Search

Objective: Warm intravenous fluid (W-IVF) administration is the standard of care to prevent hypothermia in injured adults. It is argued that such administration may not be helpful for treating injured children, because children often do not require as much intravenous fluid (i.v.f.) as adults. The purpose of this study was to compare the effects of W-i.v.f. to room temperature intravenous fluid (RT-i.v.f.) administration on aural temperature (Ta) in injured children during the first hour of trauma resuscitation., Design: A randomized, controlled repeated-measures trial., Setting: Emergency department, intensive care unit, and diagnostic areas in a level I pediatric trauma center., Sample: Thirty moderately or severely injured children, ranging in age from 2 to 17 years (mean age = 8.9 years; SD = 4.4)., Methods: Eligible children were randomly assigned to receive either W-i.v.f. or RT-i.v.f. on ED arrival. Warmed IVF was administered with the Hotline fluid warmer (SIMS Level 1, Rockland, Mass). Aural temperatures were measured on arrival and every 10 minutes for 1 hour with a Core-Check Tympanic Thermometer (IVAC Medical Systems, San Diego, Calif). The level of significance for hypothesis testing was set at 0.05 (two-tailed)., Results: Groups were comparable in age, gender, weight, amount of infused i.v.f., Revised Trauma Score, room temperature, and baseline Ta. On average, Ta for the W-i.v.f. group increased by 0.25 degree C from baseline to final Ta, whereas Ta for the RT-i.v.f. group decreased by 0.32 degree C from baseline to final Ta. Repeated-measures analysis of covariance, treating baseline Ta as a covariate, demonstrated that Ta response profiles were similar (p = 0.06)., Conclusions: When comparing the changes between baseline and final Ta for the W-i.v.f. and RT-i.v.f. groups, the standardized difference in temperature change was 0.62. Although results of the repeated measures analysis of covariance were not statistically significant, the standardized difference in temperature changes was large enough to warrant administration of W-i.v.f., even at slow flow rates, to prevent hypothermia in injured children.

Objective: The purpose of this study was to compare initial rectal and aural (i.e., ear-based) temperature measurements in children with moderate and severe injuries during their trauma care in the emergency department., Design: A cross-sectional, prospective design was used to compare aural temperature and rectal temperatures in injured children., Sample/setting: A convenience sample of 40 children who met the study inclusion criteria were enrolled at the level I pediatric regional resource trauma center in western Pennsylvania., Methods: Aural temperature was measured by infrared technology (IVAC Corporation, San Diego, Calif.), and rectal temperatures were measured with a thermistor (IVAC Corporation)., Results: The subjects (N = 40) ranged in age from 1 to 14 years (mean 6.9 years; SD = 4.4 years). The mean difference between rectal and aural temperature measurements (mean = -0.3 degree C; SD = 0.76 degree C) was statistically significant when compared with a paired t test (p < 0.05). The Pearson product-moment correlation coefficient between aural and rectal temperature measurements was moderate to high (r = 0.85)., Conclusion: The moderate to high correlation between the two methods shows promise for use of aural infrared temperature measurements as a screening measure for children with moderate and severe injuries.

Objective: The purpose of this in vitro study was to compare four methods of warming intravenous fluid (IVF) with a control of unwarmed IVF at flow rates of 200, 400, 600, 800, and 1000 ml/hr., Design: A 5 x 5 factorial experimental design was used to evaluate the methods of warming IVF and the control at varied flow rates., Methods: The methods of warming IVF in this study included the following: (1) the Level 1 System 250 fluid warmer with D-60HL tubing (Level 1 Technologies, Inc., Rockland, Mass.); (2) the Level 1 System 250 fluid warmer with D-50 tubing (Level 1 Technologies, Inc.); (3) the Hotline fluid warmer with L-70 tubing (Level 1 Technologies, Inc.); and (4) the Baxter DW 1000 D blood fluid warmer with blood cuff set tubing (Baxter Healthcare Corporation, Valencia, Calif.). The IVF temperatures were measured with thermocouples at three points: (1) in the intravenous solution bag, (2) in the tubing after the infusion pump, and (3) 2 cm proximal to the end of the tubing. Ambient temperature and the temperature at the three measurement points were recorded when the temperature at the point 2 cm proximal to the end of the tubing was stable for 3 minutes., Results: With single-lumen tubing, fluids flowing at low rates (e.g., 200 ml/hr) were barely warm at the end of the tubing. In contrast, fluid warmed with triple-lumen technology was consistently kept warm throughout the tubing.