Evidence of the risks of forced-air warming just keeps growing.

A study published online ahead of print in Anesthesia & Analgesia concludes that forced-air patient warming produces waste heat that disrupts operating room ventilation airflows over the surgical site, transporting non-sterile air to the area and hindering the ventilation system’s ability to clear potential airborne contaminants.

“There are some in our industry that would like you to believe that hot air doesn’t rise,” says Dr. Scott Augustine, “this study proves, once again, that that argument is insulting to science and common sense.”

Belani, et al, focused on contamination-sensitive surgery at the University of Minnesota, using a mannequin draped for total knee replacement.  Introducing neutral buoyancy bubbles near the mannequin’s head, researchers found a significant increase in bubble-count over the surgical site when forced air warming was used, as opposed to conductive fabric or the control.  The study states:

Laminar vs. Conventional Ventilation

Common Question: “My OR doesn’t use laminar flow. Does waste hot air still matter?”

Answer: Absolutely. Consider the following:

What is laminar ventilation and what is conventional ventilation?

Operating room air is typically introduced from the ceiling, moves towards the floor, and exits through the side vents. US standards for hospital construction require that operating room ventilation be filtered, at a minimum, to an efficiency of >90% for the removal of germ sized particles. Many ventilation systems do much better than that, by employing High Efficiency Particulate Air filtration commonly known as HEPA, which by definition removes >99.97% of germ sized particles from the airflow.