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The area of preventing unintentional hypothermia is certainly a really current topic and one where there
seems to be a lot of misleading 'spin' from certain companies.
A brief history of warming systems is available on this web site. See link below.
There are two types of heated blanket available - forced warm air such as Bair Hugger, Warm Touch, etc and resistive
(electric blanket type) such as the Geratherm that uses state of the art polymer heating mats. Both work well in varying
degrees; forced air is usually better than nothing, both have their advantages and disadvantages and neither has all the
plus points but Geratherm comes closest of all.
The Geratherm OR theatre system is unique in that the different heated sections are very pliable and can
be wrapped around exposed limbs/areas to maximise the heat transfer area to the patient. This is especially important
where large portions of the patient are exposed for surgical reasons (such as abdominal or spinal surgery, and especially
colo-rectal surgery) where no system is capable of raising core temperature right up to 37C. However the Geratherm
system seems to win this one on almost all occasions.
Some other heated blankets that are available try to mimic the Geratherm but the blankets are stiff (reducing the available
area for heat transfer) or made with PVC outers that make patients sweat.
The Geratherm recovery blanket works in the same way by laying the blanket on and then tucking the insulated
‘wings’ around. This blanket is equally at home when used for pre-warming patients or warming patients on the ward.
NICE has recognised the importance of patient temperature management perioperatively and came out with some
guidelines last year (2008). Their web site is given below from where you can download the full guideline. The quick
reference guide link is also given below. The full list of scientific references on the NICE web site is available below.
A recent study in Germany has found that the Geratherm system can transfer almost double the amount of heat into a
patient compared with forced air warming systems. This paper by Dr Brauer is available on request to us.
Geratherm was involved in a study in Vienna where patients were asked to rate several factors comparing forced air
and Geratherm systems. Parameters such as comfort, pain, temperature and fear were rated and in all cases
the Geratherm scored more favourably indicating a definite patient preference. What this study did not investigate was
'why?' but we think that it was partly because the Geratherm looks and feels pretty much like an ordinary blanket, is
silent in use and has no tubes or blowers associated with it. See ‘Vienna Study’ below.
Our 'NICE in a nutshell' shows the type of equipment to be used at different stages of managing patient temperature.
This also has appropriate pictures of the kind of equipment used. See link below.
There are also one or two companies selling heated mattresses for use in operating theatres. These work to a point but
as very little of the patient is in contact with the mattress and the upper surface of the patient where the heat escapes is
exposed there is not much effect on patient core temperature. Also patients can still be susceptible to pressure points
as well as hot spots that could lead to burns unless gel pads are used. So although they can have some pressure relief
effect mattresses are not really the answer in relation to preventing hypothermia.
MOST AT RISK
The patients most at risk of inadvertent perioperative hypothermia are children and the elderly and of course all patients
undergoing surgery lasting many hours.
There are other warming devices which, on their own, contribute to a lesser degree but are distinctly part of the
overall strategy for preventing peri-operative hypothermia. See ‘in-line’ link below.
The main synopsis seems to be to pre-warm patients before they come to theatre, warm them whenever possible in
theatre, warm them in theatre recovery and keep them warm for at least two hours when back on the ward. I
underwent surgery myself in 2008 and I can assure you that the 'shivers' is a most unpleasant experience - I was
not warmed at any stage!! Preventing the shivers would have been so nice!
Thoughts About the Prevention of Inadvertent Perioperative Hypothermia