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HOSPITAL

The body can only expend so much energy to maintain its temperature. In a deeply compromised state, these normal mechanisms do not work well. Even indoors in a hospital, IV fluids off-the-shelf are typically stored at room temperature 21°C (70°F). This creates an immediate 16°C (28°F) gradient between normal body temperature and the resuscitation fluids. Blood products are stored refrigerated, at 4°C (39°F), which greatly increases the temperature gradient a compromise patient has to overcome.

 

Resuscitation fluids given to trauma, critically ill, and surgical patients are known to potentially lower body temperature. They are one contributor to hypothermia; combined with shock, blood loss, exposure to evaluate injuries, the external environment, anesthesia, and opening a body cavity for surgical repair.

Emergency Department

According to the American College of Surgeons, there are over 5000 Emergency Departments in the US, with over 450 of those designated as trauma centers. Trauma is the #1 cause of death for Americans between 1 and 46 years old. Each year, trauma accounts for 41 million ER visits and two million hospital admissions.

 

The lethal triad of hypothermia, acidosis, and coagulopathy can occur in trauma patients. It can also occur in medical patients who are in shock from blood loss; the most common being those experiencing massive gastrointestinal bleeding.

Surgery Department & Recovery

In the US, it is estimated that 65% of surgical patients experience some degree of hypothermia. This equates to 45.5 million procedures annually where some degree of hypothermia is an issue.

 

Even episodes of mild hypothermia during surgical procedures has been clearly shown to increase the rate of postoperative infections, compared to patients who remained normothermic during the procedure. Published papers point to a higher incidence of infection in patients undergoing colorectal surgery and hip replacement surgery. The immune system works best at and above normal body temperature. It is theorized that the lowering of body temperature during surgery suppresses the immune system, leading to increased infections.

 

The CMS Surgical Care Improvement Program, known as SCIP-10, requires hospitals to document at least one temperature at 37°C (98.6°F) within 30 minutes prior to, or 15 minutes after, anesthesia end time.

Specialty and Unique Clinical Environments

Throughout the hospital, there are many other environments where temperature must be monitored closely with intentional preventative measures to maintain normothermia.

Labor and Delivery, primarily as it pertains to C-Sections, is a primary area where measures are taken to maintain normothermia. The CDC reports that there are over 1.2 million C-Sections annually in the US.

There are over 14.6 million blood transfusions given annually in the US. Because blood products are frozen and then refrigerated, anywhere transfusions occur, measures to maintain normothermia may need to be provided, depending on the volume and speed of infusion.

Patients in burn units can be quite susceptible to hypothermia. Beside emergency departments and hospitals treating burn victims, there are 128 designated burn centers in the US, with 40,000 hospitalizations related to burn injury annually. Internationally, there are 1.25 million hospitalizations related to burn injuries.

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