Thermoregulation in Colorectal Patients: Heating CO2 Insufflation Gas

BACKGROUND: 600,000 colorectal surgeries are performed annually in the United States, with 26-90% experiencing some form of unintended hypothermia. Consequences of hypothermia include surgical site infections (SSIs), delayed wound healing, cardiac dysrhythmias, and increased hospital length of stay. Utilization of the laparoscopic approach to intra-abdominal colorectal surgery uses un-warmed CO₂ gas. Multiple studies demonstrate the addition of heated CO₂, for insufflation, reduces intraoperative hypothermia.

LOCAL PROBLEM: This project was implemented at a facility in Tennessee. On average, 250 laparoscopic colorectal cases are performed at this facility annually. Participants were adult colorectal surgical patients, 18 years of age or older, with a colon anastomosis. The use of a heated CO₂ circuit was not standardized at this facility. The project aimed to maintain normothermia in 90% of colorectal surgical cases within 3 months of implementation of the heated & humidified CO₂ insufflation circuit.

METHODS: This project utilized the Evidence-Based Practice Improvement model. PDSA (plan-study-do-act) cycles were used to facilitate the implementation of heated CO₂ circuits. The implementation phase lasted 3 months. Core temperatures were collected within 30 minutes before anesthesia end time to 15 minutes after anesthesia end time.

INTERVENTIONS: Participating surgeons utilized heated CO₂ circuits over three months.

RESULTS: There was a 17% increase in temperature compliance (normothermia) from 2021 to 2023. Temperature compliance was 82.9% in 2021 and 100% in 2023. Of the 33 participants in this project, for 2023, perioperative temperature compliance reached 100%, regardless of CO₂ circuit type. A comparison of heated vs unheated CO₂ circuits demonstrated an intraoperative temperature difference of 0.01 ^oC between both circuits.

CONCLUSIONS: Temperature regulation remains an integral component of anesthetic management. Even though our AIM of 90% normothermia compliance was achieved, it is unclear to what extent the heated CO2 circuit played in obtaining that goal.