Table 2.
Effects of warmed, humidified carbon dioxide on core body temperature
| Study | Study type | Humans/animals | Operation | Device used | Study group |
Control group |
Results | ||
|---|---|---|---|---|---|---|---|---|---|
| Treatment | No. | Treatment | No. | ||||||
| Nguyen et al. 2002 [30] | RCT | Humans | Lap Nissen fundoplication | Insuflow (MR 860, Fisher & Paykel Healthcare, Auckland, New Zealand) | Warmed (37°C) + humidified (95% RH) CO2 gas + warming blanket | 10 | Warming blanket | 10 | Intraabdominal T increased by 0.2°C in the study group, but decreased by 0.5°C in the control group after 1.5 hours |
| Difference not significant | |||||||||
| Hamza et al. 2005 [29] | RCT | Humans | Lap Roux-en-Y gastric bypass | Insuflow (MR 860, Fisher & Paykel Healthcare, NZ) | Warmed (37°C) + humidified (95% RH) CO2 gas | 23 | Room temperature (20°C) gas | 21 | Study group showed a significantly higher core body temperature intraoperatively (35.5°C vs. 35.0°C) and at the end of surgery, P = 0.01 |
| Study group also had a significantly lower rate of postoperative shivering (0% vs. 19%) | |||||||||
| Davis et al. 2006 [22] | RCT | Humans | Lap Roux-en-Y gastric bypass | Control- standard CO2 | Group 1- Warmed CO2 | 33 (11 each group) | Standard CO2 | 11 | No difference in core body temperature or humidity |
| Group 1- heated insufflator tube set (Stryker) | Group 2- Humidified CO2 | ||||||||
| Group 2,3- Insuflow (MR 860, Fisher & Paykel Healthcare) | Group 3- Warmed + Humidified CO2 | ||||||||
| Peng et al. 2009 [13] | RCT | Animals (rats) | Laparoscopic insufflation only | Self-developed system | Warmed (37°C) + humidified (95% RH) CO2 gas | 75 | Cold (21°C) + dry (<1% RH) CO2 gas | 75 | Significant decrease in core body temperature in cold, dry CO2 group (decrease of 2.3°C-3.11°C); warmed + humidified CO2 group showed increased temperature by 1.3°C |
| Mouton et al. 1999 [33] | RCT | Humans | Elective laparoscopic cholecystectomy | Modified LINS-1000 Insufflator (Cook Medical Technology, Queensland, Australia) | Warmed (37°C) + humidified (90% RH) CO2 | 20 | Standard CO2 (21°C, 0% RH) | 20 | No difference in core body temperature or humidity |
| Farley et al. 2004 [23] | RCT | Humans | Elective laparoscopic cholecystectomy | Insuflow Filter Heater Hydrator; (Lexion Medical, St Paul, MN, USA) | Warmed (35°C), humidified (95% RH) CO2 | 49 | Standard CO2 | 52 | Core body temperature increased by 0.29°C in humidified, warmed |
| CO2 group and decreased by 0.03°C in standard group, P = 0.01 | |||||||||
| Saad et al. 2000 [34] | RCT | Humans | Elective laparoscopic cholecystectomy | Flow Therme (WISAP, Sauerlach, Germany) | Warmed (37°C) CO2 | 10 | Standard (21°C) CO2 | 10 | No difference in core body temperature |
| Bäcklund et al. 1998 [31] | RCT | Humans | Elective laparoscopic surgery (not specified) | Therme-Pneu Electronic Ltd., Wisap, Germany | Warmed (37°C) CO2 | 13 | Cold (21°C) CO2 | 13 | Warm CO2 group had higher core body temperature (35.8°C vs. 35.4°C, P < 0.05) |
| Warm CO2 group had higher cardiac index intraoperatively (P < 0.05). Warm CO2 group had better urine output (P < 0.05) and lower requirement of mannitol intraoperatively for low urine output | |||||||||
| Nelskylä et al. 1999 [37] | RCT | Humans | Laparoscopic hysterectomy | Thermoflator (Karl Storz, Tuttlingen, Germany) | Warmed (37°C) CO2 | 18 | Cold (24°C) CO2 | 19 | Greater decrease in temperature in the group with warmed CO2 (0.7°C vs. 0.3°C, 0.3°C vs. 0.1°C) |
| Ozgonul et al. 2007 [24] | RCT | Humans | Elective laparoscopic cholecystectomy | H-500 Fluid warmer (Level 1 Technologies, Inc., Rockland, MA, USA) | Warmed (37°C) CO2 | 31 | Cold (21°C) CO2 | 31 | No difference in core body temperature, mean arterial pressure, or heart rate |
| Hazebroek et al. 2002 [15] | RCT | Animals (rats) | Pneumoperitoneum creation | MR600 anesthesia respiratory humidifier (Fisher & Paykel Healthcare) | Group 1- Cold (24.9°C) dry (4% RH) CO2 | 12 | No pneumoperitoneum | 12 | Cold, dry CO2 group: decrease in core body temperature by 1.6°C (P < 0.001) |
| Group 2- Cold (24.8°C), humidified (87% RH) CO2 | 12 | Cold, humidified CO2 group: decrease in core body temperature by 0.3°C (P = 0.011) | |||||||
| Group 3- Warm (36.9°C), dry (5% RH) CO2 | 12 | Warm, dry CO2 group: decrease in core body temperature by 0.9°C (P = 0.031) | |||||||
| Group 4- Warm (37.1°C), humidified (88% RH) CO2 | 12 | Warm, humidified CO2 group: increase in core body temperature by 2.4°C (P = 0.031) | |||||||
| Ott 1991 [19] | Prospective, non-RCT | Humans | Diagnostic laparoscopy | R. Wolf/Weiss insufflator | Warmed (35°C) CO2 | 20 | Cold CO2 | 20 | In the cold CO2 group, a decrease in core body temperature of 0.3°C per 50 L of CO2 used was observed |
| Warmed, humidified group had improved intraoperative nor-mothermia and postoperative pain, and reduced recovery room stay | |||||||||
| Bessell et al. 1995 [38] | RCT | Animals (pigs) | Pneumoperitoneum creation | LINS-1000 insufflator (Cook Medical Technology, Queensland, Australia) | Warmed (30°C) CO2 | 6 | Cold (25°C) CO2 | 6 | No significant temperature difference was observed between animals receiving cold CO2 and those receiving warm CO2 over a 3-hour period |
| Yeh et al. 2007 [35] | Prospective, non-RCT | Humans | Laparoscopic colectomies | Insuflow (MR 860, Fisher & Paykel Healthcare) | Warmed (36°C), humidified (95% RH) CO2 | 20 | Cold (30.2°C), dry (0% RH) | 20 | No significant difference in change in core body temperature |
| Manwaring et al. 2008 [25] | RCT | Humans | Laparoscopic gynecologic procedures | Insuflow (MR 860, Fisher & Paykel Health care) | Warmed (37°C), humidified (100% RH) CO2 | 30 | Cold, dry CO2 | 30 | No difference in core body temperature or recovery room time |
| Champion and Williams 2006 [36] | RCT | Humans | Laparoscopic Roux-en-Y gastric bypass | Insuflow device (Lexion Medical, St Paul, MN, USA) | Warmed (35°C), humidified (95% RH) CO2 | 25 | Cold, dry CO2 | 25 | No difference in core body temperature, operative time, or recovery room time |
| Yu et al. 2013 [26] | RCT | Humans | Laparoscopic appendectomy | Insuflow (MR 860, Fisher & Paykel Healthcare) | Warmed (37°C), humidified (98% RH) CO2 | 97 | Cold (20°C–21°C), dry (0% RH) CO2 | 98 | No difference in core body temperature |
| Savel et al. 2005 [32] | RCT | Humans | Laparoscopic Roux-en-Y gastric bypass | Insuflow device (Lexion Medical, St. Paul, MN, USA) | Warmed (35°C), humidified (95% RH) CO2 | 15 | Cold, dry CO2 | 15 | No change in core body temperature in the cold, dry CO2 group |
| In the humidified, warmed CO2 group, core body temperature increased from 35.8°C to 36.2°C (P = 0.004) | |||||||||
| Klugsberger et al. 2014 [27] | RCT | Humans | Laparoscopic cholecystectomy | Optitherm device (Storz, Tuttlingen, Germany) | Warmed, humidified CO2 | 81 | Cold, dry CO2 | 67 | Higher core body temperature in the warmed, humidified CO2 group (37.07°C vs. 36.85°C, P = 0.01) |
| Herrmann and De Wilde 2015 [28] | RCT | Humans | Laparoscopic assisted vaginal hysterectomy | Insuflow (MR 860, Fisher & Paykel Healthcare) | Warmed (37°C), humidified (98% RH) CO2 | 48 | Cold (20°C–21°C), dry (0% RH) CO2 | 49 | No difference in core body temperature |
RCT, randomized controlled trial; RH, relative humidity.