Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Inadvertent intraoperative hypothermia

Donizetti, Enis; Perini, Fernanda Vieira; Rodrigues, Roseny dos Reis; Montano-Pedroso, Juan Carlos; Oliveira, Luciana Correa; Rizzo, Silvia Renata Cornélio Parolin; Rabello, Guilherme; Langhi Junior, Dante Mario

doi:10.1016/j.htct.2024.02.021

person Enis Donizetti

schoolHospital Sírio Libanês, São Paulo, SP, Brazil

person Fernanda Vieira Perini

schoolGrupo GSH - Gestor de Serviços de Hemoterapia, São Paulo, SP, BrazilschoolAssociação Beneficente Síria HCOR, São Paulo, SP, Brazil

person Roseny dos Reis Rodrigues

schoolHospital Israelita Albert Einstein são Paulo, São Paulo, SP, BrazilschoolFaculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil

person Juan Carlos Montano-Pedroso

schoolUniversidade Federal de São Paulo (Unifesp), São Paulo, SP, BrazilschoolInstituto de Assistência Médica do Servidor Público Estadual (Iaspe), São Paulo, SP, Brazil

person Luciana Correa Oliveira

schoolHemocentro de Ribeirão Preto, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil

person Silvia Renata Cornélio Parolin Rizzo

schoolAssociação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil

person Guilherme Rabello ⁎

schoolInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Incor - HCFMUSP), São Paulo, SP, Brazil

0000-0002-7100-7897

person Dante Mario Langhi Junior

schoolEscola Paulista de Medicina, Universidade Federal de São Paulo (EPM UNIFESP), São Paulo, SP, Brazil

person⁎ Corresponding author at: Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Incor - HCFMUSP), São Paulo, SP, Brazil. E-mail address:
grabello.inovaincor@fz.org.br (G. Rabello)

Conflicts of interest

The authors declare no conflicts of interest.

Hospital Sírio Libanês, São Paulo, SP, Brazil

Grupo GSH - Gestor de Serviços de Hemoterapia, São Paulo, SP, Brazil

Associação Beneficente Síria HCOR, São Paulo, SP, Brazil

Hospital Israelita Albert Einstein são Paulo, São Paulo, SP, Brazil

Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil

Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil

Instituto de Assistência Médica do Servidor Público Estadual (Iaspe), São Paulo, SP, Brazil

Hemocentro de Ribeirão Preto, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil

Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil

Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Incor - HCFMUSP), São Paulo, SP, Brazil

Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM UNIFESP), São Paulo, SP, Brazil

System	Complication
Cardiovascular	Myocardium ischemia Arterial hypertension Tachycardia Deep venous thrombosis
Coagulation	Platelet activation Coagulopathy
Immunology	Increased incidence of surgical site infections
Hydroelectrolytic	Hypokalemia Hypomagnesemia Hypophosphatemia
Endocrine-metabolic alterations	↓Corticoides ↓Insulin ↑Peripheral resistance to insulin ↑TSH → ↑thyroxin Hyperglycemia Hypoglycemia

Consequence	Author	n	VT_core (°C)	Normothermic	Hypothermic	p-value
Morbid cardiac events		300	1.3	1.4 %	6.3 %	<0.05
Postoperative ventricular tachycardia	Frank et al.	300	1.3	2.4 %	7.9 %	<0.05
Adrenergic activation	Frank	74	1.5	330 ± 30	480 ± 70	<0.05
Cardiac wound infection	Kurtz et al.	200	1.9	pg/mL 6 %	pg/mL 9 %	<0.01
Hospital stay	Kurtz et al.	200	1.9	12.1 ± 4.4 days	14.7 ± 6.5 days	<0.01
Lymphocytic proliferation 24 hour after anesthesia	Beiln et al.	60	1.0	4800 CPM	2750 CPM	<0.05
Necessity of allogenic transplantation	Schmied et al.	60	1.6	1 unit	8 units	<0.05
Intraoperative blood loss	Schmied et al.	60	1.6	1.7 ± 0.3 L	2.2 ± 0.5 L	< 0.001
Intraoperative blood loss	Winkler et al.	150	0.4	480 mL	618 mL	<0.005
Intraoperative blood loss	Winkler et al.	46	0.5	516 ± 272 mL	702 ± 344 mL	<0.05
Intraoperative blood loss	Johansson et al.	50	0.8	665 ± 292 mL	698 ± 314 mL	NS
Urinary nitrogen excretion	Carli et al.	12	1.5	982 mmol/day	1798 mmol/day	<0.05
Trauma mortality in 24 h	Giantilello et al.	57	1.0-2.0	7 %	43 %	<0.05
Duration of vecuronium	Heier et al.	20	2.0	28 ± 4 min	62 ± 8 min	< 0.001
Duration of vecuronium	Caldwell et al.	12	2.0	0.20 min-1	0.15 min-1	<0.05
Duration of atracurium	Leslie et al.	6	3.0	44 ± 4 min	68 ± 7 min	<0.05
Postoperative shivering	Just et al.	14	2.3	141 ± 9 mL/min/m²	269 ± 60 mL/min/m2	< 0.001
Postanesthetic recovery duration	Lenhardt et al.	150	1.9	53 ± 36 min	94 ± 65 min	< 0.001
Thermal discomfort	Kurz et al.	74	2.6	50 ± 10 mm VAS	18 ± 9 mm VAS	< 0.001

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Inadvertent intraoperative hypothermia

Abstract