[Influence of Local Insufflation of Warm Humidified CO2 on the Wound Surface and Body Core Temperature as well as on Wound Healing in Open Colorectal Surgery].

BACKGROUND

Perioperative hypothermia may lead to serious complications. This study aims to investigate whether intraoperative insufflation of warmed and humidified carbon dioxide (W-H-CO2) into the open wound during open colorectal surgery influences body core and wound surface temperatures or the incidence of wound healing disorders (WHD).

METHODS

Between 02/2018 and 07/2019, 50 patients intended to undergo open resection for colorectal cancer were recruited and randomised to a control group (n = 25) and an experimental group (n = 25). In the experimental group, a device for insufflation of W-H-CO2 was used. Body core and wound surface temperatures were recorded at the beginning and before finishing the procedure. IL-6 serum levels were determined preoperatively and during the postoperative course. Clinical observation of wound healing was performed until the 30th day post-op.

RESULTS

Both groups were homogeneous in terms of risk factors for WHD. In the control group, the median body core temperature (1. quartile/3. quartile) was 36.2 °C (36/36.4 °C) when the operation started and 36.2 °C (35.9/36.45 °C) at the end, while in the experimental group it was initially 36.2 °C (35.7/36.4 °C) and 36.4 °C (36/36.7 °C) at the end. There was no significant difference between the two groups (p = 0.08). The wound temperature in the control group dropped from 32.8 °C (median; 31.85/34.05 °C) to 30.7 °C (median; 29.85/32.15 °C). In the experimental group, we recorded a drop from 31.9 °C (median; 30.25/32.95 °C) to 31.6 °C (median; 30.25/31.85 °C), which was statistically significant (p = 0.000475). The dynamic of the IL-6 serum levels in both groups suggest that there was no significant difference (p = 0.66; p = 0.88; p = 0.88). In the control group, 8 patients experienced superficial WHD, 2 anastomotic leakages (AL), while in the experimental group, superficial WHD were observed in 5 patients and AL in 1 patient. This differences between the groups regarding in WHD were not significant (p = 0.42).

CONCLUSION

The established measures for prevention of perioperative hypothermia in elective procedures are sufficient. However, the local wound surface temperature is not preserved satisfactorily. Deployment of a device for intraoperative insufflation of W-H-CO2 into open wounds may be suitable for maintaining local normothermia. Further studies are needed to determine the influence of warm and humid CO2 on wound healing.