The Effects of Ambient Temperature and Forced-air Warming on Intraoperative Core Temperature

NCT ID: NCT02715076

Last Updated: 2021-05-11

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

292 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-01-31

Study Completion Date

2016-12-31

Brief Summary

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The purpose of this study is to determine:

1. the effect of ambient temperature on the rate of core temperature change from 1 to 3 hours after induction of anesthesia (linear phase of the hypothermia curve) in major operations lasting at least a couple of hours and
2. whether the relationship between ambient temperature and rate of core temperature change is different for patients who are or are not warmed with forced-air.

Detailed Description

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Each patient will be randomly assigned to ambient temperature of 19°C, 21°C, or 23°C. Using a factorial approach, patients will also be randomly assigned to passive insulation or forced-air warming, stratified by the three types of surgery listed below. Group allocation will be based on computer generated codes (randomly permuted block sizes) prepared by Department of OUTCOMES RESEARCH statisticians using SAS statistical software. Allocation of consented patients to designated ambient temperature and forced-air vs. passive insulation will be via a web site that will be accessed by investigators in Bejing about 90 minutes before surgery.

Patients assigned to passive insulation will be covered as usual with a cotton gown and single layer of cloth surgical draping. Patients assigned to forced-air warming will also be covered with a gown and surgical drapes, but a forced-air cover (Bair hugger 63500, 3M) will be inserted between the gown and the skin surface. A lower-body cover (about 91 by 221 cm) will be positioned so the lower end of the forced-air segments extend from the ankles upward for the entire length of the cover in thoracic and abdominal cases. The cover's foot drape will extend over the feet, and in turn be covered by the surgical drape. An upper-body forced-air cover will similarly be applied for patients having hip arthroplasties. The forced-air cover will be connected to a Bair Hugger blower and #635 covers set to "high" (≈43°C).

Ambient temperature will be adjusted to the designated temperature about an hour before a patient enters the operating room and adjusted as necessary to maintain the designated temperature throughout surgery. General anesthesia will be induced as per usual clinical routine. Neuraxial (epidural or spinal) and other regional blocks are permitted.

Any patients whose core temperature decreases to less than 34.5°C will be actively warmed with forced air and the ambient temperature increases to the extent practical.

Conditions

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Major Surgery Under General Anesthesia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Ambient Temp 19°C & Passive Insulation

Ambient Temperature 19°C and Passive Insulation: patients assigned to passive insulation will be covered as usual with a cotton gown and single layer of cloth surgical draping.

Group Type EXPERIMENTAL

Ambient Temperature 19°C

Intervention Type OTHER

Ambient Temperature 19°C

Passive insulation

Intervention Type OTHER

Patients assigned to passive insulation will be covered as usual with a cotton gown and single layer of cloth surgical draping.

Ambient Temp 19°C & Forced-air Warming

Ambient Temperature 19°C and Forced-air Warming: patients assigned to forced-air warming will also be covered with a gown and surgical drapes, but a forced-air cover (Bair hugger 63500, 3M) will be inserted between the gown and the skin surface.

Group Type EXPERIMENTAL

Ambient Temperature 19°C

Intervention Type OTHER

Ambient Temperature 19°C

Forced-air cover (Bair hugger 63500, 3M)

Intervention Type DEVICE

Patients assigned to forced-air warming will also be covered with a gown and surgical drapes, but a forced-air cover (Bair hugger 63500, 3M) will be inserted between the gown and the skin surface.

Ambient Temp 21°C & Passive Insulation

Ambient Temperature 21°C and Passive Insulation: patients assigned to passive insulation will be covered as usual with a cotton gown and single layer of cloth surgical draping.

Group Type EXPERIMENTAL

Ambient Temperature 21°C

Intervention Type OTHER

Ambient Temperature 21°C

Passive insulation

Intervention Type OTHER

Patients assigned to passive insulation will be covered as usual with a cotton gown and single layer of cloth surgical draping.

Ambient Temp 21°C & Forced-air Warming

Ambient Temperature 21°C and Forced-air Warming: patients assigned to forced-air warming will also be covered with a gown and surgical drapes, but a forced-air cover (Bair hugger 63500, 3M) will be inserted between the gown and the skin surface.

Group Type EXPERIMENTAL

Ambient Temperature 21°C

Intervention Type OTHER

Ambient Temperature 21°C

Forced-air cover (Bair hugger 63500, 3M)

Intervention Type DEVICE

Patients assigned to forced-air warming will also be covered with a gown and surgical drapes, but a forced-air cover (Bair hugger 63500, 3M) will be inserted between the gown and the skin surface.

Ambient Temp 23°C & Passive Insulation

Ambient Temperature 23°C and Passive Insulation: patients assigned to passive insulation will be covered as usual with a cotton gown and single layer of cloth surgical draping.

Group Type EXPERIMENTAL

Ambient Temperature 23°C

Intervention Type OTHER

Ambient Temperature 23°C

Passive insulation

Intervention Type OTHER

Patients assigned to passive insulation will be covered as usual with a cotton gown and single layer of cloth surgical draping.

Ambient Temp 23°C & Forced-air Warming

Ambient Temperature 23°C and Forced-air Warming: patients assigned to forced-air warming will also be covered with a gown and surgical drapes, but a forced-air cover (Bair hugger 63500, 3M) will be inserted between the gown and the skin surface.

Group Type EXPERIMENTAL

Ambient Temperature 23°C

Intervention Type OTHER

Ambient Temperature 23°C

Forced-air cover (Bair hugger 63500, 3M)

Intervention Type DEVICE

Patients assigned to forced-air warming will also be covered with a gown and surgical drapes, but a forced-air cover (Bair hugger 63500, 3M) will be inserted between the gown and the skin surface.

Interventions

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Ambient Temperature 19°C

Ambient Temperature 19°C

Intervention Type OTHER

Ambient Temperature 21°C

Ambient Temperature 21°C

Intervention Type OTHER

Ambient Temperature 23°C

Ambient Temperature 23°C

Intervention Type OTHER

Forced-air cover (Bair hugger 63500, 3M)

Patients assigned to forced-air warming will also be covered with a gown and surgical drapes, but a forced-air cover (Bair hugger 63500, 3M) will be inserted between the gown and the skin surface.

Intervention Type DEVICE

Passive insulation

Patients assigned to passive insulation will be covered as usual with a cotton gown and single layer of cloth surgical draping.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Adults scheduled for major open thoracic surgery or video assist thoracic surgery or major abdominal surgery under general anesthesia expected to last at least two hours

Exclusion Criteria

* Special risk for bleeding or myocardial infarction (as determined by the attending anesthesiologist)
* Patients who would otherwise have been actively warmed
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Cleveland Clinic

OTHER

Sponsor Role collaborator

Peking Union Medical College Hospital

OTHER

Sponsor Role lead

Responsible Party

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Lijian Pei

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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LiJian Pei, MD

Role: PRINCIPAL_INVESTIGATOR

Associate Prof. of Dept. of Anesthesiology, PUMCH

Yuguang Huang, MD

Role: STUDY_CHAIR

Chair of Dept. of Anesthesiology, PUMCH

Daniel I Sessler, MD

Role: STUDY_DIRECTOR

Chair of Dept. of Outcomes Research, Anesthesiology Institute, Cleveland Clinic

Locations

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Dept. of Anesthesiology, PUMCH

Beijing, , China

Site Status

Countries

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China

References

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Rajagopalan S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008 Jan;108(1):71-7. doi: 10.1097/01.anes.0000296719.73450.52.

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Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996 May 9;334(19):1209-15. doi: 10.1056/NEJM199605093341901.

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Lenhardt R, Marker E, Goll V, Tschernich H, Kurz A, Sessler DI, Narzt E, Lackner F. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology. 1997 Dec;87(6):1318-23. doi: 10.1097/00000542-199712000-00009.

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Kurz A, Sessler DI, Narzt E, Bekar A, Lenhardt R, Huemer G, Lackner F. Postoperative hemodynamic and thermoregulatory consequences of intraoperative core hypothermia. J Clin Anesth. 1995 Aug;7(5):359-66. doi: 10.1016/0952-8180(95)00028-g.

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Matsukawa T, Sessler DI, Christensen R, Ozaki M, Schroeder M. Heat flow and distribution during epidural anesthesia. Anesthesiology. 1995 Nov;83(5):961-7. doi: 10.1097/00000542-199511000-00008.

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Matsukawa T, Sessler DI, Sessler AM, Schroeder M, Ozaki M, Kurz A, Cheng C. Heat flow and distribution during induction of general anesthesia. Anesthesiology. 1995 Mar;82(3):662-73. doi: 10.1097/00000542-199503000-00008.

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Hynson JM, Sessler DI, Moayeri A, McGuire J, Schroeder M. The effects of preinduction warming on temperature and blood pressure during propofol/nitrous oxide anesthesia. Anesthesiology. 1993 Aug;79(2):219-28, discussion 21A-22A. doi: 10.1097/00000542-199308000-00005.

Reference Type BACKGROUND
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Cheng KW, Wang CH, Chen CL, Jawan B, Wang CC, Concejero AM, Wang SH, Liu YW, Yong CC, Yang CH, Huang CJ. Decreased fresh gas flow cannot compensate for an increased operating room temperature in maintaining body temperature during donor hepatectomy for living liver donor hepatectomy. Transplant Proc. 2010 Apr;42(3):703-4. doi: 10.1016/j.transproceed.2010.02.065.

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Sun C, Gao H, Zhang Y, Pei L, Huang Y. Risk Stratification for Organ/Space Surgical Site Infection in Advanced Digestive System Cancer. Front Oncol. 2021 Nov 9;11:705335. doi: 10.3389/fonc.2021.705335. eCollection 2021.

Reference Type DERIVED
PMID: 34858805 (View on PubMed)

Other Identifiers

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ZS-878

Identifier Type: -

Identifier Source: org_study_id

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