Impact of a Global Warming Strategy of the Patient on the Prevalence of Hypothermia in the Recovering Room (REGLO)

Impact of a Global Warming Strategy, From the Patient Arrival in the Operating Room to His Discharge From the Recovering Room, Versus a Recommended Management of Intraoperative Warming on the Prevalence of Hypothermia in the Recovering Room

50% of patients are hypothermic when they arrive in the recovery room. This hypothermia is potentially at risk for the patient (increases bleeding, risk of infection, risk of cardiac involvement, morbid mortality) and 33,2% steel hypothermic when they discharge from the recovering room. The anesthesia team must prevent these risks through prevention and treatment measures. Currently the majority of patient warming is done only in the operating room, we want to measure the impact of the extension of this warming before and after the surgery on the patient's temperature and on side effects related to hypothermia.

Study Overview

• Status: Recruiting
• Conditions: Hypothermia; Anesthesia; Perioperative/Postoperative Complications
• Intervention / Treatment: Other: global warming; Other: per operative warming

Detailed Description

Hypothermia is defined as a core temperature below 36°C. It is classified by severity stage. A temperature below 36°C is mild hypothermia, below 35°C moderate hypothermia and below 34°C severe hypothermia.

The impact of hypothermia on the body is related to decreased metabolic and immune activities. The vasoconstriction induced by hypothermia implies a decrease in vascularization of the organs that can cause tissue damage.

These effects explain the role of hypothermia in the pathophysiology of certain perioperative and postoperative complications in the longer term.

Intraoperative hypothermia is responsible for the increase of:

• 4 times the risk of Surgical Site Infection,
• twice the risk of cardiovascular morbidity, associated with increased mortality,
• 33% of transfusion need,
• 1.5 times the need for continued mechanical ventilation,
• 3 times the duration of recovering room,
• twice the hospital stay. This is why hypothermia is responsible for excess perioperative mortality.

According to a 2019 study (Alfonsi P, Bekka S, Aegerter P, SFAR Research Network investigators. Prevalence of hypothermia on admission to recovery room remains high despite a large use of forced-air warming devices: Findings of a non-randomized observational multicenter and pragmatic study on perioperative hypothermia prevalence in France), the prevalence of hypothermia increases from 16.2% of patients before anesthetic induction to 53.5% of patients admitted to the Recovering room. At the end of Recovering room, 33.2% of patients were hypothermic. Among these patients, 15.2% became hypothermic during the recovering room stay.

The risk factors for perioperative hypothermia are multiple:

Patient-related factors: low body mass index; undernutrition; ASA score > 1; pre-existing conditions altering thermoregulation (ex: diabetes with polyneuropathy, hypothyroidism, consumption of sedative or psychoactive drugs); pre-existing hypothermia at surgery.

Factors related to anesthesia techniques: duration of anesthesia > 2 hours; combined general and neuro-axial anesthesia; administration of large volumes of intravenous solutes or transfusion of non-rewarmed globular units.

Factors related to surgery: type, extent and duration of surgery witch use of large amounts of unheated irrigation fluid.

• Study Type: Interventional
• Enrollment (Estimated): 174
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Marion Said; Phone Number: 0549444444; Email: marion.said@chu-poitiers.fr

Study Locations

• France
  • Poitiers, France, 86000
    • Recruiting
    • Poitiers University Hospital
    • Contact: Matthieu BOISSON; Phone Number: 05 49 44 44 44; Email: matthieu.boisson@chu-poitiers.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patient undergoing laparoscopic visceral surgery under general anesthesia with transition to recovering room

Exclusion Criteria:

• Patient undergoing urgent surgery.
• Presence of pre-existing infection (temperature higher than 38°C when receiving the patient in the hospital ward.
• Patient with predetermined length of stay in recovering room.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: RéGlo arm; Innovative support with global warming strategy.	Other: global warming; A systematic pre- and post-operative warming associated with the optimization of per-operative warming.
Other: Control arm; Support according to recommendations	Other: per operative warming; per-operative warming only thanks to the "Optimized" Forced air blanket with a prewarming of 10 minutes performed in the operating room.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Compare between the experimental group of global warming (RéGlo) and the control group of per-operative warming, the prevalence of hypothermia at the exit of Interventional for patients who underwent laparoscopic visceral surgery.	Proportion of patients with hypothermia after discharge of recovering room. Hypothermia is defined as a body temperature < 36°C.	1 day

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Compare between the experimental group of global warming (RéGlo) and the control group of per-operative warming, the average total mechanical ventilation time	it is the time between intubation and extubation, expressed in minutes.	1 day
Compare between the experimental group of global warming (RéGlo) and the control group of per-operative warming, the average thermal comfort of preoperative patients, on arrival in the pre- anesthesia room	evaluated by the Likert scale, ranging from 0 for discomfort too cold with strong chills to 4 for discomfort too hot with sweat with optimal comfort to 2 (self-assessment)	1 day
Compare between the experimental group of global warming (RéGlo) and the control group of per- operative warming, the average thermal comfort of preoperative patients, on arrival in the recovering room	every 15minutes until discharge, evaluated by the Likert scale, ranging from 0 for discomfort too cold with strong chills to 4 for discomfort too hot with sweat with optimal comfort to 2 (self-assessment).	1 day
Compare between the experimental group of global warming (RéGlo) and the control group of per-operative warming, the proportion of patients in intraoperative hypothermia	number of patient with body temperature under 36°C between arrival in pre-operative room and discharge of operating room	1 day
Compare between the experimental group of global warming (RéGlo) and the control group of per-operative warming, The average time spent below 36°C (mild hypothermia)	expressed in minutes.	1 day
Compare between the experimental group of global warming (RéGlo) and the control group of per-operative warming, The average time spent below 35°C (moderate hypothermia)	expressed in minutes.	1 day
Compare between the experimental group of global warming (RéGlo) and the control group of per-operative warming, The average time spent below 34°C (severe hypothermia)	expressed in minutes.	1 day
Compare between the experimental group of global warming (RéGlo) and the control group of per-operative warming, The lowest average temperature reached in °C over the entire management	the lowest temperture between arrival in the pre-anaesthesia room and exit from recovering room	1 day
Compare between the experimental group of global warming (RéGlo) and the control group of per-operative warming, The proportion of hypothermic patients arriving in recovering room	number of patient with a temperature below 36°C	1 day
Compare between the experimental group of global warming (RéGlo) and the control group of per-operative warming, The average duration of oxygen therapy	calculated from the introduction of oxygen therapy until its withdrawal in post extubation, regardless of the time of implementation or cessation before resumption of treatment (failure to withdraw oxygen therapy will not be considered), expressed in minutes.	1 day
Compare between the experimental group of global warming (RéGlo) and the control group of per-operative warming, Post-intervention complications in recovering room, the average number of Nausea or Vomiting Postoperative	number of patient with Nausea or Vomiting in recovering room evaluated every 15 minutes until discharge	1 day
Compare between the experimental group of global warming (RéGlo) and the control group of per-operative warming, Post-intervention complications in recovering room, the average number of chills	number of chills during post-operative monitoring by a Likert scale	1 day
Compare between the experimental group of global warming (RéGlo) and the control group of per-operative warming, Post-intervention complications in recovering room, the average number of stirring phase presence	number of stirring phase evaluated every 15 minutes until discharge	1 day
The average amount of blood loss per operation	blood loss measured from the time of entry into the operating theatre to the exit from the operating theatre expressed in millilitres.	1 day
The average of immediate post-operative blood loss	blood loss measured in recovering room expressed in millilitres	1 day
The general average of the thermal variation	the difference between the patient's lowest and highest temperature between their arrival in the pre-anaesthesia room and their exit from recovering room, expressed in degrees Celsius	1 day
The average of thermal variation in pre operative	the difference between the lowest and highest temperature of the patient between the arrival in the waiting room of the operating room and the arrival in the operating room, expressed in degrees Celsius	1 day
The average thermal variation in per operative	the difference between the lowest and highest temperature of the patient between the arrival and exit of the operating room, expressed in degrees Celsius	1 day
the average thermal variation in post operative	the difference between the lowest and highest temperature of the patient between arrival in and validation exit criteria of recovering room,expressed in degrees Celsius	1 day
The average length of stay in recovering room	difference between the time of arrival in recovering room and the time of obtaining the exit criteria , expressed in minutes.	1 day

Collaborators and Investigators

• Sponsor: Poitiers University Hospital
• Investigators: Principal Investigator: Matthieu Boisson, Pu-Ph, Poitiers University Hospital

Publications and helpful links

General Publications

• Alfonsi P, Bekka S, Aegerter P; SFAR Research Network investigators. Prevalence of hypothermia on admission to recovery room remains high despite a large use of forced-air warming devices: Findings of a non-randomized observational multicenter and pragmatic study on perioperative hypothermia prevalence in France. PLoS One. 2019 Dec 23;14(12):e0226038. doi: 10.1371/journal.pone.0226038. eCollection 2019.

Study record dates

Study Major Dates

• Study Start (Actual): November 8, 2024
• Primary Completion (Estimated): November 1, 2026
• Study Completion (Estimated): November 1, 2026

Study Registration Dates

• First Submitted: August 9, 2024
• First Submitted That Met QC Criteria: August 12, 2024
• First Posted (Actual): August 13, 2024

Study Record Updates

• Last Update Posted (Actual): May 26, 2026
• Last Update Submitted That Met QC Criteria: May 21, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Body Temperature Changes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Hypothermia; Postoperative Complications; Ecological and Environmental Phenomena; Biological Phenomena; Climate Change; Climatic Processes; Global Warming
• Other Study ID Numbers: 2023-A02502-43

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No