Resistive Warming Mattress, Forced-Air Warming System, or a Combination of the Two in the Prevention of Intraoperative Inadvertent Hypothermia: A Randomized Trial



      To prevent intraoperative inadvertent hypothermia (IIH), resistive products and forced-air warming systems are often used simultaneously. There is insufficient evidence to show whether this application is clinically more effective than a single active warming device. The aim of this study is to compare the efficacy a single intraoperative active warming method with combined methods in IIH prevention.


      A randomized, prospective, experimental study.


      This study was conducted between June and October 2021 in the operating room of a training and research hospital. The study sample consisted of 123 patients who underwent scheduled orthopedic surgery under spinal anesthesia, were young (18-64), and had an ASA risk score of I to III. The patients were divided into three groups preoperatively according to the stratified randomization technique. To prevent IIH, a resistive warming mattress was used in group 1; a forced-air warming system was used in group 2; and a combination of the two methods were used in group 3. The body temperatures of the patients were measured and recorded every 15 minutes from admission to the operating room until the end of surgery.


      The mean intraoperative body temperature of the patients was 36.6±0.15˚C for group 1; 36.6±0.1˚C for Group 2 and 36.6 ± 0.15˚C for Group 3. There was no difference between the groups in terms of body temperature. The overall incidence of IIH was 8.1%; 9.8% in group 1, 9.8% in group 2 and 4.9% in group 3. There was no statistically significant difference between the groups in terms of IIH (p < .05).


      This study supports the efficacy of using resistive warming mattress and forced-air warming systems in preventing IIH. The use of both methods together made no difference in terms of IIH development.


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      1. National Institute for Health and Care Excellence (NICE). Clinical Practice Guideline CG65. Hypothermia: prevention and management in adults having surgery. [Internet]. London: NICE; 2008. Accessed February 20, 2021.

        • Riley C
        • Andrzejowski J.
        Inadvertent perioperative hypothermia.
        BJA Educ. 2018; 18: 227-233
        • Link T.
        Guidelines in practice: hypothermia prevention.
        AORN J. 2020; 111: 653-666
        • Bilgin H.
        Inadverdent perioperative hypothermia.
        Turk Anesteziyoloji ve Reanimasyon Dern Derg. 2017; 45: 124-126
        • Kang S
        • Park S.
        Effect of the ASPAN guideline on perioperative hypothermia among patients with upper extremity surgery under general anesthesia: a randomized controlled trial.
        J Perianesthesia Nurs. 2020; 35: 298-306
        • Torossian A
        • Bräuer A
        • Höcker J
        • Bein B
        • Wulf H
        • Horn EP.
        Clinical practice guideline: preventing inadvertent perioperative hypothermia.
        Dtsch Arztebl Int. 2015; 112: 166-172
      2. Aygin D, Yaman Ö Postoperative body temperature complications nursing care. In: Yıldız Fındık Ü, ed. Postoperative Complications and Nursing Care. Türkiye Klinikleri, Ankara. 2019; 59–65:1.

      3. Mohammad AA, Ahmed MJ. Postoperative hypothermia in surgical patients at Azadi teaching hospital. 2020;20(3):28-32.

        • Yüksel S
        • Uğraş GA.
        The role of nurses in preventing hypothermia in surgical patients.
        Mersin Univ Saglık Bilim Derg. 2016; 9: 113-121
        • Xiong Z
        • Zhu J
        • Li Q
        • Li Y.
        The effectiveness of warming approaches in preventing perioperative hypothermia: systematic review and meta-analysis.
        Int J Nurs Pract. 2022; : 1-9
        • Demirarslan E.
        Controlling postoperative hypothermia.
        Kastamonu Sağlık Akad. 2017; 2: 51-70
        • Nieh HC
        • Su SF.
        Meta-analysis: effectiveness of forced-air warming for prevention of perioperative hypothermia in surgical patients.
        J Adv Nurs. 2016; 72: 2294-2314
        • John M
        • Crook D
        • Dasari K
        • Eljelani F
        • El-Haboby A
        • Harper CM.
        Comparison of resistive heating and forced-air warming to prevent inadvertent perioperative hypothermia.
        Br J Anaesth. 2016; 116: 249-254
        • Chakladar A
        • Dixon MJ
        • Crook D
        • Harper CM.
        The effects of a resistive warming mattress during caesarean section: a randomised, controlled trial.
        Int J Obstet Anesth. 2014; 23: 309-316
        • Yoo JH
        • Ok SY
        • Kim SH
        • et al.
        Efficacy of active forced air warming during induction of anesthesia to prevent inadvertent perioperative hypothermia in intraoperative warming patients: comparison with passive warming, a randomized controlled trial.
        Medicine (Baltimore). 2021; 100: e25235
        • Perez-Protto S
        • Sessler DI
        • Reynolds LF
        • et al.
        Circulating-water garment or the combination of a circulating-water mattress and forced-air cover to maintain core temperature during major upper-abdominal surgery.
        Br J Anaesth. 2010; 105: 466-470
        • Yasar PO
        • Uzumcugil F
        • Pamuk AG
        • Kanbak M.
        Comparison of combined forced-air warming and circulating-water-mattress and forced-air warming alone in patients undergoing open abdominal surgery in lithotomy position: a randomized controlled trial.
        Indian J Surg. 2022; 84: 72-78
        • Hi N
        • Ar R
        • Campus SB
        • Hospital J
        • Buloh S.
        Routine intraoperative forced-air warmer usage in prevention of perioperative hypothermia : to use or not to use in daycare breast lumpectomy ? Discipline of anaesthesiology and critical care, faculty of medicine, Universiti Te.
        J Surg Acad. 2015; 5: 34-43
        • Noll Diemunsch S
        • Pottecher J
        • et al.
        Prevention of laparoscopic surgery induced hypothermia with warmed humidified insufflation: is the experimental combination of a warming blanket synergistic?.
        PLoS One. 2018; 13: 1-8
        • Zhang R
        • Chen X
        • Xiao Y.
        The effects of a forced-air warming system plus electric blanket for elderly patients undergoing transurethral resection of the prostate.
        Med (United States). 2018; 97
        • Liu X
        • Shi Y
        • Ren C
        • Li X
        • Zhang Z.
        Effect of an electric blanket plus a forced-air warming system for children with postoperative hypothermia: a randomized controlled trial.
        Med (United States). 2017; 96: 1-6
        • Moheb M
        • Rezaei M
        • Azizi-Fini I
        • Atoof F
        • Saadati MA.
        Comparison of the effect of forced-air warming and warmed ıntravenous fluid on the comfort and prevention of shivering after spinal anesthesia in patients undergoing orthopedic surgery.
        J PeriAnesthesia Nurs. 2022; 000: 1-7