The effects of core and peripheral warming methods on temperature and physiologic variables in injured children

Introduction: Injured children are at risk for thermoregulatory compromise, where temperature maintenance mechanisms are overwhelmed by severe injury, environmental exposure, and resuscitation measures. Adequate thermoregulat ion can be maintained, and heat loss can be prevented, by core (administrat ion of warmed intravenous fluid) and peripheral (application of convective air warming) methods. It is not known which warming method is better to mai ntain thermoregulation and prevent heat loss in injured children during the ir trauma resuscitations, The purpose of this feasibility study was to comp are the effects of core and peripheral warming measures on body temperature and physiologic changes in a small sample of injured children during their initial emergency department (ED) treatment. Methods: A prospective, randomized experimental design was used. Eight inju red children aged 3 to 14 years (mean = 6.87, SD = 3.44) treated in the ED of Children's Hospital of Pittsburgh were enrolled. Physiologic responses l eg, heart rate, blood pressure, respiratory rate, arterial oxygen saturatio n, core, peripheral temperatures) and level of consciousness were continuou sly measured and recorded every 5 minutes to detect early thermoregulatory compromise and to determine the child's response to warming. Data were coll ected throughout the resuscitation period, including transport to CT scan, the inpatient nursing unit, intensive care unit, operating room or discharg e to home. Core warming was accomplished with the Hotline Fluid Warmer (Sim s Level 1, Inc., Rockland, RIA), and peripheral warming was accomplished wi th the Snuggle Warm Convective Warming System (Sims Level 1, Inc, Rockland, MA). Data were analyzed using descriptive and inferential statistics. Results: There were no statistically significant differences between the tw o groups on age (t = -0.485, P = 0.645); weight (t = -0.005, P = 0.996); am ount of prehospital intravenous (IV) fluid (t = 0.314, P = 0.766); temperat ure on ED arrival (t = 0.287, P = 0.784); total amount of infused IV fluid (t = -0.21, P = 0.8); and length of time from ED admission to hospital admi ssion (t = -0.613, P = 0.56). There were no statistically significant diffe rences between the two groups on RTS (t = -0.516, P = 0.633). When comparin g the mean differences in temperature upon hospital admission, no statistic ally significant differences were found (t = -1.572, P = 0.167). There were no statistically significant differences between the two groups in tympani c [F(15) = 0.71, P = 0.44] and skin [F(15) = 0.06, P = 0.81] temperature me asurements over time. Conclusion: Core and peripheral,warming methods appeared to be effective in preventing heat loss in this stable patient population. A reasonable next step would be to continue this trial in a larger sample of patients who are at greater risk for heat loss and subsequent hypothermia and to use a cont rol group.