INTRAOPERATIVE HYPOTHERMIA AND VOLUME OF BLOOD LOSS OF PATIENTS WITH POLITRAUMA

Tsarev А. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Intraoperative hypothermia develops spontaneously as a result of trauma, surgical intervention and anesthesia as a result of a violation of the conformity of heat production to heat loss and suppression of the compensatory thermoregulatory response. Intensive care for polytrauma should be aimed at the “triad of death”: hypothermia, acidosis and coagulopathy are the main links in the pathogenesis of polytrauma. Temperature is one of the most important factors determining the coagulation cascade, and since temperature-sensitive plasma esterase reactions, like the functional activity of platelets, are inhibited by hypothermia, it is not surprising that coagulopathy is the final part of the lethal triad. It should be emphasized that this occurs in conditions of blood loss, i.e. the initial loss of coagulation factors and the additional development of dilutional coagulopathy associated with the implementation of infusion therapy to correct hypovolemia causing a pooling of coagulation factors initially at a low level. The aim of the work was to study the effectiveness of the method for correcting intraoperative hypothermia using a convective heating system in patients with polytrauma. Object and methods. Twenty patients with polytrauma who underwent urgent surgical interventions were examined. Patients were divided into 2 groups: Group I (n = 10) – who were actively heated by the “WarmAir 135” (CSZ) convection heating system with the use of blankets for warming in the operating room – the “FilteredFlo – 248” model; Group II – control group (n = 10) without the use of convection warming. Patients of both study groups underwent abdominal, thoracic and neurosurgical interventions, urological interventions for traumatic injury of pelvic organs and for musculoskeletal injuries. The duration of the intraoperative period was 92 to 225 minutes. All patients were monitored with a core temperature (Tco) using a thermometer for measuring rectal Tco “SureTemp Plus” (WelchAllyn). The body core temperature was measured at the following stages of the intraoperative period: initially and at the end of the operation. The volume of blood loss was determined intraoperatively. The volume of transfusion of donor erythrocytes in the intraoperative period and in the first 24 hours of the postoperative period was analyzed.Results. When analyzing the initial level of core body temperature at the time of admission to the operating room, there were no significant differences between the groups of the patients examined (P=0.420). The effectiveness of the method of intraoperative convection warming was confirmed by a significantly lower level of blood loss in the convection heating group (1173±516.39 ml) compared to the control group (2645±373.12 ml) of patients (p<0.05). The volume of transfused donor erythrocytes was significantly lower in the group of patients with convectional heating (1216.4±315.77 ml) compared to the control group (1566±415.11 ml) (p<0.05). Conclusions. In all patients with polytrauma and urgent surgical interventions, there is a development of clinically significant perioperative hypothermia. An effective method of reducing the volume of blood loss and reducing the need for donor red blood cells is the intraoperative use of a convection heating system.

perioperative hypothermia, blood loss, donor erythrocytes, convection heating system, anesthesiology

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«Bulletin of problems biology and medicine» Issue 4 Part 3 (141), 2017 year, 239-242 pages, index UDK 536.421.48-083.98

10.29254/2077–4214–2017–4–3–141–239-242