Maintaining intraoperative normothermia reduces blood loss in patients undergoing major operations: a pilot randomized controlled clinical trial

Abstract

Abstract Background Inadvertent intraoperative hypothermia (core temperature < 36 °C) is a common but preventable adverse event. This study aimed to determine whether active intraoperative warming reduced bleeding in patients undergoing major operations: open thoracic surgery and hip replacement surgery. Methods/Design The study was a pilot, prospective, parallel two-arm randomized controlled trial. Eligible patients were randomly allocated to two groups: passive warming (PW), with application of a cotton blanket (thermal insulation), or active warming (AW), with a forced-air warming system. The primary endpoint was intraoperative blood loss, and secondary endpoints were surgical-site infection, cardiovascular events, and length of stay in the post-anesthesia care unit, intensive care unit, and hospital. Results Sixty-two patients were enrolled. Forced-air active warming maintained intraoperative normothermia in all AW subjects, whereas intraoperative hypothermia occurred in 21/32 (71.8%) of PW patients (p = 0.000). The volume of blood loss was more in the PW group (682 ± 426 ml) than in the AW group (464 ± 324 ml) (p < 0.021), and the perioperative hemoglobin value declined more in the PW group (28.6 ± 17.5 g/L) than in the AW group (21.0 ± 9.9 g/L) (p = 0.045). However, there were no difference in other clinical outcomes between two groups. Conclusion Intraoperative active warming is associated with less blood loss than passive warming in open thoracic and hip replacement operations in this pilot study. Trial registration This trial was registered with Clinicaltrials.gov (Identifier: NCT02214524) on 27 August 2014.

Keywords

• Active forced warming
• Passive warming
• Intraoperative bleeding
• Major surgery
• Inadvertent intraoperative hypothermia