Perioperative thermoregulation practices in major burns management across Australia, New Zealand, and the UK (optiTHERMM)

Cody Frear¹, Guy Stanley^2,3, Majid Al-Khalil⁴, Lorna Burrows⁵, Jonathon Pleat⁶,
¹University Of Queensland, St Lucia, Queensland, Australia
²Fiona Stanley Hospital, Murdoch, Western Australia, Australia
³The University of Western Australia, Perth, Western Australia, Australia
⁴Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK
⁵Southmead Hospital, Bristol, England, UK
⁶North Bristol NHS Trust, Bristol, England , UK

Abstract

Background: Perioperative temperature management is a critical aspect of treating major burns patients, whose loss of thermoregulatory function and metabolic derangements render them vulnerable to a variety of adverse outcomes.
Methods: An online survey consisting of 24 questions was
distributed to all major burns services in Australia, New Zealand, and the UK. The survey aimed to characterise clinicians’ preferences towards identifying, monitoring, and managing hypothermia and hyperthermia in the perioperative setting.
Results: Among the 123 respondents, most indicated either an absence (38%) or lack of awareness (22%) of local protocols on perioperative thermoregulation. Absolute patient core body temperature was identified by a large majority (94%) as the most
clinically important variable. The median preferred ambient operating room temperature was 30°C (IQR 28-32°C). Patient core body temperatures below 35°C (IQR 35-36°C) and above 40°C
(IQR 39-40°C) were considered indications for delaying surgery. Differences in thermoregulatory practices between specialties (surgery vs. anaesthetics/intensive care) and patient populations (adults vs. paediatrics) did not reach statistical significance. Hypothermia was most commonly managed by increasing ambient
temperatures, applying additional insulating layers, using convective forced-air warming devices, and administering warmed intravenous fluids. Prevalent cooling methods included decreasing ambient temperature, removing dressings, and providing cooled intravenous fluids.
Conclusions: The survey’s findings provide valuable insights into the prevailing practices and preferences regarding perioperative thermoregulation in major burns patients. Despite apparent deficiencies in the availability of clear guidelines or protocols, there was a degree of consistency in clinical approaches to hypothermia and hyperthermia across the surveyed regions and healthcare settings.

Biography

Cody Frear is a junior doctor and early-career researcher currently based at the Queensland Children’s Hospital and Mater Hospital Brisbane. He earned his MD and PhD from the University of Queensland. His doctoral research focused on the acute management of paediatric burns.