Prevention of cerebral hyperthermia during cardiac surgery by limiting on-bypass rewarming in combination with post-bypass body surface warming: a feasibility study.
Cerebral hyperthermia is common during the rewarming phase of cardiopulmonary bypass (CPB) and is implicated in CPB-associated neurocognitive dysfunction. Limiting rewarming may prevent cerebral hyperthermia but risks postoperative hypothermia. In a prospective, controlled study, we tested whether using a surface-warming device could allow limited rewarming from hypothermic CPB while avoiding prolonged postoperative hypothermia (core body temperature <36 degrees C). Thirteen patients undergoing primary elective coronary artery bypass grafting surgery were randomized to either a surface-rewarming group (using the Arctic Sun thermoregulatory system; n = 7) or a control standard rewarming group (n = 6). During rewarming from CPB, the control group was warmed to a nasopharyngeal temperature of 37 degrees C, whereas the surface-warming group was warmed to 35 degrees C, and then slowly rewarmed to 36.8 degrees C over the ensuing 4 h. Cerebral temperature was measured using a jugular bulb thermistor. Nasopharyngeal temperatures were lower in the surface-rewarming group at the end of CPB but not 4 h after surgery. Peak jugular bulb temperatures during the rewarming phase were significantly lower in the surface-rewarming group (36.4 degrees C +/- 1 degrees C) compared with controls (37.7 degrees C +/- 0.5 degrees C; P = 0.024). We conclude that limiting rewarming during CPB, when used in combination with surface warming, can prevent cerebral hyperthermia while minimizing the risk of postoperative hypothermia[corrected].
Bar-Yosef
Shahar
S
Departments of *Anesthesiology (Division of Cardiothoracic Anesthesiology and Critical Care Medicine) and †Surgery (Division of Cardiothoracic Surgery), Duke University Medical Center, Durham, North Carolina.
Mathew
Joseph P
JP
Newman
Mark F
MF
Landolfo
Kevin P
KP
Grocott
Hilary P
HP
D000328:Adult; D000368:Aged; D001831:Body Temperature; D001833:Body Temperature Regulation; D001921:Brain / Q000502:physiology*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D005260:Female; D005334:Fever / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017694:Rewarming