Research Paper: Hypothermia Treatment Using Radiant Heat

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SAMPLE EXCERPT:

[. . .] How confidentiality was maintained beyond this point was not mentioned. In terms of patient vulnerability, this patient group would not be more vulnerable than other patients undergoing a surgical procedure under general anesthesia. Although the average age was between 61 and 65 years, this patient group was otherwise quite healthy.

Interpretive Dimensions

Yang and colleagues (2012) found that radiant heat warmed postoperative patients significantly (p < .001) faster (1.83° C/hr) than warmed cotton blankets (1.03° C/hr). This difference is quite large and represents a substantial improvement over warming rates found by other research groups (Yang et al., 2012; Pikus and Hooper, 2010). Yang and colleagues also divided the study groups into three temperature ranges, to better understand whether warming rates were a function of tympanic temperature upon admission into the PACU. What they found was that patients with lower body temperatures warmed at a slower rate (1.5° C/hr) than patients who were within 0.5° of the discharge temperature (36° C) upon admission to the PACU.

Most other research groups discovered warming rates well below those found by Yang et al. (2012), therefore it seems reasonable to question the use of tympanic temperature when the radiant heat source is placed next to the head. If there is a causal relationship between heat source placement and tympanic temperature, then this has important safety implications in terms of PACU discharge decisions. The use of tympanic temperature determined with an infrared probe is not recommended by ASPAN guidelines for perioperative warming (Hooper et al., 2009). Based on these guidelines, in situations when the core temperature cannot be determined without putting patient safety at risk, then oral temperature should be used to approximate core temperature. Since the patients in this study had back surgery, obtaining an oral temperature would have been feasible.

What Yang and colleagues (2012) claimed to have shown is that patients were warmed faster when subjected to radiant heat, compared to patients warmed with hospital blankets. This finding is clinically relevant because the need for active warming systems for perioperative patients has already been recognized by the ASPAN (Hooper et al., 2009), therefore much of the research being done in this area concerns the relative efficacy of the different active warming approaches. While the use of warmed blankets remains the conventional approach for treating hypothermic surgery patients, forced air warming remains the recommended approach. Yang and colleagues (2012) dismiss forced air warming as too much of a contamination risk and therefore did not include it in their study. In essence, they used the conventional warmed blankets as the control for assessing whether radiant heat was more effective. To ask this question in 2012, when active warming measures have already been shown to be more effective than warmed blankets, seems a bit redundant. When combined with the questionable outcome measure of tympanic temperature, the clinical relevance of these findings is limited.

The other outcome measures included in the study were wound infection rate, length of hospital stay, and hospitalization costs (Yang et al., 2012). Wound infection rates are important because hypothermia can induce vasoconstriction, thereby causing localized tissue hypoxia and increasing the risk of wound infection (reviewed by Hooper et al., 2008). Neutrophil function can also be impaired, which would interfere with immune surveillance of the wound. The length of hospital stays, and therefore the costs of care, can be increased by as much as 20% if the wound does not heal appropriately. Hypothermia has also been shown to increase the risk of pressure ulcers, reduce the efficacy of drugs, and increase the need for blood transfusions in peroperative patients.

The study by Yang and colleagues (2012) revealed that no infections were detected in any of the patients enrolled in their study. The length of hospital stay did differ between the two groups, but did not reach statistical significance. There was a significant amount of variability between the two experimental groups, which may have prevented a significant finding. Increasing the sample size might reveal that radiant heat is associated with a shorter hospital stay. Medical costs were also lower for radiant heat patients, but again the difference was not statistically significant. These results suggest that postoperative patients recovering in the PACU may benefit more from radiant heat than pre-warmed blankets, in terms of length of hospital stay and hospitalization costs.

Yang and colleagues (2012) conclude that their findings provide an evidenced-based rationale for choosing radiant heat to warm postoperative patients having undergone spinal surgery. While admitting that the patient population that could benefit from their research is limited to patients undergoing spinal surgery, they suggest radiant warming should be an option considered by medical facilities where forced-air warming is too expensive or labor intensive to implement because it represents too much of a contamination risk.

Based on the above analysis there are several threats to both the internal and external validity of the study by Yang and colleagues (2012). Selection bias was potentially introduced by the lack of patient randomization, which may explain why the two groups differed in terms of comorbidity and perioperative solution administration. The latter two confounding variables were not controlled for in the data analysis and could have increased the difference between the two groups in favor of radiant heat subjects. The authors were remiss in not mentioning this in the discussion section. The primary threat to external validity was mentioned by the authors in the discussion section, which was the uniform nature of the patient population used in the study and therefore its lack of generalizability to other surgical patient populations.

Yang and colleagues (2012) failed to discuss adequately the considerable limitations of their findings in the discussion and conclusions sections. They never addressed the potential confounding factor of placing a radiant heat source adjacent to the tympanic membrane, which was the primary outcome measure for the study. When this deficiency is combined with the reduced comorbidity and perioperative solution administration of the radiant heat patient group, this may explain why they found a very high warming rate for radiant heat. This deviation from previously published heating rates was never addressed in the results, discussion, or conclusion sections.

Yang and colleagues (2012) conclude that their findings show that radiant heat is superior to pre-warmed hospital blankets for treating postoperative hypothermia. However, in light of the above discussion, the only conclusion that seems reasonable to make is that radiant heat is at least as effective as pre-warmed hospital blankets. Given the trend towards shorter hospital stays and reduced hospitalization costs, it seems worthwhile to conduct a better controlled and larger study.

Presentation and Stylistic Dimensions

The research article by Yang and colleagues (2012) was both easy and pleasant to read. The format was the traditional Introduction, Methods, Results, and Discussion, which made it easy to navigate and understand what the study was about. All sections were concise and lacked jargon, but the introduction and discussion sections would have benefitted from being more comprehensive as mentioned above. The data tables were easy to read and understand, while providing a lot of information. Overall, the data and findings were well presented in a traditional style.

References

Brauer, A., English, M.J., Steinmetz, N., Lorenz, N., Perl, T., Weyland, W., and Quintel, M. (2007). Efficacy of forced-air warming systems with full body blankets. Canadian Journal of Anesthesia, 54(1), 34-41.

Giuffre, M., Finnie, J., Lynam, D.A., and Smith, D. (1991). Rewarming postoperative patients: Lights, blankets, or forced warm air. Journal of Post Anesthesia Nursing, 6(6), 387-393.

Hooper, Vallire D., Chard, Robin, Clifford, Theresa, Fetzer, Susan, Fossum, Susan, Godden, Barbara et al. (2009). ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia. Journal of PeriAnesthesia Nursing, 24(5), 271-287.

Pikus, Eugene and Hooper, Vallire D. (2010). Postoperative rewarming: Are there alternaitives to warm hospital blankets. Journal of PeriAnesthesia Nursing, 25(1), 11-23.

Villamaria, F.J., Baisden, C.E., Hillis, A., Rajab, M.H., and Rinaldi, P.A. (1997). Forced-air warming is no more effective than conventional methods for raising postoperative core temperature after cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia, 11(6), 708-711.

Weyland, W., Fritz, U., Fabian, S.,… [END OF PREVIEW]

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Hypothermia Treatment Using Radiant Heat.  (2013, January 20).  Retrieved May 23, 2019, from https://www.essaytown.com/subjects/paper/hypothermia-treatment-using-radiant/3248646

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