Tryphena, Selwyn (2013) Time to Normalisation of Temperature as a Predictor of outcome in patients admitted with Inadvertent Postoperative Hypothermia in the Surgical Intensive Care Unit. Masters thesis, Christian Medical College, Vellore.
|
Text
201001113tryphena_selwyn.pdf Download (2MB) | Preview |
Abstract
AIM OF THE STUDY: To evaluate if the time to normalization of temperature may be used as a predictor of outcome in patients admitted to the surgical intensive care unit with inadvertent postoperative hypothermia. OBJECTIVES: 1. To evaluate if time to normalization of core body temperature affects outcomes such as; • Incidence of surgical site infections, • Number of days requiring mechanical ventilation, • Duration of SICU stay. METHODS: 76 patients admitted postoperatively to the surgical intensive care unit with inadvertent postoperative hypothermia (nasopharyngeal temperature of less than 36.5⁰ C on admission) were included in the study. They were divided into 2 groups based on the time to normalization, to compare outcomes- 39 early normalisers (2 hours or less) and 37 delayed normalisers (more than 2 hours). The primary outcome was the incidence of surgical site infections. Secondary outcomes included ventilated days, arrhythmias, coagulation abnormalities and duration of ICU stay. Chi- square test was used to assess significance of difference in categorical variables and the independent t-test was used for continuous variables. RESULTS: Patients with delayed normalization of core hypothermia had an increased incidence of surgical site infections (7 in 37 patients versus 1 in 39 patients p-value 0.02),more number of ventilated days, (1.35 days versus 3.43 days p-value 0.008) and prolonged stay in the surgical intensive care unit ( 2.58 days versus 5.08 days p-value 0.002) as compared to the early normalisers. There was no significant difference in the incidence of arrhythmias (0.301), coagulopathy(p-value 0.638), readmission to the SICU (p-value 0.115) or death (p-value 0.174) between the 2 groups. Prolonged time to normalisation of inadvertent postoperative core hypothermia may contribute adversely to the morbidity as described above. CONCLUSION: Inadvertent intraoperative hypothermia has been shown to have many deleterious effects such as impaired coagulation, delayed wound healing, increased incidence of surgical site infection, cardiac arrhythmias, shivering and prolonged ICU stay. The main objective of this study was to ascertain if there was also a relationship between the duration of normalization of this hypothermia and outcome. The primary outcome was the incidence of surgical site infections. The delayed normalisers were found to have a significant increase in the incidence of surgical site infections as compared to the early normalisers (odds ratio 18.75, p-value 0.016). They also had more number of days needing mechanical ventilation and a longer duration of stay in the SICU and this difference was clinically as well as statistically significant. The incidence of arrhythmias, coagulopathy, incidence of ventilator associated pneumonias and death was not statistically significantly different between the 2 groups. A higher requirement of intraoperative crystalloids, colloids, blood and blood products and a longer duration of intraoperative hypothermia was associated with a delayed time to normalize temperature. In this study we could not demonstrate if the lack of temperature monitoring intraoperatively contributed to the time to normalization- larger number of patients may be required to demonstrate if there is an association. We can thus conclude that all efforts should be made to prevent inadvertent intraoperative hypothermia. Anaesthetists and critical care physicians must be aware of the deleterious consequences of inadvertent hypothermia and warming must be done actively preoperatively, intraoperatively as well as in the postoperative period . The NICE guidelines give us simple ways in which to avoid inadvertent perioperative hypothermia and effort must be made to adhere to them. The time to normalization of temperature does have a significant impact on the postoperative outcome and more studies may be required in this avenue.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | time to normalization of temperature ; hypothermia ; surgical site infections. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 30 Apr 2018 02:55 |
| Last Modified: | 30 Apr 2018 02:55 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7340 |
Actions (login required)
 |
View Item |
