Topical humidified carbon dioxide to keep the open surgical wound warm: the greenhouse effect revisited

Perioperative hypothermia is common in open surgery and is associated with increased rates of wound infection. This is a result of decreased wound tissue oxygenation, which can be normalized by local warming. Recently, a technique has been developed to establish a carbon dioxide atmosphere in an open surgical wound. Therefore, the authors studied the possible "greenhouse effect" of carbon dioxide insufflation and operation lamps on wound temperature.

In a fully ventilated operating room surface temperature was measured at steady state in a model of an open surgical wound containing blood agar. The wound model was randomized to either no insufflation or insufflation of dry and humidified carbon dioxide or air, respectively, at a flow of 5 l/min via a gas diffuser. The surface temperature was measured with operation lamps switched on and off, respectively. Evaporation rates were also measured.

With the operation light off, the surface temperature in the control was 31.8 degrees C, and with the operation light on, the temperature increased by 1.5 degrees C (P < 0.001). Additional insufflation of dry carbon dioxide increased the surface temperature another 1.9 degrees C (P < 0.001). When the carbon dioxide was humidified, the evaporation rate was lowest and the surface temperature increased further to 35.6 degrees C (P = 0.002). In contrast, insufflation of dry and humidified air did not have a significant effect on the evaporation rate and only marginally increased the wound temperature in comparison with the control.

Insufflation of humidified carbon dioxide in combination with light from the operation lamps may help to keep the open wound warm during surgery.