Use of an Esophageal Heat Exchanger to Maintain Core Temperature during Burn Excisions and to Attenuate Pyrexia on the Burns Intensive Care Unit

Abstract

Introduction. Burns patients are vulnerable to hyperthermia due to sepsis and SIRS and to hypothermia due to heat loss during excision surgery. Both states are associated with increased morbidity and mortality. We describe the first use of a novel esophageal heat exchange device in combination with a heater/cooler unit to manage perioperative hypothermia and postoperative pyrexia. Material and Methods. The device was used in three patients with full thickness burns of 51%, 49%, and 45% body surface area to reduce perioperative hypothermia during surgeries of >6 h duration and subsequently to control hyperthermia in one of the patients who developed pyrexia of 40°C on the 22nd postoperative day due to E. coli/Candida septicaemia which was unresponsive to conventional cooling strategies. Results. Perioperative core temperature was maintained at 37°C for all three patients, and it was possible to reduce ambient temperature to 26°C to increase comfort levels for the operating team. The core temperature of the pyrexial patient was reduced to 38.5°C within 2.5 h of instituting the device and maintained around this value thereafter. Conclusion. The device was easy to use with no adverse incidents and helped maintain normothermia in all cases.

Figures

Figure 1

Haemodynamics and temperatures for Procedure 1. Systolic pressure (mmHg): ▽; diastolic pressure (mmHg): △; heart rate (beats per minute): ●; target temperature (°C): grey solid line; ambient temperature (°C): grey dashed line; peripheral temperature (°C): black solid line; Bladder Temperature (°C): black dashed line. The ambient operating room temperature was maintained at 30°C for the first 90 minutes of surgery, a typically high temperature for a burns operating room intended to reduce evaporative heat loss, and then reduced to a more comfortable 26°C, with no drop in patient core or peripheral temperature over the remaining four and a half hours.

Figure 2

Haemodynamics and temperatures for Procedure 2. Systolic pressure (mmHg): ▽; diastolic pressure (mmHg): △; heart rate (beats per minute): ●; target temperature (°C): grey solid line; ambient temperature (°C): grey dashed line; peripheral temperature (°C): black solid line; Bladder Temperature (°C): black dashed line; Tympanic Temperature (°C): black dash-dot line. During the course of the procedure the ambient operating room temperature was reduced from approximately 26°C to 24°C while patient core and peripheral temperatures were maintained.

Figure 3

Haemodynamics and temperatures for Procedure 3. Systolic pressure (mmHg): ▽; diastolic pressure (mmHg): △; heart rate (beats per minute): ●; target temperature (°C): grey solid line; ambient temperature (°C): grey dashed line; peripheral temperature (°C): black solid line; Bladder Temperature (°C): black dashed line; Tympanic Temperature (°C): black dash-dot line. Although the temperature management unit is capable of generating a water temperature as low as 4°C, on this occasion the operator set the parameters such that the circulating water temperature did not fall below 10°C during this cooling maneuver.

Figure 4

Haemodynamics and temperatures for Procedure 4. Systolic pressure (mmHg): ▽; diastolic pressure (mmHg): △; heart rate (beats per minute): ●; target temperature (°C): grey solid line; ambient temperature (°C): grey dashed line; peripheral temperature (°C): black solid line; Bladder Temperature (°C): black dashed line; nasal temperature (°C): black dotted line. Operating room temperature was maintained at a moderate 26°C for the duration of the procedure with maintenance of patient core temperature and a small drop in peripheral temperature over this period.

Figure 5

Photograph of the esophageal heat exchange device attached to the Blanketrol III temperature management unit. A cross section of the device is represented in the upper left corner.