Thermoprotection in the perioperative period: an international consensus statement for the maintenance of normothermia

Thermoprotection in the perioperative period: an international consensus statement for the maintenance of normothermia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Thermoprotection in the perioperative period: an international consensus statement for the maintenance of normothermia Fredy Ariza, Felipe Gutiérrez-Londoño, Fitsum Kifle, Maria C. Cadena-Gaviria, and 13 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8688093/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Thermoregulation maintains core temperature within a narrow physiological range necessary for normal physiologic homeostasis and organ function. During surgery, exposure to cool environments, anesthetic-induced impairment of thermoregulatory responses, and infusion of unheated fluids predispose patients to unintentional perioperative hypothermia (UPH). In the absence of active warming, core temperature commonly decreases by 1–2°C, largely due to early redistribution of heat from the core to the periphery. UPH is associated with adverse outcomes, including cardiovascular stress, coagulopathy and increased bleeding, delayed drug metabolism and recovery, impaired immune function, postoperative shivering, and reduced patient comfort. Objective To develop an international, evidence-based consensus providing practical recommendations for thermoprotection and prevention of UPH across the perioperative continuum. Methods This consensus statement was developed in accordance with the ACCORD framework. A multidisciplinary international panel formulated clinical questions through structured virtual meetings. A comprehensive literature search and critical appraisal were conducted for each question. Recommendations were developed and graded using the GRADE system. Each recommendation underwent independent review by multiple authors, followed by group discussion, methodological oversight, and structured voting. Consensus activities were conducted between March 2025 and January 2026. Results The panel generated graded recommendations addressing institutional policies, risk stratification, environmental control, temperature monitoring, maintenance of intraoperative normothermia (36.0–37.5°C), active prewarming, safe use of warming devices, multimodal warming strategies (including warmed fluids), and systematic postoperative temperature management. Integration of thermoprotection into enhanced recovery, patient blood management programs, and patient-experience assessment was emphasized. Conclusions UPH remains common, preventable, and clinically significant. Continuous temperature monitoring and systematic thermoprotection strategies are cost-effective measures that should be embedded into perioperative care pathways to improve safety, outcomes, and patient experience. Thermoprotection Perioperative hypothermia Normothermia Perioperative care Patient safety Temperature monitoring Active warming. Full Text Additional Declarations No competing interests reported. Supplementary Files InternationalConsensusonPerioperativeThermoprotectionrespuestas2.xlsx ThermopConsensusSupplementMaterialVerbatim.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8688093","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":585148193,"identity":"db970585-51df-4e3c-a243-2f8884f0d405","order_by":0,"name":"Fredy Ariza","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYBAC9gYGBgkgzcPAwHwMLMLGTkALzwG4FrY0BoYEIMVMpBYQ0wyshYGgFunDB2/z1NyTkW8/8+3Bxx/b5PmYGRg/fMzBo4UvLdma51gxD2NP7nbDGQm3DduYGZglZ27DrcWeh8dMmoctgYeZIXebNE/CbUagFjZmXjxaeHj4v0nz/EvgYeN/8wykxZ4ILTxs0rxtCTw8EjlsIC2JRGhhM7ac25fAIyHxzExyRtrt5DZmxma8fuHhYX544823BHv5/uRnEh9sbtvOb28++OEjHi0gwMSDymdswK8epOQHQSWjYBSMglEwogEASqpCb+NoE/sAAAAASUVORK5CYII=","orcid":"","institution":"Fundación Valle del Lili","correspondingAuthor":true,"prefix":"","firstName":"Fredy","middleName":"","lastName":"Ariza","suffix":""},{"id":585148194,"identity":"b19e7585-647b-4672-a222-9fed59c1c907","order_by":1,"name":"Felipe Gutiérrez-Londoño","email":"","orcid":"","institution":"University of La Sabana","correspondingAuthor":false,"prefix":"","firstName":"Felipe","middleName":"","lastName":"Gutiérrez-Londoño","suffix":""},{"id":585148195,"identity":"fd69f629-8895-484a-bafb-c00619d462b8","order_by":2,"name":"Fitsum Kifle","email":"","orcid":"","institution":"Debre Berhan University","correspondingAuthor":false,"prefix":"","firstName":"Fitsum","middleName":"","lastName":"Kifle","suffix":""},{"id":585148196,"identity":"d4797c97-b79b-42d2-834b-9739bbb98dce","order_by":3,"name":"Maria C. 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During surgery, exposure to cool environments, anesthetic-induced impairment of thermoregulatory responses, and infusion of unheated fluids predispose patients to unintentional perioperative hypothermia (UPH). In the absence of active warming, core temperature commonly decreases by 1\u0026ndash;2\u0026deg;C, largely due to early redistribution of heat from the core to the periphery. UPH is associated with adverse outcomes, including cardiovascular stress, coagulopathy and increased bleeding, delayed drug metabolism and recovery, impaired immune function, postoperative shivering, and reduced patient comfort.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo develop an international, evidence-based consensus providing practical recommendations for thermoprotection and prevention of UPH across the perioperative continuum.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis consensus statement was developed in accordance with the ACCORD framework. A multidisciplinary international panel formulated clinical questions through structured virtual meetings. A comprehensive literature search and critical appraisal were conducted for each question. Recommendations were developed and graded using the GRADE system. Each recommendation underwent independent review by multiple authors, followed by group discussion, methodological oversight, and structured voting. Consensus activities were conducted between March 2025 and January 2026.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe panel generated graded recommendations addressing institutional policies, risk stratification, environmental control, temperature monitoring, maintenance of intraoperative normothermia (36.0\u0026ndash;37.5\u0026deg;C), active prewarming, safe use of warming devices, multimodal warming strategies (including warmed fluids), and systematic postoperative temperature management. Integration of thermoprotection into enhanced recovery, patient blood management programs, and patient-experience assessment was emphasized.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eUPH remains common, preventable, and clinically significant. Continuous temperature monitoring and systematic thermoprotection strategies are cost-effective measures that should be embedded into perioperative care pathways to improve safety, outcomes, and patient experience.\u003c/p\u003e","manuscriptTitle":"Thermoprotection in the perioperative period: an international consensus statement for the maintenance of normothermia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-04 13:28:18","doi":"10.21203/rs.3.rs-8688093/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"660dea62-6ae2-4c61-8cdd-991975b8f991","owner":[],"postedDate":"February 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-25T07:56:12+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-04 13:28:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8688093","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8688093","identity":"rs-8688093","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}