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      Development of a perioperative thermal insulation system: Testing comfort properties for different textile sets

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          Abstract

          The poorly physical and psychological conditions of the patients make the body thermal protection crucial in the perioperative context, due to the risk of hypothermia. The lack of evidence regarding the effectiveness of textile coverings in protecting patients in the operating room, underscores the recommendation of the forced warming system using non-woven fabric for ensuring the best thermal protection in the perioperative context. This study is part of a development process of a three-layered thermal insulation system, a blanket for use in the perioperative context. After previous selection of two fabrics for the mid and outer layers, in this study three fabric samples for the inner layer with same soft tactile sensation and different textile compositions were tested to find its effect on increasing the thermal insulation of the whole set, using a thermal manikin. The serial method was used to calculate the thermal insulation properties of the sets. The best thermal insulation and thermal comfort performance was obtained by the set using an inner layer composed of polypropylene, polyamide, and elastane whose results were the highest thermal conductivity and thickness and the lowest maximum stationary heat flow density. The results indicated that this fabric influenced positively the values of the whole set once increased its thermal protection effectiveness when compared to the other tested sets. This set is more suitable for future testing in patients during their stay in the perioperative setting.

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          Most cited references31

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          Perioperative heat balance.

          D Sessler (2000)
          Hypothermia during general anesthesia develops with a characteristic three-phase pattern. The initial rapid reduction in core temperature after induction of anesthesia results from an internal redistribution of body heat. Redistribution results because anesthetics inhibit the tonic vasoconstriction that normally maintains a large core-to-peripheral temperature gradient. Core temperature then decreases linearly at a rate determined by the difference between heat loss and production. However, when surgical patients become sufficiently hypothermic, they again trigger thermoregulatory vasoconstriction, which restricts core-to-peripheral flow of heat. Constraint of metabolic heat, in turn, maintains a core temperature plateau (despite continued systemic heat loss) and eventually reestablishes the normal core-to-peripheral temperature gradient. Together, these mechanisms indicate that alterations in the distribution of body heat contribute more to changes in core temperature than to systemic heat imbalance in most patients. Just as with general anesthesia, redistribution of body heat is the major initial cause of hypothermia in patients administered spinal or epidural anesthesia. However, redistribution during neuraxial anesthesia is typically restricted to the legs. Consequently, redistribution decreases core temperature about half as much during major conduction anesthesia. As during general anesthesia, core temperature subsequently decreases linearly at a rate determined by the inequality between heat loss and production. The major difference, however, is that the linear hypothermia phase is not discontinued by reemergence of thermoregulatory vasoconstriction because constriction in the legs is blocked peripherally. As a result, in patients undergoing large operations with neuraxial anesthesia, there is the potential of development of serious hypothermia. Hypothermic cardiopulmonary bypass is associated with enormous changes in body heat content. Furthermore, rapid cooling and rewarming produces large core-to-peripheral, longitudinal, and radial tissue temperature gradients. Inadequate rewarming of peripheral tissues typically produces a considerable core-to-peripheral gradient at the end of bypass. Subsequently, redistribution of heat from the core to the cooler arms and legs produces an afterdrop. Afterdrop magnitude can be reduced by prolonging rewarming, pharmacologic vasodilation, or peripheral warming. Postoperative return to normothermia occurs when brain anesthetic concentration decreases sufficiently to again trigger normal thermoregulatory defenses. However, residual anesthesia and opioids given for treatment of postoperative pain decreases the effectiveness of these responses. Consequently, return to normothermia often needs 2-5 h, depending on the degree of hypothermia and the age of the patient.
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            Thermal comfort models: A review and numerical investigation

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              ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia: second edition.

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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: MethodologyRole: Writing – original draft
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: Validation
                Role: Formal analysisRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 September 2023
                2023
                : 18
                : 9
                : e0291424
                Affiliations
                [1 ] Department of Operating Room, Hospital da Prelada, Porto, Portugal
                [2 ] Center for Health Technology and Services Research (CINTESIS@RISE) Porto, Porto, Portugal
                [3 ] Department of Textile Engineering, University of Minho, Guimarães, Portugal
                [4 ] Escola Superior de Enfermagem do Porto, Porto, Portugal
                [5 ] Medical Faculty University of Porto, Porto, Portugal
                [6 ] Director of the Anesthesiology Service, Centro Hospitalar Universitário S. João, Porto, Portugal
                Birla Institute of Technology and Science - Hyderabad Campus, INDIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-6028-2172
                https://orcid.org/0000-0003-3395-7653
                Article
                PONE-D-21-32944
                10.1371/journal.pone.0291424
                10497167
                37699056
                b76bb5c9-ea5e-4c3b-ad9c-3a8a8520c17a
                © 2023 Carvalho et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 October 2021
                : 30 August 2023
                Page count
                Figures: 2, Tables: 5, Pages: 12
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100001871, Fundação para a Ciência e a Tecnologia;
                Award ID: UIDB/4255/2020 and reference UIDP/4255/2020).
                This work is financed by national funds through FCT - Portuguese Foundation for Science and Technology under the project UIDB/4255/2020 and reference UIDP/4255/2020. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Physical Sciences
                Chemistry
                Polymer Chemistry
                Macromolecules
                Polymers
                Polypropylene
                Physical Sciences
                Materials Science
                Materials
                Polymers
                Polypropylene
                Physical Sciences
                Chemistry
                Polymer Chemistry
                Polymers
                Polypropylene
                Physical Sciences
                Materials Science
                Material Properties
                Thermal Conductivity
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Physical Sciences
                Chemistry
                Polymer Chemistry
                Macromolecules
                Polymers
                Polyesters
                Physical Sciences
                Materials Science
                Materials
                Polymers
                Polyesters
                Physical Sciences
                Chemistry
                Polymer Chemistry
                Polymers
                Polyesters
                Physical Sciences
                Materials Science
                Material Properties
                Permeability
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Hypothermia
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Temperature
                Custom metadata
                All relevant data are within the manuscript. Supplementary data files are available: https://doi.org/10.5061/dryad.np5hqbzx7.

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                Uncategorized

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