In adults’ patients undergoing general anesthesia, does forced-air warming before or during induction compared to passive blanket warming decrease incidence of hypothermia and improve intraoperative blood pressure stability during intraoperative period through PACU discharge?
Scope of the Problem
Consider the number of people impacted globally, nationally, and locally. Consider how much the problem costs. Depending on your topic consider what has or is being done to address the problem. This section should be a minimum of 1.5 pages.
Consequences of the Problem
What happens if the problem is not fixed? Consider economic, social, political and/or environmental outcomes, depending on the scope of the problem. This section should be a minimum of 1.5 pages.
Knowledge Gaps
Evaluate the literature and determine what is not known about the problem. Where are their gaps in knowledge? What knowledge is needed to fix the problem. This section should be a minimum of 1.5 pages.
Include a description of the gap analysis of the project site to identify why this project is appropriate for the site where it will be implemented. Use your Agency for Health Care Research and Quality (AHRQ) Guide and other resources to outline this section.
Proposed Solution
What is your proposed solution? Remember, this must be evidence-based. Provide details of the solution and how it works. This section should be a minimum of 2 pages.
Addressing Gaps and Implementation ContextA critical aspect of the report involves defining knowledge gaps, including conflicts in evidence regarding the optimal timing of warming (pre-induction vs. peri-induction). I am also specifically looking for resources related to the Agency for Healthcare Research and Quality (AHRQ) guidelines to frame the required gap analysis. Since the project will be implemented in a specific site, I am searching for information on the feasibility and challenges of using forced-air warming technology in low-resource settings, such as Kisumu, Kenya, to ensure the proposed solution is contextually appropriate.Next Steps: Broad Information GatheringI will proceed with broad information gathering across all seven planned nodes, prioritizing high-quality sources such as guidelines (AHRQ, ASA, WHO) and comprehensive reviews to build a robust foundation for all mandated sections of the final report.
Researching websitesresearchgate.netComparison of resistive heating and forced-air warming to prevent inadvertent perioperative hypothermia | Request PDF - ResearchGateheraldopenaccess.usEfficacy and Safety of Forced- Air Warming System versus Passive Warming Measures in Major Surgeries: A Systematic Review - Herald Scholarly Open Access
pmc.ncbi.nlm.nih.govEffectiveness of active and passive warming for the prevention of inadvertent hypothermia in patients receiving neuraxial anesthesia: A systematic review and meta-analysis of randomized controlled trials - PubMed Centralpmc.ncbi.nlm.nih.govIncidence and associated factors of perioperative hypothermia in adult patients at a university-based, tertiary care hospital in Thailand - PMCpubmed.ncbi.nlm.nih.govThe incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors - PubMedqpp.cms.govQuality ID #424 (NQF 2681): Perioperative Temperature Managementpmc.ncbi.nlm.nih.govPerioperative Temperature Monitoring and Patient Warming: A Survey Study - PMCpubmed.ncbi.nlm.nih.govConsequences of inadvertent perioperative hypothermia - PubMedpmc.ncbi.nlm.nih.govUnintended Perioperative Hypothermia - PMC - PubMed Centralmdpi.comOptimal Application of Forced Air Warming to Prevent Peri-Operative Hypothermia during Abdominal Surgery: A Systematic Review and Meta-Analysis - MDPIohsu.eduOREGON HEALTH AND SCIENCE UNIVERSITY OFFICE OF CLINICAL INTEGRATION AND EVIDENCE-BASED PRACTICEahrq.govGa Analysis - AHRQahrq.govGap Analysis Facilitator's Guide | Agency for Healthcare Research and Qualityresearchgate.net(PDF) Forced-Air Warming During Pediatric Surgery: A Randomized Comparison of a Compressible with a Noncompressible Warming System - ResearchGatepmc.ncbi.nlm.nih.govStrategies for perioperative hypothermia management: advances in warming techniques and clinical implications: a narrative review - PubMed CentralEstablishing Efficacy and ScopeMy initial investigation confirms that forced-air warming (FAW) is generally superior to passive warming in preventing postoperative hypothermia, with one study showing significantly higher core temperatures at the end of surgery with FAW. This aligns with the consensus that FAW is the gold standard, although passive warming remains a cost-effective alternative. I have also confirmed that the incidence of perioperative hypothermia is high (up to 73.5% in monitored patients) and is associated with adverse outcomes and a longer stay in the recovery unit (PACU), confirming the problem's significance for the Scope section. Furthermore, I have identified a CMS quality measure (NQF 2681) that mandates maintaining a temperature above 35.5°C near the end of anesthesia, which will be essential for framing the quality improvement aspect.Resolving Conflicting Hemodynamic EffectsA significant finding relating to the 'Consequences' section and the PICO question is the nuanced effect of hypothermia on blood pressure (BP). Some literature suggests that hypothermia elevates BP and heart rate due to sympathetic activation and increased catecholamines, which runs contrary to the specific PICO goal of *improving* intraoperative blood pressure stability. However, I found conflicting evidence suggesting mild hypothermia might not affect BP intraoperatively. This conflict requires a deeper dive to accurately describe the hemodynamic consequences of hypothermia and how FAW specifically addresses BP stability.Refining Knowledge Gaps and Local ContextWhile I have evidence that FAW helps, the precise optimal timing—pre-induction versus peri-induction—remains a subtle knowledge gap, as systematic reviews have yet to confirm a statistically significant benefit for application timing alone. For the 'Knowledge Gaps' section, I have secured excellent resources from the Agency for Healthcare Research and Quality (AHRQ) detailing the methodology for performing a site-specific gap analysis. I recognize the necessity of tailoring the proposed solution to the context of the project site; thus, I must specifically research the costs, logistical barriers, and feasibility of implementing FAW systems in low-resource settings, such as East African hospitals.
Sample Answer
Structuring the Research ApproachI am initiating a comprehensive research effort to address the required report sections based on the PICO question concerning forced-air warming (FAW) versus passive warming (PW) in adult surgical patients. My plan is structured to simultaneously investigate the core efficacy of FAW (reducing hypothermia and stabilizing blood pressure) and the broader context required for the report: Scope, Consequences, Knowledge Gaps, and the Proposed Solution.Investigating Core Efficacy and ScopeMy initial searches are designed to gather systematic reviews and meta-analyses to establish the evidence base for FAW's effectiveness compared to passive warming. Concurrently, I am quantifying the problem by searching for the global and national incidence and economic costs associated with unintended perioperative hypothermia. This will establish the necessity and relevance of the proposed intervention.