title: Circulating-water garment or the combination of a circulating-water mattress and forced-air cover to maintain core temperature during major upper-abdominal surgery.
abstract: BACKGROUND
  A recent heat-balance study in volunteers suggested that greater efficacy of circulating-water garments (CWGs) results largely from increased heat transfer across the posterior skin surface since heat transfer across the anterior skin surface was similar with circulating-water and forced-air. We thus tested the hypothesis that the combination of a circulating-water mattress (CWM) and forced-air warming prevents core temperature reduction during major abdominal surgery no worse than a CWG does.
  
  
  METHODS
  Fifty adult patients aged between 18 and 85 yr old, undergoing major abdominal surgery, were randomly assigned to intraoperative warming with a combination of forced-air and a CWM or with a CWG (Allon ThermoWrap). Core temperature was measured in the distal oesophagus. Non-inferiority of the CWM to the CWG on change from baseline to median intraoperative temperature was assessed using a one-tailed Student's t-test with an equivalency buffer of -0.5°C.
  
  
  RESULTS
  Data analysis was restricted to 16 CWG and 20 CWM patients who completed the protocol. Core temperature increased in both groups during the initial hours of surgery. We had sufficient evidence (P=0.001), to conclude that the combination of a CWM and forced-air warming was non-inferior to a CWG in preventing temperature reduction, with mean (95% CI) difference in the temperature change between the CWM and the CWG groups (CWM-CWG) of 0.46°C (-0.09°C, 1.00°C).
  
  
  CONCLUSIONS
  The combination of a CWM and forced-air warming is significantly non-inferior in maintaining intraoperative core temperature than a CWG.
  
  
  BACKGROUND
  This trial has been registered at clinical trials.gov, identifier: NCT 00651898.
authors.affiliation: Anaesthesiology Institute, The Cleveland Clinic, 9500 Euclid Avenue, P-77, Cleveland, OH 44195, USA.
authors.forename: S
authors.initials: S
authors.lastname: Perez-Protto
authors.forename: D I
authors.initials: DI
authors.lastname: Sessler
authors.forename: L F
authors.initials: LF
authors.lastname: Reynolds
authors.forename: M H
authors.initials: MH
authors.lastname: Bakri
authors.forename: E
authors.initials: E
authors.lastname: Mascha
authors.forename: J
authors.initials: J
authors.lastname: Cywinski
authors.forename: B
authors.initials: B
authors.lastname: Parker
authors.forename: M
authors.initials: M
authors.lastname: Argalious
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001513:Beds; D001831:Body Temperature; D003020:Clothing; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000517:prevention & control*; D007430:Intraoperative Care / Q000379:methods*; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D055815:Young Adult