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Perioperative Temperature Management During Burn Care.

We were interested to the read excellent review “Perioperative Temperature Management During Burn Care” by Rizzo et al.1 However, we believe that several additional temperature management techniques and methods for measuring and reporting temperature bear consideration. First, other noninvasive and invasive warming techniques are available for the perioperative management of patients with burns. Prewarming through the application of a forced air warmer for up to 1 hour before anesthesia has been shown to diminish the core to peripheral temperature gradient.2 Alternatively, an esophageal heat exchange device has been demonstrated to control temperature for major burns surgery, facilitating concurrent reduction in the ambient temperature of the operating theatre.3 Second, methods of measuring and reporting temperature in perioperative patients are not standardized, contributing to heterogeneity. Reporting the area under the core temperature time curve may be most appropriate for this setting as both severity and duration of hypothermia are associated with adverse outcomes.4,5 We believe that standardization is a priority for future studies exploring the relationship between perioperative temperature variation and outcomes after burns. Third, there are additional limitations to reliance on high ambient temperatures in burns theaters including the safe operating temperatures for medical equipment and storage of drugs.6,7 Finally, we believe that there is a need to undertake high-quality research investigating a range of temperature management strategies and the consequences of temperature variation. While there are specific considerations for thermal management in patients with burns, the underlying principles and hypotheses may be comparable with other perioperative settings.