The Society of Thoracic Surgeons, Society of Cardiovascular Anesthesiologists, and American Society of ExtraCorporeal Technology have collaboratively drafted a set of principles to practice while monitoring (Fever) a patient’s temperature during open heart surgery. These new guidelines cover the gaps and lapses in the current protocols, and address the matter of accurately recording and reporting temperature during cardiopulmonary bypass (CPB).
The Set Of Guidelines Presented: For Fever During Surgery
Various strategies related to body temperature are employed during cardiac surgery – effectively cooling blood, maintaining body temperature and re-warming the blood. However, current methods used to manage a patient’s body temperature during heart surgery require a heart-lung machine (CPB), and though there is evidence to justify its efficacy, the procedure has not been optimized.
To provide a more effective solution, a team of experts from across the US and Australia – cardiac surgeons, anesthesiologists, epidemiologists, etc – decided to address the matter.
They carefully evaluated the procedure a surgical team uses to manage a patient’s body temperature during cardiac surgery. They also went through literature mainly involving heart valve surgical procedures and coronary artery bypass grafting to see how a heart-lung machine was used to maintain body temperatures during such surgeries. The multidisciplinary team reviewed 3,321 abstracts and 935 complete articles to find the most appropriate and scientifically accurate material for drafting their guidelines.
The renewed evidence-based guidelines for clinical practice include the following recommendations:
- Optimal site for recording temperature
- Avoidance of over-warming the blood (hyperthermia)
- Peak cooling temperature gradient
- Cooling rate
- Peak warming temperature gradient
- Re-warming rate
Advantages Of The Developmental Process
In an editorial of The Annals of Thoracic Surgery, the journal which published the guidelines, the authors gave an outline of how they developed the guidelines, and explained the implications these would have in clinical practice. Dr John W. Hammon, MD, a Cardiothoracic Surgeon from Wake Forest University in Winston-Salem, NC stated that the team had prepared a comprehensive set of principles that are the best to date with regard to CPB temperature management.
Fever During Surgery
Dr Hammon suggests that subsequent guidelines would address other aspects of CBP, such as protecting the kidneys, neurological protection, management of anticoagulation, selection of equipment, and safety of conduct.
“These newly formulated guidelines will help improve our understanding of the relationship between temperature management and clinical outcomes – particularly its impact on brain function”, highlighted co-author Richard Engelman, MD, from Baystate Medical Center in Springfield, Mass.
In addition, these principles will help improve patient awareness regarding CBP and encourage an educated dialogue with his or her cardiothoracic surgical team before surgery. These guidelines will also serve as the base for directed research into various areas where evidence is lacking to support a recommendation.