Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial.
OBJECTIVE
To assess the relationship between body temperature and cardiac morbidity during the perioperative period.


METHODS
Randomized controlled trial comparing routine thermal care (hypothermic group) to additional supplemental warming care (normothermic group).


METHODS
Operating rooms and surgical intensive care unit at an academic medical center.


METHODS
Three hundred patients undergoing abdominal, thoracic, or vascular surgical procedures who either had documented coronary artery disease or were at high risk for coronary disease.


METHODS
The relative risk of a morbid cardiac event (unstable angina/ischemia, cardiac arrest, or myocardial infarction) according to thermal treatment. Cardiac outcomes were assessed in a double-blind fashion.


RESULTS
Mean core temperature after surgery was lower in the hypothermic group (35.4+/-0.1 degrees C) than in the normothermic group (36.7+/-0.1 degrees C) (P<.001) and remained lower during the early postoperative period. Perioperative morbid cardiac events occurred less frequently in the normothermic group than in the hypothermic group (1.4% vs 6.3%; P=.02). Hypothermia was an independent predictor of morbid cardiac events by multivariate analysis (relative risk, 2.2; 95% confidence interval, 1.1-4.7; P=.04), indicating a 55% reduction in risk when normothermia was maintained. Postoperative ventricular tachycardia also occurred less frequently in the normothermic group than in the hypothermic group (2.4% vs 7.9%; P=.04).


CONCLUSIONS
In patients with cardiac risk factors who are undergoing noncardiac surgery, the perioperative maintenance of normothermia is associated with a reduced incidence of morbid cardiac events and ventricular tachycardia.
Frank
S M
SM
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Md, USA. sfrank@welchlink.welch.jhu.edu
Fleisher
L A
LA
Breslow
M J
MJ
Higgins
M S
MS
Olson
K F
KF
Kelly
S
S
Beattie
C
C
D000368:Aged; D000704:Analysis of Variance; D000758:Anesthesia; D015142:Baltimore; D001831:Body Temperature; D003327:Coronary Disease / Q000150:complications* / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006439:Hemodynamics; D006785:Hospitals, University; D006801:Humans; D007035:Hypothermia; D015994:Incidence; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011184:Postoperative Period; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013514:Surgical Procedures, Operative