The Effects of Active Warming on Core Body Temperature and Thermal Comfort in Patients After Transurethral Resection of the Prostate: A Randomized Clinical Trial

Abstract

Prevention and treatment of hypothermia by active warming in perioperative period care is recommended but scientific evidence of its effectiveness in a clinical setting is scarce. The purpose of this study was to determine the effects of warmed intravenous fluids (WIVF) on the core body temperature and the patients’ thermal comfort. Baseline data of 105 male patients undergoing TUR-P surgery and bladder irrigation were analyzed. The experimental group was warmed using active WIVF, and the control group’s routine care was conducted using a cotton blanket. Body temperature was higher in patients in the experimental group than those in the control group. Repeated measures Manova revealed significantly different core temperature changes between groups (F = 34.446, p = .001). The thermal comfort scores were also higher in the experimental group than in the control group (x² = 203.552, p = .001). The findings indicated that WIVF can enhance body temperature and improve the thermal comfort of patients.

Keywords

body temperature thermal comfort nursing care postoperative care

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References

Andrzejowski

J. C.

Turnbull

Nandakumar

Gowthaman

Eapen

(2010). A randomised single blinded study of the administration of pre-warmed fluid vs active fluid warming on the incidence of peri-operative hypothermia in short surgical procedures. Anaesthesia, 65(9), 942–945. https://doi.org/10.1111/j.1365-2044.2010.06473.x

Azmoon

Dehghan

Akbari

Souri

(2013). The relationship between thermal comfort and light intensity with sleep quality and eye tiredness in shift work nurses. Journal of Environmental and Public Health, 2013, 639184–639185. https://doi.org/10.1155/2013/639184

Baradaranfard

Jabalameli

Ghadami

Aarabi

(2019). Evaluation of warming effectiveness on physiological indices of patients undergoing laparoscopic cholecystectomy surgery: A randomized controlled clinical trial. Journal of PeriAnesthesia Nursing, 34, 1016–1024. https://doi.org/10.1016/j.jopan.2018.11.013

Benson

E. E.

McMillan

D. E.

Ong

(2012). Original research: The effects of active warming on patient temperature and pain after total knee arthroplasty. The American Journal of Nursing, 112(5), 26–33. https://doi.org/10.1097/01.NAJ.0000414315.41460.bf

Bommadevara

Zhu

(2002). Temperature difference between the body core and arterial blood supplied to the brain during hyperthermia or hypothermia in humans. Biomechanics and Modeling in Mechanobiology, 1(2), 137–149. https://doi.org/10.1007/s10237-002-0011-2

Burger

Fitzpatrick

(2009). Prevention of inadvertent perioperative hypothermia. British Journal of Nursing, 18, 1114–1119. https://doi.org/10.12968/bjon.2009.18.18.44553

Burns

Wojnakowski

Piotrowski

Caraffa

(2009). Unintentional hypothermia: implications for perianesthesia nurses. Journal of PeriAnesthesia Nursing, 24(3), 167–173. https://doi:10.1016/j.jopan.2009.03.003

Campbell

Alderson

Smith

A. F.

Warttig

(2015). Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia. Cochrane Database of Systematic Reviews, (4), CD009891. https://doi.org/10.1002/14651858.CD009891.pub2.

Cassidy

E. S.

Adkins

C. R.

Rayl

J. H.

Wipfler

3rd . (2001). Evaluation of warmed intravenous fluids in the prehospital setting. Air Medical Journal, 20(5), 25–26. https://doi.org/10.1016/S1067-991X(01)70055-7

10.

Chebbout

Newton

R. S.

Walters

Wrench

I. J.

Woolnough

(2017). Does the addition of active body warming to in-line intravenous fluid warming prevent maternal hypothermia during elective caesarean section? A randomised controlled trial. International Journal of Obstetric Anesthesia, 31, 37–44. https://doi.org/10.1016/j.ijoa.2017.04.008

11.

Chue

A. L.

Moore

R. L.

Cavey

Ashley

E. A.

Stepniewska

Nosten

McGready

(2012). Comparability of tympanic and oral mercury thermometers at high ambient temperatures. BMC Research Notes, 5(1), 1–6. https://doi.org/10.1186/1756-0500-5-356

12.

Chung

S. H.

Lee

B. S.

Yang

H. J.

Kweon

K. S.

Kim

H. H.

Song

Shin

D. W.

(2012). Effect of preoperative warming during cesarean section under spinal anesthesia. Korean Journal of Anesthesiology, 62(5), 454–460. https://doi.org/10.4097/kjae.2012.62.5.454

13.

Çoban

Dolgun

(2016). A comparision of axillary with infrared tympanic and non-contact infrared thermometry. Journal of Pediatric Infection, 10(3), 82–85. https://doi:10.5152/ced.2016.2417

14.

Connelly

Cramer

DeMott

Piperno

Coyne

Winfield

Swanberg

(2017). The optimal time and method for surgical prewarming: A comprehensive review of the literature. Journal of PeriAnesthesia Nursing, 32(3), 199–209. https://doi.org/10.1016/j.jopan.2015.11.010

15.

Constantine

R. S.

Kenkel

Hein

R. E.

Cortez

Anigian

Davis

K. E.

Kenkel

J. M.

(2015). The impact of perioperative hypothermia on plastic surgery outcomes: A multivariate logistic regression of 1062 cases. Aesthetic Surgery Journal, 35(1), 81–88. https://doi.org/10.1093/asj/sju022

16.

De Mattia

A. L.

Barbosa

M. H.

de Freitas Filho

J. P.

Rocha Ade

Pereira

N. H.

(2013). Warmed intravenous infusion for controlling intraoperative hypothermia. Revista Latino-Americana de Enfermagem, 21(3), 803–810. https://doi.org/10.1590/S0104-11692013000300021

17.

Frank

S. M.

Fleisher

L. A.

Breslow

M. J.

Higgins

M. S.

Olson

K. F.

Kelly

Beattie

(1997). Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: A randomized clinical trial. JAMA, 277(14), 1127–1134. https://doi:10.1001/jama.1997.03540380041029.

18.

Hasankhani

Mohammadi

Moazzami

Mokhtari

Naghizadeh

M. M.

(2005). The effects of warming intravenous fluids on perioperative haemodynamic situation, postoperative shivering and recovery in orthopaedic surgery. British Journal of Anaesthetic and Recovery Nursing, 6(1), 7–11. https://doi.org/10.1017/s1742645605000045

19.

Hausfeld

Baker

R. B.

Boettcher-Prior

Hancock

Helms

Jablonski

Lin

Menne

Mittermeier

Morris

(2015). Randomized prospective clinical trial comparing room temperature and warmed intravenous fluid boluses on pediatric patients’ comfort. Journal of Pediatric Nursing, 30(6), e3–e9. https://doi.org/10.1016/j.pedn.2015.07.006

20.

Horosz

Malec-Milewska

(2013). Inadvertent intraoperative hypothermia. Anaesthesiology Intensive Therapy, 45(1), 38–43. https://doi.org/10.5603/AIT.2013.0009

21.

Jaffe

J. S.

McCullough

T. C.

Harkaway

R. C.

Ginsberg

P. C.

(2001). Effects of irrigation fluid temperature on core body temperature during transurethral resection of the prostate. Urology, 57(6), 1078–1081. https://doi.org/10.1016/s0090-4295(01)00993-1

22.

Jeong

S. M.

Hahm

K. D.

Jeong

Y. B.

Yang

H. S.

Choi

I. C.

(2008). Warming of intravenous fluids prevents hypothermia during off-pump coronary artery bypass graft surgery. Journal of Cardiothoracic and Vascular Anesthesia, 22(1), 67–70. https://doi.org/10.1053/j.jvca.2007.04.003

23.

Kiekkas

Theodorakopoulou

Stefanopoulos

Tsotas

Baltopoulos

G. I.

(2011). Postoperative hypothermia and mortality in critically ill adults: Review and meta-analysis. Australian Journal of Advanced Nursing, 28(4), 60–67.

24.

Kim

M. H.

Lee

S. M.

Choi

S. J.

Shin

Y. H.

Jeong

H. J.

(2014). Effect of pre-warmed intravenous fluids on perioperative hypothermia and shivering after ambulatory surgery under monitored anesthesia care. Journal of Anesthesia, 28(6), 880–885. https://doi.org/10.1007/s00540-014-1820-z

25.

Kurz

(2008). Thermal care in the perioperative period. Best Practice & Research Clinical Anaesthesiology, 22(1), 39–62. https://doi.org/10.1016/j.bpa.2007.10.004

26.

Kurz

Sessler

D. I.

Lenhardt

(1996). Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. New England Journal of Medicine, 334, 1209–1216. https://doi.org/10.1056/nejm199605093341901

27.

Leslie

Sessler

D. I.

Bjorksten

A. R.

Moayeri

(1995). Mild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium. Anesthesia & Analgesia, 80(5), 1007-1014. https://doi:10.1213/00000539-199505000-00027.

28.

Lista

Doherty

C. D.

Backstein

R. M.

Ahmad

(2012). The impact of perioperative warming in an outpatient aesthetic surgery setting. Aesthetic Surgery Journal, 32(5), 613–620. https://doi.org/10.1177/1090820x12449342

29.

Lynch

Dixon

Leary

(2010). Reducing the risk of unplanned perioperative hypothermia. AORN Journal, 92:553–562. https://doi:10.1016/j.aorn.2010.06.015

30.

Miller

R. D.

Eriksson

L. I.

Fleisher

L. A.

Wiener-Kronish

J. P.

Young

W. L.

(2010). Miller’s anesthesia (7th ed.). Churchill Livingstone.

31.

Okeke

L. I.

(2007). Effect of warm intravenous and irrigating fluids on body temperature during transurethral resection of the prostate gland. BMC Urology, 7, 15–17. https://doi.org/10.1186/1471-2490-7-15

32.

Oshvandi

Shiri

F. H.

Fazel

M. R.

Safari

Ravari

(2014). The effect of pre-warmed intravenous fluids on prevention of intraoperative hypothermia in cesarean section. Iranian Journal of Nursing and Midwifery Research, 19(1), 64–69.

33.

Özsaban

(2017). The effect of active warming method on postoperative hypothermia on the control of body temperature and thermal comfort sensation [Doctoral Thesis]. Istanbul University, Institute of Health Sciences, Fundamentals of Nursing Department. İstanbul.

34.

O’Brien

Greenfield

M. L.

Anderson

J. E.

Smith

B. A.

Morris

(2010). Comfort, satisfaction, and anxiolysis in surgical patients using a patient-adjustable comfort warming system: A prospective randomized clinical trial. Journal of PeriAnesthesia Nursing, 25(2), 88–93. https://doi.org/10.1016/j.jopan.2010.01.008

35.

Rajagopalan

Mascha

Sessler

D. I.

(2008). The effects of mild perioperative hypothermia on blood loss and transfusion requirement. The Journal of the American Society of Anesthesiologists, 108 (1), 71–77. https://doi:10.1097/01.anes.0000296719.73450.52

36.

Roberson

M. C.

Dieckmann

L. S.

Rodriguez

R. E.

Austin

P. N.

(2013). A review of the evidence for active preoperative warming of adults undergoing general anesthesia. AANA Journal, 81(5), 351–356.

37.

Saito

Sessler

D. I.

Fujita

Ooi

Jeffrey

(1998). Thermoregulatory effects of spinal and epidural anesthesia during cesarean delivery. Regional Anesthesia and Pain Medicine, 23(4), 418–423. https://doi:10.1016/S1098-7339(98)90017-7

38.

Schmied

Reiter

Kurz

Sessler

D. I.

Kozek

(1996). Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet, 347, 289–292. https://doi.org/10.1016/s0140-6736(96)90466-3

39.

Self

W. H.

White

S. J.

McNaughton

C. D.

Storrow

A. B.

Slovis

C. M.

Collins

S. P.

(2013). Warming intravenous fluids for improved patient comfort in the emergency department: A pilot crossover randomized controlled trial. The Western Journal of Emergency Medicine, 14(5), 542–546. https://doi.org/10.5811/westjem.2013.1.13303

40.

Sessler

D. I.

(1997). Mild perioperative hypothermia. New England Journal of Medicine, 336(24), 1730–1737.

41.

Slotman

G. J.

Jed

E. H.

Burchard

K. W.

(1985). Adverse effects of hypothermia in postoperative patients. American Journal of Surgery, 149(4), 495–501. https://doi.org/10.1016/s0002-9610(85)80046-5

42.

S. F.

Nieh

H. C.

(2018). Efficacy of forced-air warming for preventing perioperative hypothermia and related complications in patients undergoing laparoscopic surgery: A randomized controlled trial. International Journal of Nursing Practice, 24(5), e12660-10. https://doi.org/10.1111/ijn.12660

43.

Wagner

Byrne

Kolcaba

(2006). Effects of comfort warming on preoperative patients. AORN Journal, 84(3), 427–448. https://doi.org/10.1016/S0001-2092(06)63920-3

44.

Wagner

V. D.

(2006). Unplanned perioperative hypothermia and surgical complications: evidence for prevention. Perioperative Nursing Clinics, 1(3), 267–281. https://doi:10.1016/j.cpen.2006.05.008

45.

Warttig

Alderson

Campbell

Smith

A. F.

(2014). Interventions for treating inadvertent postoperative hypothermia. Cochrane Database of Systematic Reviews, 11, CD009892–NaN51. https://doi.org/10.1002/14651858.CD009892.pub2

46.

Woolnough

Allam

Hemingway

Cox

Yentis

S. M.

(2009). Intra-operative fluid warming in elective caesarean section: A blinded randomised controlled trial. International Journal of Obstetric Anesthesia, 18(4), 346–351. https://doi.org/10.1016/j.ijoa.2009.02.009

47.

H. X.

You

Z. J.

Zhang

(2010). Prevention of hypothermia by infusion of warm fluid during abdominal surgery. Journal of PeriAnesthesia Nursing, 25(6), 366–370. https://doi.org/10.1016/j.jopan.2010.10.007

48.

Yang

H. L.

Lee

H. F.

Chu

T. L.

Y. Y.

L. H.

Fan

J. Y.

(2012). The comparison of two recovery room warming methods for hypothermia patients who had undergone spinal surgery. Journal of Nursing Scholarship, 44(1), 2–10. https://doi.org/10.1111/j.1547-5069.2011.01426.x

49.

Zaman

S. S.

Rahmani

Majedi

M. A.

Roshani

Valiee

(2018). A clinical trial of the effect of warm intravenous fluids on core temperature and shivering in patients undergoing abdominal surgery. Journal of PeriAnesthesia Nursing, 33(5), 616–625. https://doi.org/10.1016/j.jopan.2016.12.010