Driving the point home, Allison Doviak, associate marketing manager for communications, medical division, Cincinnati Sub-Zero Products Inc., Cincinnati, OH, stated: "Temperature management is not just for fever reduction anymore. Temperature has become a drug that can be dosed and managed. Temperature management has become a science not an art. We have clinical data to support how temperature impacts patient outcome. There has been a shift to aggressive normothermia." 

Robert Kline, president and CEO, Medivance, Louisville, CO, added: "Until recently temperature-management technology has basically remained unchanged for the last 40 years. With the publication of numerous studies showing the impact of active temperature management, there is now a recognized need for more advanced technologies to control and manage temperature as a vital parameter. I expect that more studies will be published expanding the use of therapeutic temperature management to new critical applications."

Thermoflect heat reflective technology from Encompass Group, LLC, banks the patient’s own heat to help prevent hypothermia.

Literature published by research scientists, and supported by leading advisory and regulatory organizations, is shaping up to show that managing temperature definitely can have a positive impact on patient outcomes. Clinicians are heeding their advice. Robyn Whalen, marketing director of North American medical devices, Kimberly-Clark Health Care, Roswell, GA, attributed this movement to organizations who recognized and promoted the concept of temperature management and whose efforts have been rewarded in improved patient outcomes. "We support and applaud the efforts of the Surgical Care Improvement Project (SCIP), Institute for Healthcare Improvement, American Society of PeriAnesthesia Nurses, and others for recommending the maintenance of normothermia as one of the best ways to reduce surgical-site infections (SSIs)."

Offering further explanation on the connection between normothermia and better outcomes for surgical patients, Troy Bergstrom, marketing communications manager, Arizant Healthcare Inc., Eden Prairie, MN, told Healthcare Purchasing News: "Unintended hypothermia can triple the rate of wound infection (SSIs), extend length of stay, and increase mortality rates. It’s no wonder numerous evidence-based initiatives are citing normothermia maintenance as a tool to reduce complications, specifically SSIs."

Enthermics Medical Systems’ EC1540bl, a combination irrigation and injection/IV fluid and blanket warmer

Joe Przepiorka, vice president, marketing, Encompass Group LLC, McDonough, GA, agreed, adding: "Maintaining patient normothermia during the surgical process is key in reducing adverse patient outcomes. Mahoney and Odom’s meta-analysis of outcomes and costs (AANA J 1999;67:155-163) showed that, when a patient’s temperature drops by only 1.5°C, the risk of serious and costly complications like infection and blood transfusions are more likely."

Other serious issues that may develop related to a drop in a patient’s core temperature, according to Tom Parafinik, director of sales, Enthermics Medical Systems, Minneapolis, MN, include "cardiac arrhythmias, increased blood clotting times, and increased risk of infection." Parafinik noted that something as simple as "using warmed fluids and blankets help prevent these negative outcomes."

In a world as complicated as the medical field, it almost seems incredible that such a simple thing as not allowing the body’s temperature to drop by only a degree or two can prevent such serious adverse events, but normothermia has been linked with better healing time and time again. "It has been proven that  normothermic patients recover better than hyper- or hypothermic patients," said Doviak, Cincinnati Sub-Zero Products Inc.

Normothermia often is the goal; however, depending on the situation, hypothermia serves medical purposes well, too. "The optimum temperature therapy really depends on the patient’s condition," said Kline, Medivance. "During surgery, preventing hypothermia has been shown to reduce potential infections and recovery time. Other studies have shown that inducing hypothermia after cardiac arrest can reduce mortality and improve neurological outcomes. There are many more examples, including aggressively maintaining normal temperatures in febrile patients who have suffered brain trauma."

Added Doviak, "We know that localized cooling decreases swelling and pain post-op. We know that heat can cause local vasodilation. Whole body cooling has been proven to improve outcomes of hypoxic neonates. Whole body cooling has been proven to decrease the effects of reperfusion injury after cardiac arrest."

Kimberly-Clark Health Care Patient Warming System

What features should you look for in warming or cooling equipment? Well, like anything else, it depends on what you expect of it and how much you have to spend. Certainly the nation’s current economic situation doesn’t make it any easier. Troy Bergstrom, Arizant Healthcare, sympathized with those working and purchasing in the healthcare field today. "Today’s hospital leaders are facing a unique set of challenges. They are being asked to do more with less, while ensuring that all patients receive the right care. They need products that offer versatility, performance. They need to ensure there is true value. Purchases made in today’s environment should, at a minimum, meet the following three key requirements: improve clinical outcomes, be cost-effective, and enhance the patient experience."

Kline of Medivance and Przepiorka of Encompass Group both strongly recommended looking for temperature-management products that are safe, easy to use, and effective. "There are very simple devices that are safe but require significant nursing labor and do a poor job of controlling temperature," said Kline. "Newer invasive approaches control temperature well but add complexity and clinical risk. It really comes down to what the hospital and caregivers are most comfortable with and think is best for their patients." Przepiorka noted: "Compliance is also extremely important. A product that is difficult or inconvenient to use can reduce overall effectiveness. Continuous use is another strong feature to look for. If a product can only be used for a short time and then has to be disconnected or paused while a patient is moved, the patient is at risk for heat loss during that time."

Bair Paws, Arizant Healthcare Inc.

Money is always a consideration, but the good news regarding temperature-management equipment is that, while helping to improve patient outcomes, it also can be a cost-saver. Reducing infections and other complications is its own reward in more ways than one. Kline, Medivance, explained: "Historically temperature-management devices were chosen by most hospitals based on supply costs due to their similar form and performance. Hospitals now realize that there is great potential to improve patient outcomes through therapeutic temperature management and at the same time reduce costs through fewer complications such as infection and reduced stays. This is particularly important now, since there is a new focus on hospital-acquired complications and loss of reimbursement. In addition, in some cases, many patients actively treated with temperature-management therapy that may have otherwise had poor outcomes go on to secondary procedures that actually generate revenue for the hospital."

Referring to the report he cited earlier, Przepiorka, Encompass Group, named the specific numbers involved in calculating the cost of hypothermia, clearly illustrating the savings. "Mahoney and Odom’s study asserts that the cumulative adverse outcomes of hypothermia add between $2,500 and $7,000 per surgical patient to hospitalization costs. The cost of preventing hypothermia is much less than the cost of treating the outcomes."

Medivance’s safe, non-invasive Arctic Sun offers technology for therapeutic cooling

Whalen, Kimberly-Clark Health Care, continued in the same vein: "Studies have shown that patients who successfully reach normothermia during surgery require fewer transfusions, experience less post-operative bleeding, spend less time on mechanical ventilators, require less time in intensive care, and go home sooner. The hypothermic state can also lead to excess bleeding and longer recovery times. Patients in this state are more susceptible to SSI. Not only do these factors compromise patient safety, they are costly. Most of the cost associated with hypothermia occurs after the surgery. For example, the most expensive place in the hospital after the operating room is the intensive care unit (ICU); so, if you can move a patient to a general floor sooner, there are a lot of dollars there to be saved."

Whalen mentioned that Kimberly-Clark offers a cost-benefit analysis for facilities that compares current warming practices and results. This analysis is focused on the following five key elements:

• Use of blood products – Cold patients bleed more and their blood takes longer to clot, raising risk of transfusion. Warmed patients experience a 20% to 40% reduction in use of blood products, according to Whalen.

• Recovery time – A warm patient may recover from anesthesia faster, spend less time in the ICU, and be discharged sooner, lowering the cost to hospital.

• Incidence of wound infection – Wound infections carry a big price tag. Hypothermia weakens the immune system’s response to contaminants. Blood moves slower, white blood cells take longer to respond, and white blood cells are less effective because they carry less oxygen.

• Rate of re-operation – Complications due to bleeding postoperatively may lead to follow-up surgery.

• Prolonged intubation times – There is a 30% to 40% reduction in time spent on a ventilator for patients who have been warmed in the ICU, said Whalen.

Temperature management is definitely a concept coming into its own. In the overall scheme of medical care, however, it is a relatively new concept. Industry experts think the science of temperature management will continue to be refined as it evolves. Keeping patients comfortable is far more than just a nicety; it’s becoming a standard of good patient care, emphasized Przepiorka, Encompass Group. "As evidenced by quality measures identified by the Joint Commission, SCIP, and the Centers for Medicare and Medicaid Services, temperature management is not an optional care factor. Care providers responsible for patient normothermia will be focused on multifaceted solutions and interventions to eliminate hypothermia. Those products that prevent hypothermia, are easy to use, and are cost-effective will become part of a new standard of care."

Gaymar Medi-Therm III offers warming and cooling options.

Brian Stelley, senior marketing manager, Gaymar Industries Inc., Orchard Park, NY, observed that temperature management is moving front and center. "The desire to manage a patient’s temperature has a higher priority today than any time in the past," said Stelley. "Whether we are talking about maintaining normothermia in the surgical patient, treating fever in the ICU, or inducing mild hypothermia post cardiac arrest, the need is great. I expect to see Gaymar, as well as other manufacturers, continue to develop products that offer greater precision and control in regulating a patient’s temperature, while taking up less surface area on the patient, and continuing to offer ease of use to the clinician."

Whalen, Kimberly-Clark Health Care, believes that patient temperature may even become mandated. "With more attention given to the tie between hypothermia and SSIs, and because of mandatory reporting, we may see a move to mandated patient temperatures for certain cases. Facilities will standardize to the best preventable solutions they have and mandate them. Most hospitals adhering to best practices are already doing that. At the end of the day, it’s all about having the right technologies in place to deliver the best patient care possible while preventing costly negative outcomes."

"Patient-temperature management is finally receiving the attention it deserves," Parafinik, Enthermics Medical Systems, stated. "Clinicians are now well aware that a warm patient is a healthier patient." His statement represents a major accomplishment, a huge first step toward refining the treatment of temperature management.