Managing infection unintended

hypothermy
©
19/02/19
3M
. All Rights Reserved. 3M Confidential. 2
 Thermoregulasi

Konsep Normothermia: Nilai suhu 37oC

tubuh ideal
Suhu tubuh inti:3
37.0°C (98.6°F)
Gradien suhu:
2-4°C antara suhu tubuh inti
dan peripheral.

periphery
2-4oC
cooler
 Unintended Hypothermia:
Setiap Suhu Tubuh <36°C (96.8°F)1-3

Penyebab utama Hypothermi

Perioperative meliputi :2-3
Pemberian obat anestesi
menyebabkan redistribusi suhu
General anesthesia
Regional anesthesia
Temperature OR yang dingin
Terpaparnya rongga tubuh
Pemberian therapy cairan dan darah
dalam kondisi dingin
Lamanya proses pembedahan
Anesthesia Regional
Pasien sering merasa lebih hangat karena
persepsi yang salah dari thermoreceptors
di daerah diblokir3
Kejadian Hypothermia sering
kali tidak terdeteksi pada pasien dengan
regional anesthesia karena:3
Suhu tubuh inti tidak dimonitor
secara regular.
Pasien biasanya tidak
mengungkapkan perasaan dengan
suhu yang tidak nyaman
Thermoregulation: Under Normal
Circumstances
0.2°C Interthreshold Range

Vasoconstrictio
n Vasodilation

NST
Sweating

Shivering

32 33 34 35 36 37 38 39 40 41
The body’s normal response to
temperature (°C)
Thermoregulation: Under Anesthesia

4.0°C Interthreshold Range

Vasoconstrictio
n Vasodilation

NST
Sweating

Hypothermia
: < 36.0°C

32 33 34 35 36 37 38 39 40 41
Anesthesia-impaired response to
temperature (°C)
Effects of Anesthesia

Anesthesia causes
vasodilation
This is known as heat
redistribution

cold environment
 Hypothermia in the anesthetized surgical patient follows a
characteristic pattern of core temperature reduction1,2,3
Prewarming surgical patients reduces or prevents the redistribution of heat3,4, which is especially
important due to the significant core temperature decrease in the early phases of surgery
Characteristic Patterns of
General Anesthesia-Induced
Hypothermia1,2,3
Phase 1 - Rapid decrease in core temperature.
•Develops immediately after induction of
anesthesia, a result of internal core-to-peripheral
redistribution of heat
•Core temperatures can drop 0.5°C to 1.5°C
Phase 2 – Slow, linear decline in temperature.
•Occurs in the second hour, heat loss exceeds the
body’s ability to metabolically produce heat
•Results from significantly decreased metabolism
due to anesthesia and diminished heat production
Core Body Temperature (˚C) by muscles
Phase 3 – Temperature plateau.
•Occurs three-to-five hours into surgery
•Reemergence of thermoregulatory
Elapsed Time (hours) vasoconstriction reestablishes the normal
Graph Adapted from: temperature gradient, and core temperature will
Sessler Dl, Anesth. 2000;
92(2): 578-96.
1. Sessler, DI. NEJM. 1997;336(24): 1730-1737. 2. Sessler DI. Anesth. 2000. 3. Matsukawa T,
plateau
et al. Anesth. 1995;82(3):662-673. 4. Hynson JM. Sessler DI. J Clin Anesth. 1992;4:194-199.
 Menggigil dan
Meningkaatkan tidak nyaman
kematian karena suhu
(40 – 60%)

Delayed
emergence from Adverse effects of Luka Infeksi
(3x)
anesthesia
(28 mins to 68
IPH
mins)

Coagulopathy
(16% lebih banyak
Myocardial
darah yang
ischemia (5x)
hilang)

Anesthesiology News. October 2008:

17-28.
Warming Approaches: Aktive
Patient Warming
Skin-surface warming

Conductive:
direct contact

Convective:
warmed with
air
Relative Effectiveness

Forced-air warming adalah metode yang lebih efektif

Effects of Warming Methods on
untuk mempertahankan normothermia21
21
Mean Body Temperature
4

Forced-Air
2 3 Cotton Blankets
1 Cotton
Circulating WaterBlanket
Mattress

Airway Heating &

Change in Mean Body Humidifcation
Temperature (°C)
0 0 2 4 6
8 Hours
Adapted from: Sessler, Anesth Clin N Am,
1994
 CMS SCIP-Infection-10 Perioperative
Temperature Management Measure

What this means for facilities:

1.Warming more patients – regardless
of age
2.Warming more procedures* –
regardless of complexity
3.Ensuring normothermia

Normothermia is the
goal
*Excludes patients with physician documentation of Intentional Hypothermia for the procedure
performed
Specifications Manual for National Hospital Inpatient Quality Measures Discharges 01-01-12 (1Q12)
through 06-30-12 (2Q12).
 Who Should Be Warmed?

Everyone
Anesthetized patients can’t regulate their
temperature
 Conductive vs. Convective
warming

3M Health Care Academy

SM

© 3M 2015. All Rights Reserved 15

 Conductive Warming: Direct
Contact
Electric blanket Warm mattress

Pressure

Pressure
Recruits Recruits
approx. approx.
Sores
20% of 20% of
skin skin Thermal Injury
surface surface

Time Heat
Convective Warming: Warmed
with air
Even temperature across
the blanket is important to
warming effectiveness

Recruits
up to 64%
of skin
surface
 The key to effective skin
surface warming is to
actively warm as much skin
surface as possible at a safe
temperature

Recruitment
 Warming blanket performance
comparison
•New 3M™ Bair Hugger™ Multi-position upper body warming
blanket

©
19/02/19
3M
. All Rights Reserved. 3M Confidential. 19
How can we get better results?

•Add prewarming to
intraoperative warming
Prewarming Can Prevent
Hypothermia
30 – 60 minutes of prewarming
with forced-air warming can
“bank heat” in the periphery and
reduce or eliminate redistribution
temperature drop.
Prewarming the periphery is the
only practical way to prevent
redistribution temperature drop
and resulting hypothermia.
 Prewarming
Increases the heat
content in arms and
legs, and reduces
temperature gradient
between the core and
the periphery
Reduces redistribution
of heat

Hynson et al (1993) Anesthesiology 79:219

Sessler et al (1995) Anesthesiology 82: 674
Prewarming
 Wide ranges of surgical applications

©
19/02/19
3M
. All Rights Reserved. 3M Confidential. 24
 Patient Safety Issues

NO Hosing
Do NOT Reuse

Cross-contamination
Risk for unintended
hypothermia
✓
 NO
Commingling
29
Preventive Maintenance
 A 3M™ Bair Hugger™ warming blanket for every
procedure
Unique, flexible, easy-to-use designs ∙ Safe, even temperature ∙ Resealable hose ports ∙ Not made with
natural rubber latex
Intraoperative
blankets:
Simple solutions with
clinician preferred
features designed for
use during most
surgical procedures
Underbody blankets:
Provide full, unrestricted
access and simplified prep
for routine-to-complex Specialty blankets:
procedures with adult or Designed to warm in
pediatric patients clinically challenging
scenarios with a unique
blanket solution for adult
and pediatric patients

Pre-/Post-op blankets:
Adult and pediatric
blankets to prewarm and
maintain normothermia
following surgery
Thank you!