title: Recovery from postoperative hypothermia predicts survival in extensively burned patients.
abstract: To clarify the cause of postoperative hypothermia in extensively burned patients, factors affecting postoperative hypothermia were studied in 16 extensively burned adult patients (8 survivors and 8 nonsurvivors) with a burn index greater than 35. Body temperature was monitored continuously in either the urinary bladder or rectum. Hypothermia of less than 35 degrees C occurred in 89% (66 of 74) of the total operations performed in these 16 patients. The rate of temperature rise (RTR) was significantly lower in nonsurvivors (0.4 +/- 0.2 degrees C/h) than in survivors (1.7 +/- 0.9 degrees C/h; p < 0.001). Continuous indirect calorimetry performed in seven patients (four survivors and three nonsurvivors) demonstrated that RTR was determined primarily by heat production. The measured energy expenditure reached only 1.7 +/- 0.2 times the basal energy expenditure during rewarming in nonsurvivors, whereas it was 2.7 +/- 0.9 times the basal energy expenditure in survivors (p < 0.01). Surprisingly, in nonsurvivors, the RTR was significantly decreased even during the first 2 weeks. These findings suggest that those who cannot generate heat well in postoperative hypothermia are unable to produce the additional energy required to overcome sepsis.
authors.affiliation: Department of Traumatology, Osaka University Medical School, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Shiozaki
authors.forename: M
authors.initials: M
authors.lastname: Kishikawa
authors.forename: A
authors.initials: A
authors.lastname: Hiraide
authors.forename: T
authors.initials: T
authors.lastname: Shimazu
authors.forename: H
authors.initials: H
authors.lastname: Sugimoto
authors.forename: T
authors.initials: T
authors.lastname: Yoshioka
authors.forename: T
authors.initials: T
authors.lastname: Sugimoto
mesh_terms: D000328:Adult; D001833:Body Temperature Regulation; D002056:Burns / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate