Vliv strategie globálního oteplování pacienta na prevalenci hypotermie v zotavovací místnosti (REGLO)
Vliv strategie globálního oteplování, od příjezdu pacienta na operační sál po jeho propuštění z zotavovacího sálu, versus doporučený management intraoperačního oteplování na prevalenci hypotermie na zotavovacím sále
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.
Přehled studie
Postavení
Postavení
Podmínky
Podmínky
Intervence / Léčba
Intervence / Léčba
Detailní popis
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.
Typ studie
Typ studie
Zápis (Aktuální)
Zápis
Fáze
Fáze
- Nelze použít
Kontakty a umístění
Studijní místa
-
-
-
Poitiers, Francie, 86000
- Poitiers University Hospital
-
-
Kritéria účasti
Kritéria způsobilosti
Kritéria způsobilosti
Věk způsobilý ke studiu
Přijímá zdravé dobrovolníky
Pohlaví způsobilá ke studiu
Popis
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.
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Prevence
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Žádné (otevřený štítek)
Počet zbraní
Zbraně a zásahy
Skupina účastníků / ArmSkupina účastníků / Arm |
Intervence / LéčbaIntervence / Léčba |
|---|---|
|
Experimentální: RéGlo arm
Innovative support with global warming strategy. |
A systematic pre- and post-operative warming associated with the optimization of per-operative warming. |
|
Jiný: Control arm
Support according to recommendations |
per-operative warming only thanks to the "Optimized" Forced air blanket with a prewarming of 10 minutes performed in the operating room. |
Co je měření studie?
Primární výstupní opatření
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
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.
Časové okno: 1 day
|
Proportion of patients with hypothermia after discharge of recovering room. Hypothermia is defined as a body temperature < 36°C. |
1 day
|
Sekundární výstupní opatření
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Compare between the experimental group of global warming (RéGlo) and the control group of per-operative warming, the average total mechanical ventilation time
Časové okno: 1 day
|
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
Časové okno: 1 day
|
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
Časové okno: 1 day
|
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
Časové okno: 1 day
|
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)
Časové okno: 1 day
|
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)
Časové okno: 1 day
|
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)
Časové okno: 1 day
|
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
Časové okno: 1 day
|
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
Časové okno: 1 day
|
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
Časové okno: 1 day
|
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
Časové okno: 1 day
|
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
Časové okno: 1 day
|
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
Časové okno: 1 day
|
number of stirring phase evaluated every 15 minutes until discharge |
1 day
|
|
The average amount of blood loss per operation
Časové okno: 1 day
|
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
Časové okno: 1 day
|
blood loss measured in recovering room expressed in millilitres |
1 day
|
|
The general average of the thermal variation
Časové okno: 1 day
|
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
Časové okno: 1 day
|
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
Časové okno: 1 day
|
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
Časové okno: 1 day
|
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
Časové okno: 1 day
|
difference between the time of arrival in recovering room and the time of obtaining the exit criteria , expressed in minutes. |
1 day
|
Spolupracovníci a vyšetřovatelé
Sponzor
Sponzor
Vyšetřovatelé
Vyšetřovatelé
- Vrchní vyšetřovatel: Matthieu Boisson, Pu-Ph, Poitiers University Hospital
Publikace a užitečné odkazy
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Aktuální)
Začátek studia
Primární dokončení (Aktuální)
Primární dokončení
Dokončení studie (Aktuální)
Dokončení studie
Termíny zápisu do studia
První předloženo
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
První zveřejněno
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Poslední zveřejněná aktualizace
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Naposledy ověřeno
Více informací
Termíny související s touto studií
Další relevantní podmínky MeSH
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