Hypothermia has a profound impact on the entire body – it compromises the immune system leading to a higher risk of post-operative wound infections, promotes coagulopathy, decreases drug metabolism and wound healing, delays emergence from anesthesia, alters mental status, and negatively affects hemodynamics. As an anesthesiologist and intensivist, I’m often preoccupied with minute-to-minute changes in a patient’s blood pressure, volume status, oxygenation/ventilation, antibiotics, etc, but for the aforementioned reasons, preserving normothermia is essential!
For large volume blood product and crystalloid resuscitation, I’m always turning to either the Level 1 or high flow Ranger fluid warming systems. It’s known that a liter of room temperature crystalloid or a unit of cooled packed red blood cells (pRBCs) can decrease a patient’s temperature by ~ 0.25°C (with additive effects)! Couple this with the cold operating room, exposed skin surfaces, and large surgical incisions such as those used in laparotomies and thoracotomies, and it’s clear that significant heat loss is not only probable but inevitable. Fluid warmers allow the treatment team to rapidly transfuse warm fluids while using forced air warmers, blankets, warming the room, etc. to help minimize heat loss.
Drop me a comment below with questions! 🙂
Coagulopathy is what you’re most worried about in the short term, correct? Everyone says that hypothermia causes coagulopathy… but pts clot just fine when they come off a short DHCA. I’ve been searching the literature for years, but what EXACTLY does hypothermia affect on the coagulation cascade??? Do you counteract the effects of 30C temp if you give unit of FFP premptively?
With any cardiopulmonary bypass case where cooling or DHCA is involved, I’m more concerned about platelet dysfunction (a qualitative defect) than other defects in the coagulation cascade (ie, hypofibrinogenemia, factor deficiency, etc.) I don’t preemptively address this with platelet transfusions in every patient after coming off bypass, but my clinical suspicion is always there.