Archive January 2017 XVIII, No. 1

Is Forced Air Warming Losing Steam?

Why some surgical facilities are seeking alternatives for maintaining normothermia.

Bill Donahue, Senior Editor


forced-air warmer HOT AIR? Lawsuits allege that forced-air warmers have caused surgical site infections.

Each surgical facility seems to have its own method of patient warming. Some use intravenous fluid warmers and warmed cotton blankets, while others opt for one or more of the host of warming devices — forced-air warming blankets and gowns, underbody heat mattresses and conductive-fabric warmers among them — to maintain normothermia.

There's a lot at stake. Numerous studies suggest that even a mild case of hypothermia can have adverse health consequences, including an increased risk of infections. But one mode of patient warming — the highly popular forced air — faces increasing scrutiny over allegations that it can actually cause surgical site infections. Detractors suggest that a forced-air warming unit can disrupt the flow of sterile air inside an OR and stir up contaminants from the floor, thereby increasing the potential for SSIs.

A flood of lawsuits filed against 3M, the maker of the industry's most-used warming system, the FDA-approved Bair Hugger, allege the forced-air system has caused some patients to develop deep-joint infections that have resulted in tragic outcomes, such as amputation and multiple follow-up surgeries, including the removal of implants. 3M has refuted the claims as "baseless" and offered numerous clinical studies to prove the technology's safety and efficacy. ECRI Institute, a highly-regarded laboratory for testing medical products, found "insufficient evidence to establish that the use of [forced-air warming] systems leads to an increase in SSIs compared to other warming methods."

Where there's smoke, there's fire
So has the debate affected the industry's faith in forced air, which has been used to warm hundreds of millions of patients in hospitals and surgery centers around the world? Based on interviews with surgical facility leaders across the country, not really, though some are currently investigating alternatives to forced air in light of the allegations.

Nalan Narine, MD, an anesthesiologist with Loma Linda University Medical Center-Murrieta (Calif.), takes a balanced approach to patient warming: forced-air warming blankets, as well as an underbody water blanket, warm IV fluids and airway humidification, plus a plastic head cover, "because the head represents the biggest part of heat loss," he says. He thinks forced air could one day be a "thing of the past," supplanted by other modalities. He also poses a bigger question.

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