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BMC Surgery
Published in: BMC Surgery 1/2017

Open Access 01-12-2017 | Research article

Prevention of hypothermia in patients undergoing orthotopic liver transplantation using the humigard® open surgery humidification system: a prospective randomized pilot and feasibility clinical trial

Authors: Laurence Weinberg, Andrew Huang, Daniel Alban, Robert Jones, David Story, Larry McNicol, Brett Pearce

Published in: BMC Surgery | Issue 1/2017

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Abstract

Background

Perioperative thermal disturbances during orthotopic liver transplantation (OLT) are common. We hypothesized that in patients undergoing OLT the use of a humidified high flow CO2 warming system maintains higher intraoperative temperatures when compared to standardized multimodal strategies to maintain thermoregulatory homeostasis.

Methods

We performed a randomized pilot study in adult patients undergoing primary OLT. Participants were randomized to receive either open wound humidification with a high flow CO2 warming system in addition to standard care (Humidification group) or to standard care alone (Control group). The primary end point was nasopharyngeal core temperature measured 5 min immediately prior to reperfusion of the donor liver (Stage 3 − 5 min). Secondary endpoints included intraoperative PaCO2, minute ventilation and the use of vasoconstrictors.

Results

Eleven patients were randomized to each group. Both groups were similar for age, body mass index, MELD, SOFA and APACHE II scores, baseline temperature, and duration of surgery. Immediately prior to reperfusion (Stage 3 − 5 min) the mean (SD) core temperature was higher in the Humidification Group compared to the Control Group: 36.0 °C (0.13) vs. 35.4 °C (0.22), p = 0.028. Repeated measured ANOVA showed that core temperatures over time during the stages of the transplant were higher in the Humidification Group compared to the Control Group (p < 0.0001). There were no significant differences in the ETCO2, PaCO2, minute ventilation, or inotropic support.

Conclusion

The humidified high flow CO2 warming system was superior to standardized multimodal strategies in maintaining normothermia in patients undergoing OLT. Use of the device was feasible and did not interfere with any aspects of surgery. A larger study is needed to investigate if the improved thermoregulation observed is associated with improved patient outcomes.

Trial registration

ACTRN12616001631​493. Retrospectively registered 25 November 2016.
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Metadata
Title
Prevention of hypothermia in patients undergoing orthotopic liver transplantation using the humigard® open surgery humidification system: a prospective randomized pilot and feasibility clinical trial
Authors
Laurence Weinberg
Andrew Huang
Daniel Alban
Robert Jones
David Story
Larry McNicol
Brett Pearce
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2017
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-017-0208-z

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