Shivering and rewarming after cardiac surgery: comparison of ventilator circuits with humidifier and heated wires to heat and moisture exchangers

BACKGROUND: Detrimental physiologic effects of shivering in the cardiac surgery patient have been well documented. Rewarming techniques have been compared, with noted differences in the incidence of shivering. Ventilator circuits have not been examined independently from other rewarming variables. OBJECTIVE: To compare heated wire humidification circuits with heat and moisture exchanger circuits on the incidence of shivering and speed and pattern of rewarming in mechanically ventilated patients. METHODS: A prospective, descriptive, correlational study was done on 140 adult cardiac surgery patients in a university teaching medical center. All subjects underwent cardiac surgical procedures with hypothermic cardiopulmonary bypass. Subjects were randomized to humidified, heated wire circuits (n = 70) or heat and moisture exchanger circuits (n = 70). Heated water blankets were used on all patients. RESULTS: Mean intensive care unit admission temperature was 35.28 degrees C. No statistical differences were found in preoperative, demographic, or operative course data between treatment and control groups. Shivering was more common in the heat and moisture exchanger group than in the heated wire group. In our analysis, the only variable associated with shivering was the type of ventilator circuit. Patients using heated wire systems rewarmed more rapidly and had significantly higher temperatures than did patients using heat and moisture exchangers. CONCLUSION: These data suggest that use of heated wire humidified ventilator circuits with heated water blankets in adult cardiac surgery patients significantly reduces the incidence of shivering and results in a more rapid return to normothermia.