Patient Warming Excess Heat: The Effects on Orthopedic Operating Room Ventilation Performance
Patient Warming Excess Heat: The Effects on Orthopedic Operating Room Ventilation Performance
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DOI：
10.1213/ane.0b013e31825f81e2
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发表时间：
2013-08-01
影响因子：
5.7
通讯作者：
Nachtsheim, Christopher
中科院分区：
文献类型：
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作者：
Belani, Kumar G.;Albrecht, Mark;Nachtsheim, Christopher
背景技术背景：基于普通外科手术中确立的益处，患者加温已成为预防意外体温过低的护理标准。然而，这些益处可能不能完全转化为污染敏感性手术（即，植入物），因为患者加温装置释放多余的热量，这可能会破坏预期的天花板到地板的通风气流，并使手术部位暴露于额外的污染。因此，我们研究了两种流行的患者加温技术，强制通风和导电织物，与控制条件下的通风性能在骨科手术室与人体模型覆盖全膝关节replacement.METHODS：通风性能进行了评估，通过释放中性浮力洗涤剂气泡（气泡）到非无菌区域下的头侧的麻醉铺巾。然后，我们跟踪了上半身患者加热产生的多余热量是否将气泡动员到手术部位。形式上，随机重复设计评估了器械（强制通风、导电织物、对照）和麻醉铺巾高度（低铺巾，高铺巾）对手术部位上拍摄的气泡数量的影响。来自强制空气加热的直接质量流排气产生热空气对流，其使麻醉铺巾上的气泡流动并进入手术部位，导致患者加温装置因素的气泡计数显著增加（P <0.001）。在两种铺巾高度上，强制通风的平均计数为132.5，导电织物为0.48（P = 0.003），对照条件为0.01（P = 0.008）。两种铺巾高度的平均气泡计数差异在导电织物和对照条件之间不显著（P = 0.87）。悬垂高度的因素没有显着的效果（P = 0.94）对bubble counts. CONCLUSIONS：多余的热量从强制空气加热导致在手术部位的通风气流中断，而传导性的病人取暖设备对通风气流没有显着的影响。这些研究结果保证了未来的研究，在污染敏感的手术过程中，强制空气加热多余的热量对临床结果的影响。
BACKGROUND: Patient warming has become a standard of care for the prevention of unintentional hypothermia based on benefits established in general surgery. However, these benefits may not fully translate to contamination-sensitive surgery (i.e., implants), because patient warming devices release excess heat that may disrupt the intended ceiling-to-floor ventilation airflows and expose the surgical site to added contamination. Therefore, we studied the effects of 2 popular patient warming technologies, forced air and conductive fabric, versus control conditions on ventilation performance in an orthopedic operating room with a mannequin draped for total knee replacement.METHODS: Ventilation performance was assessed by releasing neutrally buoyant detergent bubbles (bubbles) into the nonsterile region under the head-side of the anesthesia drape. We then tracked whether the excess heat from upper body patient warming mobilized the bubbles into the surgical site. Formally, a randomized replicated design assessed the effect of device (forced air, conductive fabric, control) and anesthesia drape height (low-drape, high-drape) on the number of bubbles photographed over the surgical site.RESULTS: The direct mass-flow exhaust from forced air warming generated hot air convection currents that mobilized bubbles over the anesthesia drape and into the surgical site, resulting in a significant increase in bubble counts for the factor of patient warming device (P < 0.001). Forced air had an average count of 132.5 versus 0.48 for conductive fabric (P = 0.003) and 0.01 for control conditions (P = 0.008) across both drape heights. Differences in average bubble counts across both drape heights were insignificant between conductive fabric and control conditions (P = 0.87). The factor of drape height had no significant effect (P = 0.94) on bubble counts.CONCLUSIONS: Excess heat from forced air warming resulted in the disruption of ventilation airflows over the surgical site, whereas conductive patient warming devices had no noticeable effect on ventilation airflows. These findings warrant future research into the effects of forced air warming excess heat on clinical outcomes during contamination-sensitive surgery.