Prevention of hypothermia in patients undergoing orthotopic liver transplantation using the humigard(R) open surgery humidification system: a prospective randomized pilot and feasibility clinical trial.
Weinberg L, Huang A, et al.BMC Surg 2017; 17(1): 10.
Aims
To examine whether a humidified high flow CO2 warming system is more effective in maintaining thermoregulatory homeostasis, compared to standardized multimodal strategies in patients undergoing orthotopic liver transplantation (OLT).
Interventions
Participants were randomized to receive either open wound humidification with a high flow CO2 warming system in addition to standard care (Humidification group), or to standard care alone (Control group).
Participants
22 adult recipients aged >18 years undergoing primary OLT.
Outcomes
The primary outcome was core temperature measured 5 min prior to reperfusion of the donor liver. Secondary measured outcomes included temperature measurements at 60 min after start of the dissection phase, 30 min after start of the anhepatic phase, 5 min post reperfusion, 60 min post reperfusion and at closure of the surgical wound.
Follow-up
End of hospital stay
CET Conclusions
Hypothermia is common in major open operations such as orthotopic liver transplantation unless attempts are made to prevent its development. In this interesting small pilot trial from Melbourne, 11 patients were randomised to exposure to open wound humidification with a high flow CO2 warming system in addition to standard care or to standard care alone. The primary end point which was nasopharyngeal core temperature measured just before reperfusion of the donor liver was higher in the humidification group than the control group. This was significant but was very modest and the question arises, which the authors deal with very thoroughly, as to whether that modest increase in core temperature would have clinical significance. The authors suggested a larger study is needed to investigate if this improved thermoregulation observed with humidification is associated with improved patient outcomes. This is an example of where small gains might be important but of course do need large trials to demonstrate their importance.
Data analysis
Strict intention-to-treat analysis
Trial registration
ACTRN12616001631493