Active Warming Technologies for preventing Perioperative Hypothermia: A Narrative Review of Evidence and Clinical Practice
Keywords:
Forced-air warming, Intravenous fluid warmer, Perioperative hypothermia, Temperature management, Warming mattressAbstract
Perioperative hypothermia, defined as a core body temperature below 36°C, remains a frequent and preventable complication during anesthesia and surgery. It contributes to adverse outcomes, including increased blood loss, wound infection, delayed anesthetic recovery, and prolonged hospital stay.
This review aims to summarize current evidence regarding active warming technologies—Forced-Air Warming, Warming Mattress, and Intravenous Fluid Warmer—as evidence-based tools for preventing perioperative hypothermia. However, limited evidence is available comparing commonly used warming technologies in routine clinical anesthetic practice. Relevant clinical and experimental studies published over the past decade were reviewed to assess device performance, thermal efficacy, safety, and cost-effectiveness.
Evidence consistently supports Forced-Air Warming as the most validated and effective method for maintaining intraoperative normothermia, supported by multiple randomized controlled trials and meta-analyses. Warming mattresses provide additional conductive heat but are less efficient when used alone; their effectiveness improves when integrated into multimodal warming protocols. Intravenous fluid warmers are particularly valuable in surgeries involving large-volume fluid administration, minimizing heat loss through cold infusions. Despite strong validation, limitations remain, including variations in device design, incomplete standardization of testing methods, and potential safety concerns related to misuse or infection risk.
In clinical practice, selection of warming strategies should consider patient risk factors, surgical duration, and expected fluid administration. Future research should focus on standardizing protocols, optimizing integration with perioperative temperature monitoring systems, and exploring emerging technologies for precise thermal control.
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