ta cs jed v3
TRANSCRIPT
Preventing inadvertent perioperative hypothermia in elective
arthroscopic shoulder surgery: A protocol for a randomised
controlled trial
By Renatta DiStaso and Kerry-Anne Cobbe
Research Team Nicole Draper (NUM)
Professor Kim Walker (NRI)
Kerry-Anne Cobbe (CNS)
Renatta Di Staso (CNS)
Jed Duff (Research Fellow)
Professor Sandy Middleton (NRI)
Dr. Simon Tan (Orthopaedic
surgeon)
Dr. Emma Halliday (Anaesthetist)
Associate Professor Lawrence
Lam (Statistician)
Todd Allen (Research Assistant)
DSU Staff
Session Overview Background
Inadvertent perioperative hypothermia
Literature review
Time line: research process
Temperature and Comfort Study (TaCS): protocol
Ethical Issues
Stumbling blocks
Context St Vincent’s Private is a 25o bed acute care private hospital catering for
all major specialities excluding maternal and paediatric care
Day Surgery
5 operating theatres
1 lithotripsy suite
2 treatment rooms
Approximately 10,000 cases with 1/3 planned overnight stay
Background Research all starts with an idea...How can nurses better
care for patients to see better outcomes and improve
recovery time.
As clinicians the easiest way to become involved in research
in your own practice is to answer your own clinical
problems.
Literature Review Perioperative hypothermia is core temperature below 36°C
Contributing factors:
Reduced metabolic heat production due to anaesthetic
Cold perioperative environment
Impaired thermoregulation.
Linked to poorer postoperative outcomes, extended recovery stay &
increased resource use.
Literature review Literature says that active and passive measures for
preventing perioperative hypothermia are as follows:
Warm blankets
Forced air warming gowns and blankets
Space blankets
Warm irrigation fluids
Time line July 2009: Initial Idea
July- October 2009: Development of idea, study proposal
October 2009: Application for Research Grant
January 2010: Nursing Research grant approved
March 2010: Ethics Approval Application
May 2010 Feasibility study : Forced Air Warming Study (FAWS)
Time line....July 2010:
Ethics Approval
Commenced staff education
Australian and New Zealand Clinical Trials Register
September 3rd 2010: 1st patient recruited
January 31st 2011: 40 patients
Purpose The effects of pre-warming and/or warmed irrigation fluids on
elective arthroscopic shoulder surgery patients’
Temperature
Thermal comfort
Total recovery time
Study Design Randomised 2x2 factorial
design
Study groups: 4
Participants: 12o
Duration: 12-16 months
Preoperative warming
No preoperative
warming
Warmed irrigation
fluidsT1 T2
No warmed irrigation
fluidsT3 T4
Participant SelectionInclusion Criteria Exclusion Criteria
Elective arthroscopic
shoulder surgery
>/=18years
ASA grade 1-111
Willing & able to give consent
BMI <18.5 or >40
Preop temperature >37.5
Unable to speak or
understand English
Randomisation in Clinical Trials Randomisation is the process of assigning
clinical trail participants to treatment
groups.
Allocation is carried out using a chance
mechanism so that neither the
participant nor the investigator will know
in advance which will be assigned.
Ethical Issues
Consent
Blinding and un-blinding
Data collection and storage
Stumbling Blocks
Research: terminology, literature review, critiquing
Computer skills: excel, designing data collection forms,
statistics
Time
Thank youWe would like to acknowledge:
St Vincent’s & Mater Health Sydney Research Grants (2010-2011)
SV&MHS Nursing Research Institute (NRI)
NUM – Nicole Draper
Professor Kim Walker, Professor Sandy Middleton and Research
Fellow Jed Duff for their ongoing support and encouragement.