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A Pilot Quality Improvement Project to Reduce Intraoperative MRI Hypothermia in Neurosurgical Patients
Becky J Wong1, Asheen Rama2, Thomas J Caruso1
1Department of Anesthesiology Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, Calif.
Abstract:
Intraoperative hypothermia increases patient morbidity, including bleeding and infection risk. Neurosurgical intraoperative magnetic resonance imaging (iMRI) can lead to hypothermia from patient exposure and low ambient temperature in the MRI suite. This quality improvement project aimed to reduce the risk of hypothermia during pediatric neurosurgery laser ablation procedures with iMRI. The primary aim was to increase the mean lowest core temperature in pediatric patients with epilepsy during iMRI procedures by 1 °C from a baseline mean lowest core temperature of 34.2 ± 1.2 °C within 10 months and sustain for 10 months.
Methods:
This report is a single-institution quality improvement project from March 2019 to June 2021, with 21 patients treated at a pediatric hospital. After identifying key drivers, temperature-warming interventions were instituted to decrease hypothermia among patients undergoing iMRI during neurosurgery procedures. A multidisciplinary team of physicians, nurses, and MRI technologists convened for huddles before each case. Interventions included prewarmed operating rooms (ORs), blanket coverings, MRI table and room; forced-air blanket warming, temperature monitoring in the OR and iMRI environments; and the MRI fan turned off.
Results:
Data were analyzed for five patients before and nine patients after the institution of the temperature-warming elements. The sustainment period included 15 patients. The mean lowest intraoperative temperature rose from 34.2 ± 1.3 °C in the preintervention period to 35.5 ± 0.6 °C in sustainment (P = 0.004).
Conclusion:
Hybrid OR and MRI procedures increase hypothermia risk, which increases patient morbidity. Implementation of a multidisciplinary, multi-item strategy for patient warming mitigates the risk.
Insights
This quality improvement project successfully reduced hypothermia risk in pediatric neurosurgery patients undergoing intraoperative magnetic resonance imaging (iMRI). Implementing warming strategies significantly increased patient core temperatures, enhancing safety during these complex procedures.
Area of Science:
- Pediatric Neurosurgery
- Medical Imaging
- Patient Safety
Background:
- Intraoperative hypothermia poses significant risks, including increased bleeding and infection, particularly during neurosurgical procedures.
- Neurosurgical intraoperative magnetic resonance imaging (iMRI) environments can exacerbate hypothermia due to patient exposure and low ambient temperatures.
- Pediatric patients undergoing laser ablation with iMRI are especially vulnerable to hypothermia.
Purpose of the Study:
- To decrease the incidence of hypothermia in pediatric epilepsy patients during neurosurgical laser ablation procedures utilizing iMRI.
- To increase the mean lowest core body temperature by 1°C within 10 months and sustain this improvement for an additional 10 months.
Main Methods:
- A multidisciplinary team implemented a comprehensive warming strategy in a single-institution quality improvement project (March 2019 - June 2021).
- Interventions included prewarming operating rooms and MRI suites, utilizing forced-air blanket warming, and continuous temperature monitoring.
- Key procedural adjustments involved turning off the MRI fan and ensuring blanket coverage for the patient and MRI table.
Main Results:
- The mean lowest intraoperative core temperature increased significantly from 34.2 ± 1.3°C in the pre-intervention phase to 35.5 ± 0.6°C during the sustainment period (P = 0.004).
- Data analyzed included 5 patients pre-intervention, 9 post-intervention, and 15 during the sustainment phase.
Conclusions:
- Hybrid operating room and iMRI procedures present a heightened risk of hypothermia, contributing to increased patient morbidity.
- A coordinated, multi-faceted patient warming strategy effectively mitigates the risks associated with hypothermia during these procedures.
