnesthesia Nurses, Association of Operating Room Nurses and the National Institute for Health and Care Excellence. The study included 223 patients who underwent a planned orthopedic surgery and who were more than 18 years old. As a method of data collection I chose studying the medical documentation. The obtained data were processed quantitatively. The recommended body temperature range 36.5-37.5řC before leaving an operating room had total of 60.55% of cases. Neither one patient has been no action in terms of prevention of hypothermia. Body temperature was taken in 22.4% of cases at the beginning of and during the surgery. Except for a cotton sheet, which was used in 100% of patients, no additional measures were taken in 18,4% of patients. Thermal insulation was used in 41,7% of patients, in-line warming system of infusion fluids in 65% of patients, forced air warming system in 17.9% of patients, and disposable...

Abstract Syftet med denna studie var att påvisa effekter av ofrivillig hypotermi samt beskriva anestesisjuksköterskans omvårdnadsåtgärder för att belysa vilka förebyggande faktorer som bibehåller normotermi i den perioperativa vården. Metod: Studien genomfördes som en litteraturöversikt. Artiklarna har sökts via Cinahl och Medline. Studiens resultat baserades på sjutton vetenskapliga artiklar med kvantitativ ansats, dessa grupperades under olika teman. Resultatet redovisas i följande huvudteman fysiologiska effekter, komplikationer, perioperativa teamet, aktiv uppvärmning, administrering av intravenösa vätskor, miljön i operationssalen samt riktlinjer för bibehållande av normotermi. Ofrivillig hypotermi i samband med ett kirurgiskt ingrepp ökade risken för komplikationer i form av ökad infektionsbenägenhet, påverkan på koagulationen med ökad blödningsrisk och hjärtpåverkan med risk för myocardischemi. Hypotermi påverkade också läkemedelsmetabolismen. Dessa effekter av ofrivillig hypotermi under den perioperativa vården orsakade patienten onödigt lidande, förlängd sjukhus vistelse och ökade kostnader för samhället.Slutsats: Anestesisjuksköterskans mest framgångsrika omvårdnadsåtgärder i den perioperativa fasen för att bibehålla normotermi var att använda aktiv uppvärmning, (värmetäcke) vätskevärmare och förhöjd rumstemperatur i operationssalen. Därigenom minskade värmeförlusten via strålning från patientens hud till omgivande miljö. Dessa omvårdnadsåtgärder förutsätter gott samarbete och ska vara självklara i det perioperativa teamet.

Les espèces endothermes amphibies font face à de fortes contraintes durant leurs séjours en mer dont l’augmentation des coûts de thermorégulation. La recherche alimentaire du manchot royal (Aptenodytes patagonicus) s’étend sur plusieurs jours alternant des plongées profondes de chasse et des périodes de repos à la surface de l’eau correspondant à deux stratégies de thermorégulation différentes. Durant les plongées, l’hypothermie des tissus suggère une économie d’énergie visant à augmenter la durée d’apnée. Cependant, l’utilité de la réaugmentation des températures corporelles durant les périodes de repos reste méconnue. Alors que la digestion débute durant les plongées, nous supposons que le stockage des acides gras dans les tissus adipeux périphériques ne peut se faire que par le retour à normothermie de ces tissus. Nous avons testé cette hypothèse en maintenant des individus équipés d’enregistreurs de températures (périphériques et interne) dans une piscine d’eau de mer afin d’étudier les variations de températures en fonction de l’état nutritionnel des manchots. De plus, nous avons mesuré, par respirométrie, les dépenses énergétiques en fonction des températures corporelles. Enfin, nous avons étudié les variations de flux sanguins à l’aide de thermographie infra-rouge afin de comprendre le retour à normothermie des tissus périphériques et les coûts énergétiques associés. / The energetic cost of foraging activities in King Penguin (Aptenodytes patagonicus) consists to reach favourable areas, realizes depth diving to attempt fish patch and resting in high latitude cold water. Several studies have shown that resting in cold water could be represent a more expensive cost than realized depth diving. Indeed, this paradox is probably linked with contrasting thermoregulation processes. During daylight, a general hypothermia occurs and is believed to reduce energy expenditure. At sunrise occurs a re-warming to normothermia, contributing to increase heat-loss during the night. We hypothesise an energetic conflict between thermoregulation and digestive processes. During daylight, the organism may be unable to assimilate the end product of prey digestion (free fatty acids) inside the peripheral subcutaneous adipose tissues (SAT), because skin is no more blood perfused. During the night, re-warming and re-connecting to blood circulation peripheral tissues could be inevitable to end the assimilation of FFA inside the SAT. In a first step, we have reproduced the conditions of a resting night at sea and events of rewarming skin temperature, using a sea water tank in which king penguins equipped with internal temperature loggers were maintained several days. In a second step, we have tested a generalisation of our hypothesis studying body temperature variations on penguins fast and feed. Finally, we have measured the cost to maintain normothermia in cold water with respirometry measures and investigated peripheral vasodilation with body temperature variations and infrared thermography.

Background Moderate hypothermia after decompressive surgery might not be beneficial for stroke patients. However, normothermia may prove to be an effective method of enhancing neurological outcomes. The study aims were to evaluate the application of a pre-specified normothermia protocol in stroke patients after decompressive surgery and its impact on temperature load, and to describe the functional outcome of patients at 12 months after treatment. Methods We analysed patients with space-occupying middle cerebral artery (MCA) infarction treated with decompressive surgery and a pre-specified temperature management protocol. Patients treated primarily with device-controlled normothermia or hypothermia were excluded. The individual temperature load above 36.5 °C was calculated for the first 96 h after hemicraniectomy as the Area Under the Curve, using °C x hours. The effect of temperature load on functional outcome at 12 months was analysed by logistic regression. Results We included 40 stroke patients treated with decompressive surgery (mean [SD] age: 58.9 [10.1] years; mean [SD] time to surgery: 30.5 [16.7] hours). Fever (temperature > 37.5 °C) developed in 26 patients during the first 96 h after surgery and mean (SD) temperature load above 36.5 °C in this time period was 62,3 (+/− 47,6) °C*hours. At one year after stroke onset, a moderate to moderately severe disability (modified Rankin Scale score of 3 or 4) was observed in 32% of patients, and a severe disability (score of 5) in 37% of patients, respectively. The lethality in the cohort at 12 months was 32%. The temperature load during the first 96 h was not an independent predictor for 12 month lethality (OR 0.986 [95%-CI:0.967–1.002]; p < 0.12). Conclusions Temperature control in surgically treated patients with space-occupying MCA infarction using a pre-specified protocol excluding temperature management systems resulted in mild hyperthermia between 36.8 °C and 37.2 °C and a low overall temperature load. Future prospective studies on larger cohorts comparing different strategies for normothermia treatment including temperature management devices are needed.

Bakgrund: Hypotermi innebär en kärntemperatur under 36 °C och är en vanlig komplikation under perioperativa förloppet. Vid anestesi störs kroppens normala fysiologiska temperatureglering. Hypotermi kan leda till flertalet allvarliga komplikationer som kan orsaka ett lidande för patienten samt en ökad kostnad för samhället. Trots att forskning länge visat att preventiva åtgärder minskar risken för hypotermi kvarstår problemet. Syfte: Syftet är att identifiera preoperativa aktiva värmebevarande metoder och vilken effekt dessa har på att minska risken för perioperativ hypotermi hos den vuxna patienten. Metod: En systematisk litteraturstudie valdes som metod för att besvara syftet. Sökningar genomfördes i CINAHL, PubMed och Web of Science. Totalt 19 kvantitativa artiklar inkluderades och data extraherades genom en extraktionsmall. Resultat: Resultatet är sammanfattat i två huvudkategorier, preoperativa aktiva värmebevarande metoder och effekten av preoperativ aktiv värmning på patientens perioperativa temperatur. Fem olika värmebevarande metoder identifierades. Resultatet visar att preoperativa aktiva värmemetoder har en positiv effekt på att minska uppkomst av hypotermi under det perioperativa förloppet. Slutsats: Perioperativ hypotermi kan förebyggas genom ökad medvetenhet hos vårdpersonal kring problemet och genom aktiva värmebevarande metoder under det perioperativa förloppet. / Background: Hypothermia means a core temperature below 36 ° C and is a common complication during the perioperative process. In the event of anesthesia, the body's normal physiological temperature control is disturbed. Hypothermia can lead to a number of serious complications that can cause a patient suffering and an increased cost for society. Although research has long shown that preventive efforts reduce the risk of hypothermia, the problem persists. Aim: The aim is to identify preoperative active heat-saving methods and the effect they have on reducing the risk of perioperative hypothermia in the adult patient. Method: A systematic literature study was chosen as a method of answering the purpose. Searches were conducted in CINAHL, PubMed and Web of Science. A total of 19 quantitative scientific articles were included and data extracted by an extraction template. Result: The result is summarized in two main categories, preoperative active heat-saving methods and the effect of preoperative active warming at the patient's perioperative temperature. Five different heat-saving methods were identified. The result shows that preoperative active heat methods have a positive effect on reducing the appearance of hypothermia during the perioperative process. Conclusion: Perioperative hypothermia can be prevented through increased awareness of healthcare professionals around the problem and through active heat-saving methods during the perioperative process.

Background Moderate hypothermia after decompressive surgery might not be beneficial for stroke patients. However, normothermia may prove to be an effective method of enhancing neurological outcomes. The study aims were to evaluate the application of a pre-specified normothermia protocol in stroke patients after decompressive surgery and its impact on temperature load, and to describe the functional outcome of patients at 12 months after treatment. Methods We analysed patients with space-occupying middle cerebral artery (MCA) infarction treated with decompressive surgery and a pre-specified temperature management protocol. Patients treated primarily with device-controlled normothermia or hypothermia were excluded. The individual temperature load above 36.5 °C was calculated for the first 96 h after hemicraniectomy as the Area Under the Curve, using °C x hours. The effect of temperature load on functional outcome at 12 months was analysed by logistic regression. Results We included 40 stroke patients treated with decompressive surgery (mean [SD] age: 58.9 [10.1] years; mean [SD] time to surgery: 30.5 [16.7] hours). Fever (temperature > 37.5 °C) developed in 26 patients during the first 96 h after surgery and mean (SD) temperature load above 36.5 °C in this time period was 62,3 (+/− 47,6) °C*hours. At one year after stroke onset, a moderate to moderately severe disability (modified Rankin Scale score of 3 or 4) was observed in 32% of patients, and a severe disability (score of 5) in 37% of patients, respectively. The lethality in the cohort at 12 months was 32%. The temperature load during the first 96 h was not an independent predictor for 12 month lethality (OR 0.986 [95%-CI:0.967–1.002]; p < 0.12). Conclusions Temperature control in surgically treated patients with space-occupying MCA infarction using a pre-specified protocol excluding temperature management systems resulted in mild hyperthermia between 36.8 °C and 37.2 °C and a low overall temperature load. Future prospective studies on larger cohorts comparing different strategies for normothermia treatment including temperature management devices are needed.