Perioperative hypothermia is a frequent and clinically significant complication in cancer surgery. Even mild reductions in body temperature are associated with increased bleeding, infection risk, and delayed recovery, and may also affect the timely delivery of adjuvant therapy. Despite advances in perioperative temperature monitoring and warming practices, hypothermia remains common, particularly during complex oncologic procedures. We conducted a prospective observational cohort study including 230 adult patients undergoing elective cancer surgery at the King Hussein Cancer Center, Jordan. The primary outcome was unintended perioperative hypothermia, defined as a body temperature below 36 °C. Temperature was monitored continuously during surgery and measured postoperatively upon admission to and discharge from the Post-Anesthesia Care Unit (PACU). Hypothermia was graded according to severity. Demographic and perioperative variables, including anesthesia type, recent chemotherapy or radiotherapy exposure, intraoperative fluid administration, and warming methods, were collected. Logistic regression was used to identify factors associated with intraoperative and postoperative hypothermia. Analyses of early postoperative recovery indicators were exploratory, and the study was not powered for definitive outcome inference. Intraoperative hypothermia (IOH) occurred in 34.4% of patients, whereas postoperative hypothermia (POH) occurred in 42.6%. Higher rates were observed in gastrointestinal and thoracic procedures; however, subgroup sizes were small. Lack of active warming was associated with increased odds of intraoperative hypothermia, and IOH was independently associated with POH (OR 13.1, p < 0.0001). Forced-air warming was independently associated with lower odds of POH (OR 0.20, p = 0.0006). Exploratory analyses demonstrated associations between POH and poorer early recovery indicators, including longer PACU stays and higher rates of postoperative pain and delirium. In this cohort of patients undergoing cancer surgery, perioperative hypothermia remained common. Intraoperative hypothermia (IOH) and the use of active warming were independently associated with postoperative hypothermia (POH). Exploratory analyses also identified associations between postoperative hypothermia and selected early postoperative recovery indicators. Given the observational design of the study and the exploratory nature of these analyses, the findings should be interpreted as associations rather than evidence of causal relationships.
To analyze the influencing factors for intraoperative hypothermia in patients undergoing percutaneous nephrolithotomy (PCNL). Prospective observational study. A total of 236 patients undergoing percutaneous nephrolithotomy (PCNL) at a tertiary hospital from January 6 to April 6, 2025, were selected as the subjects of this study. Patients were divided into hypothermia and non-hypothermia groups based on whether they experienced hypothermia during surgery. Univariate and binary logistic regression analysis were used to screen for influencing factors associated with intraoperative hypothermia. 136 patients (57.6%) experienced intraoperative hypothermia, while 100 patients (42.4%) did not. Univariate analysis revealed that there were statistically significant differences between the hypothermia group and non-hypothermia group in terms of gender, BMI, duration of anesthesia, room temperature, number of tracts, preoperative warming measures, and intraoperative warming measures. Binary logistic regression analysis indicated that gender (OR=2.204, 95%CI: 1.164~4.173, P=0.015), BMI (OR=1.202, 95%CI: 1.096~1.317, P<0.001), number of tracts (OR=0.276, 95%CI: 0.123~0.619, P=0.002), and comprehensive preoperative warming measures (OR=3.041, 95%CI: 1.016~9.097, P=0.047) were independent influencing factors for intraoperative hypothermia in patients undergoing percutaneous nephrolithotomy. The incidence of intraoperative hypothermia in patients undergoing percutaneous nephrolithotomy is relatively high, and its occurrence is associated with gender, BMI, the number of surgical tracts, preoperative warming measures and intraoperative warming measures.
To use patient characteristics to estimate individualized treatment effects (ITE) of hypothermia vs. normothermia after pediatric cardiac arrest. Secondary, exploratory analysis of two pediatric randomized controlled trials (RCTs), Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH; NCT00878644) and Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital In-Hospital (THAPCA-IH; NCT00880087), using a causal forest machine learning model to estimate ITEs within each trial. THAPCA-OH was conducted at 38 children's hospitals across the United States and Canada. THAPCA-IH was conducted at 37 children's hospitals across the United States, Canada, and the United Kingdom. Pediatric patients aged 48 hours to 18 years who remained comatose within 6 hours after return of circulation following cardiac arrest and were randomized in THAPCA-OH and THAPCA-IH to normothermia or therapeutic hypothermia for 48 hours. Patients with a baseline Vineland Adaptive Behavior Scales, Second Edition (VABS-II) score less than 70 were excluded. None. The final cohorts included 260 patients in THAPCA-OH and 257 in THAPCA-IH. The primary outcome was survival at 1 year with VABS-II greater than or equal to 70 (favorable outcome). In THAPCA-OH, estimated ITEs (calculated as the individualized absolute risk difference [iARD] between hypothermia and normothermia, positive favoring hypothermia) ranged from -0.01 to 0.16. Patients were grouped into tertiles of estimated ITE within each trial. In THAPCA-OH, the tertile with the greatest estimated benefit from hypothermia had an observed absolute risk difference (ARD; hypothermia minus normothermia) of 0.18 (95% CI, 0.02-0.34). In THAPCA-IH, estimated ITEs ranged from -0.17 to 0.13. The tertile estimated to benefit most from hypothermia had an ARD of 0.27 (95% CI, 0.07-0.48), whereas the tertile estimated to benefit from normothermia had an ARD of -0.20 (95% CI, -0.40 to -0.01). These analyses suggest heterogeneity of treatment effect may exist in postcardiac arrest temperature management warranting further study.
Intraoperative hypothermia is common during major surgery, but its economic implications in liver transplantation remain unclear. This study evaluated the association between intraoperative hypothermia and total hospitalization cost in adult liver transplant recipients. This single-center retrospective cohort study included adult liver transplant recipients who underwent transplantation between January 2020 and December 2025. Intraoperative hypothermia was defined as any recorded intraoperative core temperature < 36.0 °C. Multivariable linear regression with log-transformed total hospitalization cost was used to evaluate the association after adjustment for prespecified covariates. Sensitivity analyses used additional adjustment models and alternative temperature exposure metrics. Cost components were analyzed descriptively. Among 343 recipients, 239 (69.68%) experienced intraoperative hypothermia. Median total hospitalization cost was higher in the hypothermia group than in the normothermia group (161,173.00 [127,519.50-218,826.50] vs. 120,691.00 [104,492.25-150,064.00] Chinese yuan (CNY); P < 0.001). After multivariable adjustment, intraoperative hypothermia remained associated with higher log-transformed total hospitalization cost (β, 0.153; 95% CI, 0.065 to 0.241; P < 0.001), corresponding to an approximately 16.6% higher cost. The association remained robust in additional adjustment models, although alternative temperature exposure metrics did not show a consistent dose-response pattern. Cost-component analysis suggested that the cost difference was mainly attributable to medication, laboratory, treatment, material, and blood transfusion costs. Intraoperative hypothermia was associated with higher total hospitalization cost following liver transplantation after adjustment for prespecified covariates. These findings suggest that intraoperative hypothermia may be a marker of increased perioperative resource use. Prospective studies are needed to clarify whether targeted temperature management can improve clinical outcomes and resource utilization in liver transplantation.
In this study, we evaluated the effect of a previous exposure of in vitro produced blastocysts to hypothermia (33°C) on their further cryotolerance. In Experiment 1, embryos were exposed to hypothermia for either 6 or 12 h on day 5 or 6 of development, and the blastocyst rates and kinetics were evaluated. In Experiment 2, the transcriptome of embryos exposed to hypothermia on either day 5 or 6 for 12 h was assessed. In Experiment 3, embryos were exposed to hypothermia for 12 h on day 6, vitrified-warmed, and their re-expansion, apoptotic index, and total cell number were assessed. Results showed that hypothermia had no effect on blastocyst rate but reduced the percentage of hatched blastocysts when applied for 12 h. Moreover, hypothermia was associated with changes in the transcriptional profile, particularly in embryos exposed on day 6, including increased expression of the cold-shock-related transcripts RBM3 and CIRBP. Finally, hypothermia on day 6 did not improve embryo re-expansion after cryopreservation but did reduce apoptosis in the surviving embryos. Our results provide insight into transcriptomic responses associated with mild hypothermia in bovine embryos and support the hypothesis that hormetic-like responses may contribute to improved embryo quality after cryopreservation.
Hypothermia is defined as a core body temperature of less than 35°C or 95°F. It is a rare condition with clinical manifestations ranging from asymptomatic bradycardia to death. While sepsis and endocrine abnormalities are common causes, drug-induced hypothermia is being seen lately. Antipsychotics such as risperidone and olanzapine are reported to cause hypothermia, but very few case reports exist on quetiapine-induced hypothermia. We present the case of an 80-year-old gentleman who was on quetiapine for his behavioral disturbances secondary to dementia. While he had been on the medication for years, with no new dosage adjustments, he was noted to have significant hypothermia, causing a prolonged hospital stay. After a thorough workup ruling out other causes of hypothermia, it was attributed to be a side effect of quetiapine. Hypothermia resolved within a few hours of holding the medication. This case underscores the importance of considering quetiapine-induced hypothermia in the differential diagnosis, as timely intervention may prevent prolonged hospitalization and functional decline.
While the therapeutic potential of hypothermia for treating tissue damage has been investigated for over 90 years, its effectiveness is still debated. This review introduces the history of hypothermia in medicine first, followed by a description of cellular mechanisms behind its neuroprotective effects observed in animal studies and some clinical studies. The next section focuses on current cooling approaches/devices, as well as cooling parameters recommended by researchers and clinicians to maximize the benefits of hypothermia. Animal and clinical studies of implementing hypothermia for spinal cord and brain tissue injury are presented next. The outcomes in treating conditions like traumatic brain injury (TBI), spinal cord injury (SCI), stroke, and cardiopulmonary issues will be discussed in detail. The review also examines the risks and benefits of hypothermia, supported or disputed by clinical studies. Contributions from bioengineers in the research field are presented in the last section, with details of cooling device design and theoretical simulations. Ultimately, the review highlights that successful hypothermia treatment hinges on achieving targeted tissue cooling quickly after injury, with mild hypothermia often being proven as effective as deeper cooling, provided a slow rewarming rate is implemented.
This study aimed to evaluate the effects of therapeutic hypothermia (TH) on oxygen demand, respiratory function, and overall clinical outcomes in post-cardiac arrest patients, specifically focusing on improvements in oxygenation, ventilatory parameters, and metabolic status. A retrospective cohort study was conducted from January 1, 2018, to June 30, 2022, including patients who received therapeutic hypothermia after cardiac arrest. Initially, 146 patients with bilateral lower-lung infiltrates suggestive of pneumonia on chest radiographs were screened. After applying exclusion criteria-such as in-hospital death during hypothermia (n = 58), non-pneumonia cases (n = 3), use of ECMO (n = 2), missing data (n = 3), and uncommon ventilator modes (n = 2)-79 patients remained for final analysis. Key ventilator parameters, including FiO2 and minute ventilation (MV), were assessed over time. Of the 146 patients screened, 79 met the inclusion criteria. The PaO2/FiO2 (P/F) ratio remained stable throughout the therapeutic hypothermia period, indicating no significant deterioration in pulmonary oxygenation. Conversely, lactate levels progressively decreased, reflecting improved systemic oxygenation. Both minute ventilation (MV) and oxygen demand declined over time, suggesting a more favorable oxygen supply-demand balance under the reduced metabolic conditions induced by hypothermia. Therapeutic hypothermia did not significantly alter pulmonary oxygenation, as evidenced by stable P/F ratios. However, it effectively reduced metabolic demand, cardiac output, and overall oxygen consumption, potentially improving tissue-level oxygenation and enhancing clinical outcomes, particularly in terms of survival and recovery. Further prospective studies are needed to clarify its impact on pulmonary circulation, long-term prognosis, and its role in optimizing post-cardiac arrest care strategies. CMUH114-REC2-096(AR-1); date of registration: 2026-06-02.
Elevated pancreatic enzymes and pancreatitis-like imaging findings have been reported in patients with accidental hypothermia; however, their clinical significance remains unclear. This study aimed to explore a serum amylase threshold that may support consideration of computed tomography (CT) for evaluating pancreatitis-like findings in accidental hypothermia and describe the clinical course of affected patients. We conducted a retrospective single-center observational study of adult patients with accidental hypothermia admitted to a tertiary emergency and critical care center in Japan between November 2011 and April 2023. Accidental hypothermia was defined as a core body temperature <35°C. Receiver operating characteristic (ROC) analysis was performed to evaluate the ability of serum amylase levels to identify pancreatitis-like CT findings. Patients with hyperamylasemia and pancreatitis-like CT findings were descriptively analyzed. Among 169 patients included in the study, 36 (21.3%) had hyperamylasemia. Pancreatitis-like CT findings were observed in 14 patients, of whom 13 had hyperamylasemia. ROC analysis among patients who underwent CT evaluation identified 428 IU/L as a serum amylase threshold associated with pancreatitis-like CT findings (area under the curve, 0.91; sensitivity, 93%; specificity, 86%). The positive and negative predictive values were 44.8% and 99.0%, respectively. Most CT abnormalities consisted of localized peripancreatic fat stranding, fluid collection, or pancreatic enlargement. No patients developed pancreatic necrosis or required invasive pancreatic intervention. Most patients were managed conservatively with fluids and nutritional support, and short-term outcomes were generally favorable. In patients with accidental hypothermia, serum amylase levels ≥428 IU/L may support consideration of CT evaluation of pancreatitis-like findings. Although hyperamylasemia alone showed limited positive predictive value, most patients with pancreatitis-like CT findings had favorable short-term outcomes with conservative management.
Objective: To identify risk factors for intraoperative hypothermia in patients undergoing thyroid cancer surgery and to develop a risk prediction model. Methods: Clinical data of patients who underwent thyroid cancer surgery at the Affiliated Hospital of Hangzhou Normal University from January 2021 to June 2025 were retrospectively analyzed as the modeling cohort, and were subdivided into hypothermia and normothermia groups based on intraoperative body temperature. Logistic regression analysis and R software were used to construct the prediction model and nomogram. Data from patients treated at Hangzhou Traditional Chinese Medicine Hospital from January 2022 to June 2025 were collected for external validation. Results: The modeling cohort comprised 86 males and 252 females (age range, 27-77 years). The overall incidence of intraoperative hypothermia was 37.0%(125/338). Multivariate analysis identified age, body mass index (BMI), hypothyroidism, preoperative body temperature, anesthesia duration, preoperative active warming, and cervical lymph node dissection as independent risk factors (all P<0.05). The Hosmer-Lemeshow test yielded χ²=5.577 (P>0.05). The area under the receiver operating characteristic (ROC) curve was 0.911 for the modeling cohort (sensitivity 0.808, specificity 0.859), and 0.841 for the external validation cohort (n=101; sensitivity 0.871, specificity 0.700). The predicted probabilities demonstrated good concordance with observed incidences. Conclusion: The developed prediction model exhibits satisfactory goodness-of-fit, discriminative ability, and calibration, offering significant clinical value for identifying high-risk patients for intraoperative hypothermia during thyroid cancer surgery. 目的： 分析甲状腺癌行手术治疗患者术中低体温的危险因素并构建风险预测模型。 方法： 回顾性分析2021年1月至2025年6月杭州师范大学附属医院甲状腺癌手术患者的临床资料作为建模组，根据术中体温情况分为低体温组和正常组。采用Logistic回归分析与R软件构建预测模型与列线图。收集2022年1月至2025年6月杭州市中医院甲状腺癌手术患者的临床资料，进行模型的外部验证。 结果： 建模组患者男性86例，女性252例，年龄27~77岁。甲状腺癌手术患者术中低体温的发生率为37.0%（125/338），经单因素与多因素分析结果得出，年龄、体质量指数（BMI）、甲状腺功能减退、术前体温、麻醉时长、术前主动保温及行颈部淋巴清扫是甲状腺癌手术患者发生低体温的影响因素（P值均<0.05）。预测模型的拟合结果χ2=5.577（P>0.05），建模组受试者工作特征（ROC）曲线下面积为0.911，灵敏度为0.808，特异度为0.859；外部验证组模型（n=101）ROC曲线下面积为0.841，灵敏度为0.871，特异度为0.700。模型预测概率与实际发生概率趋于一致。 结论： 本研究构建的预测模型的拟合效果、区分度及一致性较好，具有良好的预测价值，可识别甲状腺癌术中发生低体温的高危人群。.
Neonatal hypothermia, especially occurring in the early postnatal period, is a critical condition associated with increased morbidity and mortality. Effective thermal management is essential, yet regional data on early postnatal hypothermia (EPH) incidence among critically ill neonates requiring inter-hospital transport are limited. This retrospective, multicentre, observational cohort study involved critically ill newborns transported from six delivery hospitals, including two women's hospitals and four general hospitals, to a tertiary care neonatal centre between January 2022 and April 2023. According to the lowest body temperature measured within the first postnatal 2 hours, patients were divided into four groups: normal group (36.5°C-37.5°C), mild EPH group (36.0°C-36.4°C), moderate EPH group (32.0°C-35.9°C) and severe EPH group (<32°C). The perinatal risk factors and early outcomes within 7 days after birth (including mortality, hypoglycaemia, pulmonary haemorrhage and shock) were analysed. A total of 457 newborns were enrolled and 82.1% experienced EPH, including 42.5% mild, 39.6% moderate and 0% severe. Notably, the incidence of EPH was significantly higher in very preterm infants (VPIs), reaching 93.2%. Based on multivariable analysis, general hospital births (OR 5.00; 95% CI 3.20 to 7.88) and delivery room intubation (OR 1.74; 95% CI 1.19 to 2.55) increased the risk of hypothermia severity (p<0.05). Women's hospitals demonstrate superior adherence to neonatal thermoregulation protocols compared with general hospitals. Mortality and other early complications during postnatal 7 days showed no significant differences among groups. EPH remains common among critically ill transported neonates, particularly in VPIs. Variations in thermal management practices, especially in general hospitals, may contribute to its occurrence. These findings underscore the need to establish and implement standardised, targeted temperature management protocols across delivery settings to improve neonatal care quality.
Accidental hypothermia is an unintentional drop in core body temperature below 35 °C. It can occur at any time of year and in any climate, and can affect all age groups. The epidemiology of accidental hypothermia reflects the interaction between biological susceptibility, social conditions and exposure to environmental factors. As core temperature falls and thermoregulation mechanisms become insufficient, the metabolism slows, consciousness deteriorates and the hypothermic myocardium becomes increasingly prone to arrhythmias and cardiac arrest. The prognosis is variable, and treatment outcomes are dependent on multiple factors, with cardiac arrest being the decisive determinant, carrying an in-hospital mortality rate of up to 50%. Diagnosis relies on accurate core temperature measurement whenever possible, together with clinical staging when measurement is unavailable. The management of accidental hypothermia should follow the hypothermic chain of survival: prevent further cooling, handle the patient gently, provide airway, breathing and circulatory support, choose the correct destination hospital, and rewarm the patient using passive, active external, active internal or extracorporeal techniques according to severity. Extracorporeal life support is crucial for patients with hypothermic cardiac arrest. Most survivors of hypothermic cardiac arrest have excellent neurological outcomes. Effective prevention and education, together with well-organized regional pathways of care and personalized strategies to prevent cardiac arrest, are needed to improve outcomes.
Cold seawater immersion is a critical lethal risk in maritime accidents and military operations, frequently inducing fatal myocardial dysfunction. However, the mechanisms underlying this seawater immersion hypothermia-induced cardiac injury remain poorly defined. This study aimed to elucidate the pathological progression and underlying mechanisms of myocardial injury induced by cold seawater immersion. A male SD rat model was immersed in 15 °C seawater for 2 h. Echocardiography, transmission electron microscopy, transcriptomics, and Western blot were performed to assess cardiac function, mitochondrial ultrastructure, and molecular mechanisms. Cold stress triggered progressive bradycardia (~480 to ~100 bpm) with initial Frank-Starling compensation, followed by decompensation with reduced cardiac output and impaired diastolic function. Mitochondrial ultrastructural damage preceded histological lesions and was accompanied by elevated cardiac injury markers (cTnT, CK-MB, BNP). Cardiac tissue exhibited upregulated TNF-α, IL-1β, and IL-6, while transcriptomic analysis revealed enrichment of inflammatory pathways (TNF, NF-κB) and coordinated upregulation of pattern recognition receptors including scavenger receptor, Toll-like receptor, and NOD-like receptor families. The Western blot confirmed NF-κB activation, NLRP3 inflammasome assembly, and the N-terminal fragment of gasdermin D (GSDMD-NT) accumulation, indicating pyroptotic cell death. These findings demonstrate that cold seawater stress disrupts mitochondrial homeostasis and activates the NF-κB/NLRP3/pyroptosis cascade, contributing to inflammatory cardiomyocyte death and cardiac decompensation. This mechanistic insight may inform therapeutic strategies for seawater immersion hypothermia.
Stroke continues to be a leading cause of death and long-term neurological disability globally, with current treatment options limited by narrow time windows and insufficient neuroprotective strategies. Over recent decades, research into effective neuroprotective interventions has advanced significantly, shifting from single-target approaches like excitotoxicity modulation to recognizing the diverse protective potential of therapeutic hypothermia (TH). This review summarizes recent advances in TH research, emphasizing its neuroprotective effects through reducing cerebral metabolism, maintaining blood-brain barrier integrity, and decreasing neuronal death. Traditional surface-cooling TH (TH1.0) has produced disappointing clinical results, mainly because shivering thermogenesis increases cerebral oxygen demand and cardiac stress, negating therapeutic benefits. Additional sedation or neuromuscular blockade is also necessary to enhance patient tolerance. New insights into neural thermoregulatory mechanisms that underlie torpor-like states in homeotherms have led to the development of neuromodulation-based TH (TH2.0). Deep-brain stimulation of hypothalamic thermoregulatory neurons allows for swift, stable hypothermia in mouse models, inducing shivering-free torpor and overcoming the main limitations of TH1.0. Because mice are facultative heterotherms, validation in non-human primates is essential for translation. Nevertheless, TH2.0 stands out as a promising, fast, targeted, and reversible approach to induce TH with significant potential to improve stroke treatment.
Accurate temperature monitoring is essential for detecting perioperative hypothermia during spinal anesthesia, where rapid redistribution of body heat commonly occurs. Although zero-heat-flux (ZHF) thermometry has emerged as a noninvasive method for estimating core temperature, the reliability of chest skin temperature monitoring in this context remains unclear. In this prospective observational study, temperature measurements were obtained at 5-minute intervals using a forehead ZHF sensor, an infrared tympanic thermometer, and a non-axillary chest skin probe in patients undergoing orthopedic surgery under spinal anesthesia. Agreement between methods was evaluated using Bland-Altman analysis for repeated measurements, the proportion of paired measurements within ±0.5°C, and Lin's concordance correlation coefficient. Ninety-nine patients completed the study. ZHF and tympanic temperatures showed good agreement, with a mean difference of 0.04 ± 0.35°C, limits of agreement from -0.63°C to 0.72°C, and 89% of paired measurements within ±0.5°C. In contrast, chest skin temperature demonstrated poor agreement with both ZHF and tympanic measurements. The mean difference between ZHF and chest skin temperature was 0.99 ± 1.11°C, with wide limits of agreement (-1.18°C to 3.17°C), and no measurements met the predefined ±0.5°C threshold. Similar discrepancies were observed when chest skin temperature was compared directly with tympanic temperature. These findings indicate that non-axillary chest skin temperature does not reliably reflect core temperature during redistribution hypothermia under spinal anesthesia and should not be used as a surrogate. ZHF thermometry showed substantially better agreement with tympanic temperature and may provide a more reliable noninvasive alternative for perioperative temperature monitoring.
Intraoperative hypothermia (IOH, core temperature < 36.0°C) is common during gynecological laparoscopic surgery and is associated with adverse outcomes. However, predicting its occurrence using only preoperative indicators remains challenging. This retrospective cohort study included patients who underwent gynecological laparoscopic surgery at a single center. Candidate predictors were extracted from electronic health records (EHRs). Least absolute shrinkage and selection operator (LASSO) regression was applied for feature selection. Logistic regression (LR) and extreme gradient boosting (XGBoost) were developed and compared. The SHapley Additive exPlanations (SHAP) method was used to interpret the model and identify key predictors. A total of 301 patients were included in this study, of which 118 cases (39.2%) developed IOH during gynecological laparoscopic surgery. Using LASSO regression, five predictors were retained: age, American Society of Anesthesiologists (ASA) physical status, basal temperature, estimated duration of surgery, and hypertension. The XGBoost model exhibited the best performance, achieving an area under the curve (AUC) of 0.980 in the training set and an AUC of 0.905 in the test set. SHAP analysis indicated that estimated duration of surgery was the most important predictive factor. The XGBoost model best predicted IOH in patients undergoing gynecological laparoscopic surgery. SHAP analysis identified estimated duration of surgery as the most important predictor.
This study aimed to investigate the characteristics of intraoperative hypothermia (IH) and evaluate the efficacy of rewarming interventions in elderly patients undergoing general anesthesia, with particular emphasis on the influence of different traditional Chinese medicine (TCM) constitutions. A two-phase study was conducted. The first phase involved a retrospective analysis of 500 elderly patients undergoing general anesthesia to identify risk factors associated with IH. The second phase consisted of a randomized controlled trial comparing rewarming strategies in 80 elderly patients with IH. Between March and August 2022, data from 500 elderly patients at the First Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively reviewed and categorized into IH and non-IH groups based on the occurrence of hypothermia during surgery. Baseline characteristics were collected and analyzed using univariate and multivariate logistic regression models. A predictive model for IH was developed and validated through receiver operating characteristic (ROC) curve analysis. From September to October 2022, 80 elderly patients with confirmed IH were prospectively enrolled and randomly assigned to either a control group or an observation group to compare the effectiveness of rewarming interventions; the observation group received active warming via an inflatable warming blanket. IH was prevalent among elderly surgical patients under general anesthesia, affecting 36.0% of the cohort. Patients with specific TCM constitutions - particularly Qi Yang, or blood deficiency - along with those exhibiting a low body mass index (<24 kg/m²) and preoperative core body temperature below 37.0°C, were at significantly higher risk. Factors such as major surgical procedures, low operating room temperatures (<24°C), prolonged anesthesia duration (≥2 h), and high intraoperative fluid administration (≥2000 ml) were independently associated with increased IH risk (odds ratios ranging from 3.258 to 12.305). The timely application of inflatable warming blankets significantly reduced both rewarming time and postoperative shivering incidence (5.0% vs. 22.5% in controls), demonstrating its effectiveness in managing IH. IH is highly prevalent among elderly patients undergoing general anesthesia, particularly among individuals with certain TCM constitutions, low BMI, and reduced preoperative core temperature. Several perioperative factors significantly increase the likelihood of IH. Timely intervention with inflatable warming blankets proves to be an effective and clinically relevant strategy for mitigating IH and improving thermal management in this vulnerable population.
To determine the incidence, risk factors, and outcomes associated with subcutaneous fat necrosis (SCFN) in a regional cohort of newborns treated with therapeutic hypothermia (TH) for neonatal encephalopathy (NE). Data from a regional Neonatal Encephalopathy Registry was retrospectively analysed. All newborns treated with TH between 2018 and 2022 were included. The primary outcome was the incidence of SCFN. Secondary outcomes included associated risk factors and complications. SCFN occurred in 4% of newborns (20/499) undergoing TH. Factors associated with SCFN included elevated maternal BMI, maternal preeclampsia/hypertension, pyrexia during labor, earlier initiation of active cooling, thrombocytopenia, and blood product administration. Half of the SCFN cases developed hypercalcemia. SCFN was associated with longer hospital stay (median 11.5 vs. 8 days, p = 0.007). In this large, contemporary cohort, SCFN occurred in 4% of newborns with NE treated with TH. Enhanced monitoring and risk stratification may facilitate early diagnosis and improve management outcomes.
Postoperative involuntary hypothermia (IH) is an important complication that occurs when the body temperature drops below normal and can negatively affect the patient's recovery process. IH has a significant impact on patients' experiences, both physiologically and psychologically. To explore patient perceptions and experiences of IH following total hip and knee surgery and its impact on postoperative care. This study was conducted using a qualitative content analysis approach on patients who underwent total hip and knee surgery and developed IH in the orthopedic unit of a tertiary hospital in Central Anatolia, Türkiye, between April and August 2025. After obtaining ethical approval and informed consent, a purposive sampling method was used, and data saturation was achieved with a sample size of 15 patients. Data were collected through face-to-face and in-depth interviews 3-4 days after surgery, and the data were analyzed using thematic analysis to identify key themes. The analysis of the data identified seven main themes ((1) Physical Experiences, (2) Psychological responses, (3) Care Experiences, (4) Information and Awareness, (5) Environment factors, (6) Interventions and Coping Methods, and (7) Expectations and Recommendations) and 27 subthemes. The research findings revealed that IH following total hip and knee surgery is multidimensional in terms of physical (chills, shivering, pain, nausea, and insomnia), psychological (anxiety, fear, panic, stress, and relaxation), and care-related experiences (attention, communication, and lack of information). Environmental conditions and the transfer process affected patient comfort, while blankets, warm air devices, pharmacological support, and social support were among the coping methods. Patients suggested room temperature regulation, blanket use, and staff attention. This study revealed the effects of IH on patient experiences following total hip and knee surgery and provided important data to enhance patient safety and comfort in clinical practice. The findings indicate that nurses and healthcare teams should prioritize environmental temperature regulation, patient education, and appropriate intervention methods in their care processes.
Depending on seasonal availability and quality of range forage, extensively managed ewes can experience nutritional challenge during any point of gestation. Neonatal lamb performance after severe experimental nutrient restriction during gestation has been well studied; however, there is a gap in understanding of how nutrient restriction experienced over the course of a production cycle impacts lamb success. Therefore, the objective of this study was to investigate early life performance of lambs from ewes fed a diet simulating winter forage in the Intermountain West. Timed-mated Rambouillet × Merino ewes were allocated to one of two dietary treatments, consisting of a diet formulated to meet nutritional requirements for the entirety of gestation based on National Research Council (NRC) recommendations (balanced diet) or a poor-quality diet fed from 30-125 d of gestation (dGA) and then realimented with the nutritionally balanced diet for the remainder of gestation. From 30 dGA to lambing, BW were obtained every 7 d and body condition scores (BCS) every 14 d. At the end of gestation ewes were group housed in a fully enclosed barn for lambing, to produce lambs born to balanced diet ewes (CONT; n = 33) and lambs born to poor-quality diet ewes (NC; n = 33). For the first week of life, rectal temperature and blood samples were collected daily from all lambs. Bodyweight and morphometrics (crown-rump length, CRL; abdominal circumference, AC; crown circumference, CC; and cannon bone length, CBL) were collected at birth, and then weekly thereafter. Treatment by time interactions were observed where poor-quality diet ewes weighed less (P < 0.05) from weeks 6-17 and had lower (P < 0.05) BCS from weeks 6-16 of the treatment period There were no differences in birthweight or birth morphometrics between treatments. There was an increased (P < 0.05) incidence of hypothermic events (rectal temperatures < 38 °C) in NC lambs in the first week of life, despite having normal blood glucose concentrations. Beginning at four weeks of life through weaning (70d), NC lambs weighed less (P < 0.05) compared to CONT. Nutrient challenged lambs also exhibited asymmetric growth, indicated by increased (P < 0.05) CRL/BW, CC/BL, CRL/ BW and AC/BW ratios compared to CONT. These data suggest that sustained moderate nutritional challenge during gestation, even when supplemented in late gestation, negatively impacts offspring pre-weaning performance. Sheep in extensive grazing systems often face periods of poor-quality forage, particularly during winter, which can impede ewe nutrition during pregnancy. Nutrient restriction during mid-to-late gestation is known to negatively impact ewe health and lamb development. This study investigated early life performance in lambs from ewes fed a poor-quality diet that simulates winter forage with a prolonged moderate nutrient restriction followed by late gestation supplementation, versus lambs from ewes fed a diet meeting all nutritional requirements for the entirety of gestation. Ewes receiving the poor-quality diet lost weight and body condition during the feeding period well before traditional supplementation windows. Lambs from poor-quality diet ewes were born at similar size to controls but were more likely to experience hypothermia in the first week of life, despite having normal blood glucose concentrations. From five weeks of age until weaning, lambs from poor-quality fed ewes grew slower and asymmetrically. These results indicate that even moderate nutritional challenges during pregnancy can impair lamb thermoregulation and growth, highlighting the importance of maintaining ewe nutrition at all gestational time points to support offspring health and productivity.