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Impact of a Thermal Care Bundle (Short Prewarming) on Shivering and Thermal Comfort in Osteosynthesis Patients: A
Esther Espuñes-Mestres1, Jordi Castillo-García2, Suresh K Sharma3
1Department of Nursing, Mutua ASEPEYO Hospital, Barcelona, Spain; Department of Nursing, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.
Purpose:
Shivering during a surgical procedure has been shown to lead to patient thermal discomfort that can result in an unsatisfactory experience of the whole surgical process besides the physiological consequences that may arise due to the adrenergic activation response. The aim was to determine if implementation of a thermal care bundle with a short prewarming period decreased the incidence of shivering and improved thermal comfort in patients undergoing osteosynthesis.
Design:
Open-label, single-center randomized controlled trial.
Methods:
In total, 148 patients who underwent osteosynthesis surgery in an academic teaching hospital were randomly divided into intervention and control groups. The intervention group received the thermal care bundle, which consisted of prewarming patients 10 minutes before anesthesia delivery and maintaining body temperature with a forced-air device during surgery and the immediate postoperative period; in addition, the operating room environmental temperature was kept at 21 ºC, and fluids were warmed to 38 ºC. Significance was set at 5% level.
Findings:
All 148 patients completed the study; there were no significant differences between the groups at baseline. The cumulative incidence of shivering in the control group was 9.9% among 6.5% in the bundle group. Between the start of surgery and minute 30, the mean difference in core temperature was 0.13 °C (standard deviation [SD] 0.31). However, in patients who experienced shivering, this difference was higher, 0.33 °C (SD 0.49) compared with those who did not, 0.12 °C (SD 0.29), with a statistically significant difference (P = .010). The bundle was effective in improving perceived thermal comfort (P = .034) and was associated with a 60.5% relative reduction in the risk of thermal discomfort.
Conclusions:
The bundle did not impact shivering but was effective in improving perceived thermal comfort and was associated with a 60.5% relative reduction in the risk of thermal discomfort.
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