Matt Harmon

35 Chapter two respondents delayed rewarming of patients starting at a lower temperature than their hypothermia definition. The target temperature to which patients are rewarmed also varied; most patients were rewarmed to a target temperature of 37°C (28%) (Figure 1C). There was a large variation in rewarming practice, which ranged from 0.5°C per hour to as fast as possible (Figure 1D). Among respondents, 58% said that the decision to rewarm patients was predominantly physician driven compared with 42% who said that it was nurse driven. Respondents were asked which factors influenced their decision to rewarm patients on a scale of 0 (not influential at all) to 5 (extremely influential). Shivering was the most influential (3 [2–4]), followed by the presence of shock (3 [2– 3]). The predominant first-line method of rewarming was forced warm air (90%), followed by warmed IV fluids (36%). Respondents were asked which factors influenced their decision to rewarm patients on a scale of 0 (not influential at all) to 5 (extremely influential). Shivering was the most influential (3 (2-4)), followed by the presence of shock (3 (2-3)). The predominant first line method of rewarming was forced warm air (90%), followed by warmed IV fluids (36%). Respondents opinion Respondents were also asked their opinion on the effect of hypothermia on the outcome of patients. Most respondents expressed a belief that hypothermia is associated with increased mortality (66%), followed by do not know (24%), does not affect mortality (8%), and decreases mortality (2%). The majority of respondents believe that patients should be rewarmed (55%), compared with 18% who believe that patients should not be rewarmed. Among respondents who believe that patients should be rewarmed, the majority (52%) believe that rewarming negates the negative effects of hypothermia. Among respondents who believe that patients should not be rewarmed, 41% believe that rewarming negated the positive effects of spontaneous hypothermia. Discussion In this study, we describe the results of a survey on the management of patients with spontaneous hypothermia. The main findings of this study are as follows: (1) both the definition of spontaneous hypothermia and the practice of active rewarming in these patients are extremely variable; (2) a considerable proportion of respondents do not rewarm patients with spontaneous hypothermia during sepsis; and (3) there is no consensus on the etiology of spontaneous hypothermia.