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Perioperative temperature management and coagulation: effects of mild hypothermia in a prospective study
Alena Trčková1, Tereza Bönischová1,2, Hana Zelinková3
1Department of Pediatric Anesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia.
Insights
Mild hypothermia is common in pediatric surgery but does not typically cause significant bleeding issues. Low operating room temperature and older age are risk factors for hypothermia in children.
Area of Science:
- Pediatric Anesthesiology
- Coagulation Physiology
- Perioperative Medicine
Background:
- Perioperative hypothermia is a frequent complication in pediatric surgeries under general or regional anesthesia.
- Hypothermia is a known risk factor for developing coagulation disorders.
- Assessing coagulopathy in hypothermic pediatric patients is crucial for patient safety.
Purpose of the Study:
- To evaluate the occurrence of coagulopathy in pediatric patients (0-18 years) experiencing hypothermia during arthroscopic and open abdominal surgeries.
- To identify risk factors contributing to both hypothermia and coagulopathy in this patient group.
Main Methods:
- A prospective cohort study (Peritemp) observed 102 pediatric patients.
- Monitored body temperatures (below 36.5°C and 36°C) and coagulation parameters (ROTEM, aPTT, PT).
- Analyzed incidence of hypothermia and coagulopathy, and associated risk factors.
Main Results:
- Mild hypothermia (below 36.0°C) occurred in 43% of patients; temperatures below 36.5°C in 86%.
- Coagulation test abnormalities ranged from 5.9% to 32.4%, with ROTEM abnormal in 18.7% and standard tests in 15.9%.
- Low operating room temperature and older age were significant risk factors for hypothermia; only PT-R showed a significant difference between initial and later tests.
Conclusions:
- Mild hypothermia is common in pediatric surgery but generally well-tolerated by the coagulation system, not leading to clinically significant disorders.
- Coagulation parameters, apart from PT-R, showed no significant changes, indicating mild hypothermia may not severely impact pediatric coagulation.
- Operating room temperature variability is linked to intraoperative hypothermia; further research in diverse pediatric populations is recommended.
Background:
Perioperative hypothermia is a common complication of general and regional anesthesia in children and is a known risk factor for the development of coagulation disorders. The primary aim of the study was to assess the occurrence of coagulopathy in hypothermic pediatric patients (0-18 years) undergoing arthroscopic surgery and open abdominal surgery. The secondary objective was to identify potential risk factors for the development of both hypothermia and coagulopathy.
Methods:
A prospective cohort study was conducted, forming the second part of our study "Perioperative Management of Temperature in Children and the Influence of Hypothermia on Blood Clotting in Children" (Peritemp). We observed the incidence of body temperatures below normal values-specifically, below 36.5°C and 36°C-as well as the incidence of pathological values in thromboelastometry (ROTEM) (EXTEM and FIBTEM) and standard coagulation tests, including activated partial thromboplastin time (aPTT) and prothrombin time (PT).
Results:
A total of 102 patients (55 female and 47 male patients) were enrolled from 22nd January 2018 to 27th August 2021 at the Department of Pediatric Anesthesiology and Intensive Medicine, University Hospital Brno. An incidence of body temperature below 36.5°C was observed in 86 cases, and temperatures below 36.0°C were observed in 43 cases. The incidence of abnormalities in the individual parameters of the coagulation tests ranged from 5.9 to 32.4%. The ROTEM results were abnormal in 18.7% of the patients, while the standard coagulation test showed abnormalities in 15.9% of the cases. In the statistical comparison between the first and second coagulation test results, only the prothrombin time ratio (PT-R) showed a statistically significant difference. Low operating room (OR) temperature and patient age emerged as significant risk factors for the incidence of hypothermia. In addition, older age was associated with an increased likelihood of body temperature falling below 36.5°C and 36°C.
Conclusion:
Our study confirmed that mild hypothermia (core temperature below 36.0°C) is common during pediatric surgeries, but it does not appear to result in clinically significant coagulation disorders requiring intervention. Despite the incidence of coagulation abnormalities, the absence of significant changes in coagulation parameters, outside of the PT-R, suggests that mild hypothermia may be well tolerated by the coagulation system in pediatric patients. Our study confirmed the previously established association between variability in operating room temperature and intraoperative hypothermia. Future research should focus on larger, more diverse pediatric populations to validate these findings and optimize perioperative temperature management strategies.
Clinical Trial Registration:
ClinicalTrials.gov identifier: NCT03273894.
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