Peritoneal Lavage for Moderate to Severe Hypothermia

Introduction to Treatment

The American College of Cardiology recommends peritoneal lavage as a third-line active core rewarming method for severe hypothermia (<28°C) when less invasive measures fail or in cardiac arrest situations 1, 2, 3

For moderate hypothermia (28-32°C), first-line treatment consists of active external rewarming combined with warmed IV fluids, according to the American Heart Association 1, 3
Remove wet clothing immediately and move to a warm environment, as recommended by the American Red Cross 1, 2
Apply forced-air warming blankets (e.g., Bair Hugger) as the primary active rewarming method, achieving rates of approximately 2.4°C/hour, based on guidelines from the American College of Emergency Physicians 1
Administer warmed isotonic crystalloid (normal saline or Ringer's lactate) at 40-45°C, volumes of 500 mL to 30 mL/kg, as suggested by the Society of Critical Care Medicine 3
Provide humidified, warmed oxygen, according to the American Thoracic Society 1, 3
Monitor core temperature every 5-15 minutes using esophageal or bladder catheter, as recommended by the American College of Cardiology 1, 3

Target minimum core temperature of 36°C before considering the patient stable, based on guidelines from the American Heart Association 1, 2
Cease rewarming at 37°C, as higher temperatures are associated with poor outcomes, according to the American College of Emergency Physicians 1, 2
Monitor continuously for arrhythmias (particularly bradycardia and ventricular fibrillation), coagulopathy, rewarming shock, and electrolyte abnormalities, as recommended by the Society of Critical Care Medicine 1, 3

The question of whether routine warm peritoneal lavage during trauma surgery improves temperature control has never been adequately studied, according to the Society of Critical Care Medicine 4, 5