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Meta-Analysis
. 2014 Jun 4;2014(6):CD009908.
doi: 10.1002/14651858.CD009908.pub2.

Thermal insulation for preventing inadvertent perioperative hypothermia

Phil Alderson  1 , Gillian Campbell, Andrew F Smith, Sheryl Warttig, Amanda Nicholson, Sharon R Lewis
Affiliations
Meta-Analysis

Thermal insulation for preventing inadvertent perioperative hypothermia

Phil Alderson et al. Cochrane Database Syst Rev. .

Abstract

Background: Inadvertent perioperative hypothermia occurs because of interference with normal temperature regulation by anaesthetic drugs and exposure of skin for prolonged periods. A number of different interventions have been proposed to maintain body temperature by reducing heat loss. Thermal insulation, such as extra layers of insulating material or reflective blankets, should reduce heat loss through convection and radiation and potentially help avoid hypothermia.

Objectives: To assess the effects of pre- or intraoperative thermal insulation, or both, in preventing perioperative hypothermia and its complications during surgery in adults.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 2), MEDLINE, OvidSP (1956 to 4 February 2014), EMBASE, OvidSP (1982 to 4 February 2014), ISI Web of Science (1950 to 4 February 2014), and CINAHL, EBSCOhost (1980 to 4 February 2014), and reference lists of articles. We also searched Current Controlled Trials and ClinicalTrials.gov.

Selection criteria: Randomized controlled trials of thermal insulation compared to standard care or other interventions aiming to maintain normothermia.

Data collection and analysis: Two authors extracted data and assessed risk of bias for each included study, with a third author checking details. We contacted some authors to ask for additional details. We only collected adverse events if reported in the trials.

Main results: We included 22 trials, with 16 trials providing data for some analyses. The trials varied widely in the type of patients and operations, the timing and measurement of temperature, and particularly in the types of co-interventions used. The risk of bias was largely unclear, but with a high risk of performance bias in most studies and a low risk of attrition bias. The largest comparison of extra insulation versus standard care had five trials with 353 patients at the end of surgery and showed a weighted mean difference (WMD) of 0.12 ºC (95% CI -0.07 to 0.31; low quality evidence). Comparing extra insulation with forced air warming at the end of surgery gave a WMD of -0.67 ºC (95% CI -0.95 to -0.39; very low quality evidence) indicating a higher temperature with forced air warming. Major cardiovascular outcomes were not reported and so were not analysed. There were no clear effects on bleeding, shivering or length of stay in post-anaesthetic care for either comparison. No other adverse effects were reported.

Authors' conclusions: There is no clear benefit of extra thermal insulation compared with standard care. Forced air warming does seem to maintain core temperature better than extra thermal insulation, by between 0.5 ºC and 1 ºC, but the clinical importance of this difference is unclear.

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Conflict of interest statement

Amanda Nicholson (AN): from March to August 2011, AN worked for the Cardiff Research Consortium, which provides research and consultancy services to the pharmaceutical industry. The projects AN worked on at the Cardiff Research Consortium have no connection with the topic of this review. AN's husband has small direct holdings in several drug and biotech companies as part of a wider balanced share portfolio.

All other authors: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Additional insulation versus control, Outcome 1 Temperature after 30 minutes.
1.2
1.2. Analysis
Comparison 1 Additional insulation versus control, Outcome 2 Temperature after 1 hour.
1.3
1.3. Analysis
Comparison 1 Additional insulation versus control, Outcome 3 Temperature after 90 minutes.
1.4
1.4. Analysis
Comparison 1 Additional insulation versus control, Outcome 4 Temperature after 2 hours.
1.5
1.5. Analysis
Comparison 1 Additional insulation versus control, Outcome 5 Temperature at the end of procedure / arrival in PACU.
1.6
1.6. Analysis
Comparison 1 Additional insulation versus control, Outcome 6 Estimated blood loss.
1.7
1.7. Analysis
Comparison 1 Additional insulation versus control, Outcome 7 Shivering.
1.8
1.8. Analysis
Comparison 1 Additional insulation versus control, Outcome 8 Length of stay in PACU.
2.1
2.1. Analysis
Comparison 2 Additional insulation versus forced air warming, Outcome 1 Temperature after 30 minutes.
2.2
2.2. Analysis
Comparison 2 Additional insulation versus forced air warming, Outcome 2 Temperature after 1 hour.
2.3
2.3. Analysis
Comparison 2 Additional insulation versus forced air warming, Outcome 3 Temperature after 90 minutes.
2.4
2.4. Analysis
Comparison 2 Additional insulation versus forced air warming, Outcome 4 Temperature after 2 hours.
2.5
2.5. Analysis
Comparison 2 Additional insulation versus forced air warming, Outcome 5 Temperature at the end of procedure / arrival in PACU.
2.6
2.6. Analysis
Comparison 2 Additional insulation versus forced air warming, Outcome 6 Estimated blood loss.
2.7
2.7. Analysis
Comparison 2 Additional insulation versus forced air warming, Outcome 7 Shivering.
2.8
2.8. Analysis
Comparison 2 Additional insulation versus forced air warming, Outcome 8 Length of stay in PACU.
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  • doi: 10.1002/14651858.CD009908

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References

References to studies included in this review

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