A recommended early goal-directed management guideline for the prevention of hypothermia-related transfusion, morbidity, and mortality in severely injured trauma patients.
Hypothermia is present in up to two-thirds of patients with severe injury, although it is often disregarded during the initial resuscitation. Studies have revealed that hypothermia is associated with mortality in a large percentage of trauma cases when the patient's temperature is below 32 °C. Risk factors include the severity of injury, wet clothing, low transport unit temperature, use of anesthesia, and prolonged surgery. Fortunately, associated coagulation disorders have been shown to completely resolve with aggressive warming. Selected passive and active warming techniques can be applied in damage control resuscitation. While treatment guidelines exist for acidosis and bleeding, there is no evidence-based approach to managing hypothermia in trauma patients. We synthesized a goal-directed algorithm for warming the severely injured patient that can be directly incorporated into current Advanced Trauma Life Support guidelines. This involves the early use of warming blankets and removal of wet clothing in the prehospital phase followed by aggressive rewarming on arrival at the hospital if the patient's injuries require damage control therapy. Future research in hypothermia management should concentrate on applying this treatment algorithm and should evaluate its influence on patient outcomes. This treatment strategy may help to reduce blood loss and improve morbidity and mortality in this population of patients.
Department of Anesthesia, Rm M3-200, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.|Trauma, Emergency & Critical Care Research Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
Ryan
R
Perlman
Department of Laboratory Medicine & Pathobiology, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.|Department of Clinical Pathology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
Jeannie
J
Callum
Department of Anesthesia, Rm M3-200, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
Claude
C
Laflamme
Trauma, Emergency & Critical Care Research Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.|Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.|Ornge-Ontario Air Ambulance, 5310 Explorer Drive, Mississauga, ON, L4W 5H8, Canada.
Homer
H
Tien
Trauma, Emergency & Critical Care Research Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.|Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
Barto
B
Nascimento
Department of Surgery, McGill University, Montreal General Hospital, 1650 Avenue Cedar, Montréal, QC, H3G 1A4, Canada.
Andrew
A
Beckett
Department of Anesthesia, Rm M3-200, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. asim.alam@sunnybrook.ca.|Trauma, Emergency & Critical Care Research Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. asim.alam@sunnybrook.ca.|Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. asim.alam@sunnybrook.ca.
Asim
A
Alam
D001803:Blood Transfusion / Q000401:mortality; D019468:Disease Management; D006801:Humans; D007035:Hypothermia / Q000209:etiology* / Q000401:mortality; D012151:Resuscitation / Q000009:adverse effects; D017694:Rewarming / Q000379:methods; D065227:Transfusion Reaction; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality / Q000503:physiopathology