Forced-Air Warming During Pediatric Surgery: A Randomized Comparison of a Compressible with a Noncompressible Warming System.

Background: Perioperative hypothermia is a common problem, challenging the anesthesiologist and influencing patient outcome. Efficient and safe perioperative active warming is therefore paramount; yet, it can be particularly challenging in pediatric patients. Forced-air warming technology is the most widespread patient-warming option, with most forced-air warming systems consisting of a forced-air blower connected to a compressible, double layer plastic and/or a paper blanket with air holes on the patient side. We compared an alternative, forced-air, noncompressible, under-body patient-warming mattress (Baby/Kleinkinddecke of MoeckWarmingSystems, Moeck und Moeck GmbH; group MM) with a standard, compressible warming mattress system (Pediatric Underbody, Bair Hugger, 3M; group BH).

Methods: The study included 80 patients aged <2 years, scheduled for elective surgery. After a preoperative core temperature measurement, the patients were placed on the randomized mattress in the operation theater and 4 temperature probes were applied rectally and to the patients' skin. The warming devices were turned on as soon as possible to the level for pediatric patients as recommended by the manufacturer (MM = 40°C, BH = 43°C).

Results: There was a distinct difference of temperature slope between the 2 groups: core temperatures of patients in the group MM remained stable and mean of the core temperature of patients in the group BH increased significantly (difference: +1.48°C/h; 95% confidence interval, 0.82-2.15°C/h; P = 0.0001). The need for temperature downregulation occurred more often in the BH group, with 22 vs 7 incidences (RR, 3.14; 95% confidence interval, 1.52-6.52; P = 0.0006). Skin temperatures were all lower in the MM group. Perioperatively, no side effects related to a warming device were observed in any group.

Conclusions: Both devices are feasible choices for active pediatric patient warming, with the compressible mattress system being better suited to increase core temperature. The use of lower pediatric forced-air temperature settings, as recommended by the manufacturer, in the noncompressible mattress group resulted in more stable core temperature conditions, with fewer forced-air temperature adjustments necessary to avoid hyperthermia.