Active Warming during Cesarean Delivery: Should We SCIP It?

Abstract

Background The purpose of this open, cluster randomized controlled trial was to evaluate whether use of a fiber optic–regulated warming mattress would decrease the incidence of hypothermia in women undergoing cesarean delivery.

Patients and Methods A total of 484 women were randomized via the cluster method on a rotating weekly basis allocating participants to either use of the warming mattress or the standard method of warming at Parkland Hospital (heat-retaining caps, warmed intravenous and irrigation fluids, and warmed blankets). The primary outcome of interest was maternal hypothermia. Surgical site infections and neonatal outcomes were also assessed.

Results The incidence of maternal hypothermia at the conclusion of the surgery was decreased in the warming mattress group, 67 versus 80% in the standard method group (p = 0.013). There were no significant differences in maternal hypothermia at delivery or on arrival to the postanesthesia care unit. The difference in surgical site infections and neonatal outcomes were nonsignificant.

Conclusion Use of a warming mattress reduced the incidence of maternal hypothermia at the conclusion of surgery; however, on admission to the postanesthesia care unit, these effects had dissipated.

Keywords

hypothermia - active warming - cesarean delivery - warming mattress

Note

Erica N. Grant's contribution to this work was conducted with support from Center for Translational Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, and National Institute of Health/National Center for Advancing Translational Sciences, Bethesda, Maryland Grant Number KL2TR000453. The University of Texas Southwestern Institutional Review Board number was STU 042011–032 and the date of approval was June 16, 2011.

• References

• 1 Centers for Medicare & Medicaid Services, The Joint Commission. Specifications manual for national hospital inpatient quality measures, v 4.2b 2012. Available at: http://www.jointcommission.org/assets/1/6/NHQM_Release_Notes_v4_2b_1.1.2013.pdf . Accessed December 14, 2012
• 2 Mitrophanov AY, Rosendaal FR, Reifman J. Computational analysis of the effects of reduced temperature on thrombin generation: the contributions of hypothermia to coagulopathy. Anesth Analg 2013; 117 (3) 565-574
• 3 Devereaux PJ, Goldman L, Cook DJ, Gilbert K, Leslie K, Guyatt GH. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ 2005; 173 (6) 627-634
• 4 Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet 2001; 358 (9285) 876-880
• 5 Frank SM, Fleisher LA, Breslow MJ , et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 1997; 277 (14) 1127-1134
• 6 Kurz A, Sessler DI, Lenhardt R ; Study of Wound Infection and Temperature Group. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996; 334 (19) 1209-1215
• 7 Frank SM, Higgins MS, Breslow MJ , et al. The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia. A randomized clinical trial. Anesthesiology 1995; 82 (1) 83-93
• 8 Vaughan MS, Vaughan RW, Cork RC. Postoperative hypothermia in adults: relationship of age, anesthesia, and shivering to rewarming. Anesth Analg 1981; 60 (10) 746-751
• 9 Forbes SS, Eskicioglu C, Nathens AB , et al; Best Practice in General Surgery Committee, University of Toronto. Evidence-based guidelines for prevention of perioperative hypothermia. J Am Coll Surg 2009; 209 (4) 492-503.e1
• 10 Seamon MJ, Wobb J, Gaughan JP, Kulp H, Kamel I, Dempsey DT. The effects of intraoperative hypothermia on surgical site infection: an analysis of 524 trauma laparotomies. Ann Surg 2012; 255 (4) 789-795
• 11 Carpenter L, Baysinger CL. Maintaining perioperative normothermia in the patient undergoing cesarean delivery. Obstet Gynecol Surv 2012; 67 (7) 436-446
• 12 Butwick AJ, Lipman SS, Carvalho B. Intraoperative forced air-warming during cesarean delivery under spinal anesthesia does not prevent maternal hypothermia. Anesth Analg 2007; 105 (5) 1413-1419
• 13 Woolnough M, Allam J, Hemingway C, Cox M, Yentis SM. Intra-operative fluid warming in elective caesarean section: a blinded randomised controlled trial. Int J Obstet Anesth 2009; 18 (4) 346-351
• 14 Yokoyama K, Suzuki M, Shimada Y, Matsushima T, Bito H, Sakamoto A. Effect of administration of pre-warmed intravenous fluids on the frequency of hypothermia following spinal anesthesia for Cesarean delivery. J Clin Anesth 2009; 21 (4) 242-248
• 15 Fallis WM, Hamelin K, Symonds J, Wang X. Maternal and newborn outcomes related to maternal warming during cesarean delivery. J Obstet Gynecol Neonatal Nurs 2006; 35 (3) 324-331
• 16 Horn EP, Schroeder F, Gottschalk A , et al. Active warming during cesarean delivery. Anesth Analg 2002; 94 (2) 409-414
• 17 Sessler DI. Complications and treatment of mild hypothermia. Anesthesiology 2001; 95 (2) 531-543
• 18 Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrison's Principles of Internal Medicine, 18th ed. New York, NY: McGraw-Hill; 2011
• 19 Sessler DI. Perioperative heat balance. Anesthesiology 2000; 92 (2) 578-596
• 20 AORN. Perioperative Standards and Recommended Practices. Denver, CO: AORN; 2013: 513-540