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Perioperative HypothermiaWARM-NINCT07909252

Resistive Versus Forced-Air Warming for Prevention of Perioperative Hypothermia

A study testing Forced-air warming and Resistive conductive warming in people with Perioperative Hypothermia and Inadvertent Perioperative Hypothermia, run by Masarykova Nemocnice v Usti nad Labem, Krajska Zdravotni a.s. at 1 site in Czechia.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

Perioperative hypothermia (core temperature below 36.0 °C) is a common complication of surgery and is associated with increased blood loss, wound infection, cardiovascular events and patient discomfort. Forced-air warming (Bair Hugger) is the standard method of active warming. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Forced-air warming and Resistive conductive warming
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
680 participants
Where
1 siteCzechia
Study dates
1 Nov 2026to 31 Oct 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18 years or older
  • Elective surgery under general anaesthesia, any type of surgery, surgical approach and duration
  • ASA physical status I-III
  • Written informed consent

Who cannot join

  • Emergency surgery
  • General anaesthesia combined with neuraxial block (spinal or epidural)
  • Preoperative core temperature below 36.0 °C or above 38.0 °C
  • Sepsis
  • Body mass index below 18 or above 35 kg/m2
  • Known thermoregulatory disorder or significant endocrine disease affecting thermoregulation (e.g., severe thyroid disease)

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Michal Kalina, MD, PhD, MBA contact

+420773628756

michal.kalina@kzcr.eu

Czechia1 site
  • Masaryk Hospital in Usti nad Labem

    Ústí nad Labem, 400 11

    Michal Kalina, MD, PhD, MBA, +420773628756, michal.kalina@kzcr.eu

Other trials in Czechia

About this study

Official title: Resistive Conductive Warming (HotDog) Versus Forced-Air Warming (Bair Hugger) for Prevention of Perioperative Hypothermia in Elective Surgery Under General Anaesthesia: a Single-Centre Randomised Controlled Non-Inferiority Trial

Perioperative hypothermia (core temperature below 36.0 °C) is a common complication of surgery and is associated with increased blood loss, wound infection, cardiovascular events and patient discomfort. Forced-air warming (Bair Hugger) is the standard method of active warming. Resistive conductive warming (HotDog) transfers heat by direct contact and does not blow air into the operating room, which may be advantageous. This randomised trial will test whether resistive warming is not inferior to forced-air warming in preventing hypothermia on arrival in the post-anaesthesia care unit (PACU) in adults undergoing elective surgery under general anaesthesia.

Read the detailed description

Design: single-centre, prospective, randomised, controlled, parallel-group non-inferiority trial with 1:1 allocation, reported according to CONSORT and its extension for non-inferiority trials.

Randomisation: computer-generated block randomisation (random blocks of 4 and 6) using StudyRandomizer, stratified by type of surgery (laparoscopic/endoscopic in a body cavity; open body-cavity surgery; other procedures). Allocation is revealed only after eligibility is confirmed and written informed consent is obtained.

Interventions: all patients receive passive insulation with a reflective (silver) blanket from arrival in the pre-operative area until induction and during transfer to the PACU. After induction of general anaesthesia, patients receive active warming with either forced-air warming (Bair Hugger, upper- or lower-body blanket, 43 °C) or resistive conductive warming (HotDog, underbody mattress, 42 °C) until the end of surgery. Anaesthesia, fluids and operating-room temperature follow standard institutional practice and are recorded. If core temperature falls below 35.5 °C, the anaesthetist may add rescue warming; this is recorded as a protocol deviation. Duration of surgery is not restricted and is recorded.

Temperature measurement: core temperature is measured non-invasively with a zero-heat-flux sensor (3M SpotOn) placed on the forehead before induction and kept in place until the PACU; values are recorded at baseline, every 15 minutes during surgery, at the end of surgery, within 5 minutes of PACU arrival, 30 minutes after arrival and at PACU discharge.

PACU assessments: shivering (Bedside Shivering Assessment Scale), thermal comfort (5-point Likert scale), subjective feeling of cold ("Do you feel cold?") and objective signs of thermal discomfort (piloerection; cold, pale or mottled extremities; shivering; curling up; request for blankets; sweating; flushing; uncovering).

Blinding: operating-room staff cannot be blinded. Warming devices remain in the operating room and the PACU outcome assessor is blinded: PACU assessments are performed by staff not involved in intraoperative care and unaware of group allocation. Statistical analysis is performed with coded groups.

Sample size: assuming a hypothermia incidence of 12.5% in both groups, a non-inferiority margin of 7.5 percentage points, one-sided alpha 0.025 and 80% power, 305 patients per group are required; with 10% dropout, 340 patients per group (680 in total) will be enrolled.

Statistical analysis: the primary outcome is analysed as the risk difference (HotDog minus Bair Hugger) with a two-sided 95% confidence interval (Newcombe method). Non-inferiority is concluded if the upper limit is below 7.5 percentage points in both the intention-to-treat and per-protocol populations. If non-inferiority is shown, superiority is tested hierarchically. Sensitivity analyses include a stratum-adjusted (Mantel-Haenszel) risk difference and logistic regression adjusted for stratum, age, BMI, duration of surgery and operating-room temperature. Temperature over time is analysed with a linear mixed model. Secondary outcomes are exploratory.

Being tested
Forced-air warming, Resistive conductive warming
Keywords
forced-air warming, resistive warming, conductive warming, patient warming, Bair Hugger, HotDog, zero-heat-flux thermometry, postoperative shivering, thermal comfort, general anaesthesia, non-inferiority
Medical subject headings
Hypothermia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Forced-air warmingDevice

    Also called Bair Hugger

    Convective active warming system blowing warmed air through a disposable upper- or lower-body blanket (Bair Hugger, Solventum, formerly 3M), set to 43 °C, from induction of anaesthesia until the end of surgery.

  • Resistive conductive warmingDevice

    Also called HotDog

    Air-free resistive polymer warming mattress placed under the patient, transferring heat by direct contact (HotDog, Augustine Surgical), set to 42 °C, from induction of anaesthesia until the end of surgery.

Study groups in NCT07909252
Study groupRoleWhat they receive
Forced-air warming (Bair Hugger)Active comparatorForced-air warming with a Bair Hugger upper- or lower-body blanket (according to surgical site), set to 43 °C, started immediately after induction of general anaesthesia and continued until the end of surgery. Passive reflective-blanket insulation before induction and during transfer to PACU.
Receives: Device: Forced-air warming
Resistive warming (HotDog)ExperimentalResistive conductive warming with a HotDog underbody mattress, set to 42 °C, started immediately after induction of general anaesthesia and continued until the end of surgery. Passive reflective-blanket insulation before induction and during transfer to PACU.
Receives: Device: Resistive conductive warming

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of hypothermia on PACU arrival

    Proportion of patients with core temperature < 36.0 °C measured by zero-heat-flux thermometry (3M SpotOn). Non-inferiority margin for the risk difference (resistive minus forced-air): 7.5 percentage points.

    Measured: Onf arrival in the PACU max up to 5 minutes from arrival

Secondary outcomes (10)
  1. Core temperature at end of surgery

    Core temperature (°C) measured by zero-heat-flux thermometry (3M SpotOn).

    Measured: At completion of skin closure up to 10 minutes from skin closure

  2. Postoperative shivering

    Incidence (BSAS >= 1) and severity (highest Bedside Shivering Assessment Scale score, 0-3; higher score = more severe shivering).

    Measured: From PACU arrival to PACU discharge, assessed every 15 minutes (up to 4 hours)

  3. Thermal comfort

    Patient-rated 5-point Likert scale (1 = very cold, 2 = cold, 3 = comfortable, 4 = warm, 5 = too hot).

    Measured: Once fully oriented in PACU (Aldrete score >= 9), up to 4 hours after arrival

  4. Subjective feeling of cold

    Proportion of patients answering "yes" to the question "Do you feel cold?".

    Measured: On PACU arrival (if able to respond) and when fully oriented in PACU (Aldrete score >= 9), up to 4 hours after arrival

  5. Objective signs of thermal discomfort

    Proportion of patients with at least one sign of cold discomfort assessed by a blinded observer (piloerection; cold, pale or mottled extremities; shivering; curling up or pulling blankets; request for blankets or warming). Signs of heat discomfort (sweating, flushing, uncovering) are recorded separately.

    Measured: On PACU arrival and when fully oriented in PACU (Aldrete score >= 9), up to 4 hours after arrival

  6. Lowest intraoperative core temperature

    Lowest core temperature (°C) recorded during surgery by zero-heat-flux thermometry.

    Measured: From induction of anaesthesia to end of surgery (assessed during surgery) up to 4 hours from start of the surgery

  7. Incidence of intraoperative hypothermia

    Proportion of patients with any core temperature < 36.0 °C during surgery.

    Measured: From induction of anaesthesia to end of surgery (assessed during surgery) maximum of 4 hours from start of the surgery

  8. Core temperature over time

    Core temperature (°C) at 15-minute intervals during surgery and at predefined PACU time points.

    Measured: From induction to end of surgery; PACU arrival, 30 minutes after arrival and PACU discharge (up to 4 hours)

  9. Length of PACU stay

    Time from PACU arrival to PACU discharge (minutes).

    Measured: From PACU arrival to discharge, up to 24 hours

  10. Warming-related adverse events

    Incidence of skin burns, pressure injury at the mattress site, hyperthermia > 38.0 °C and device malfunction.

    Measured: From start of warming to PACU discharge (up to 24 hours)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Nov 2026
  2. Study start1 Nov 2026 (estimated)
  3. Primary completion31 Oct 2027 (estimated)
  4. Study completion31 Oct 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomised 1:1 parallel-group non-inferiority trial, stratified by type of surgery.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
680 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07909252
Sponsor's protocol ID
KZ-KAPIM-HYPOTERM-2026
Acronym
WARM-NI
Status last verified
Oct 2026
First submitted
26 Oct 2026
Last updated
2 Nov 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data will not be shared. Aggregated results will be published in a peer-reviewed journal.

Publications

  • Madrid E, Urrutia G, Roque i Figuls M, Pardo-Hernandez H, Campos JM, Paniagua P, Maestre L, Alonso-Coello P. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Database Syst Rev. 2016 Apr 21;4(4):CD009016. doi: 10.1002/14651858.CD009016.pub2.

    PubMed 27098439
  • Sessler DI. Perioperative thermoregulation and heat balance. Lancet. 2016 Jun 25;387(10038):2655-2664. doi: 10.1016/S0140-6736(15)00981-2. Epub 2016 Jan 8.

    PubMed 26775126
  • Wongyingsinn M, Pookprayoon V. Incidence and associated factors of perioperative hypothermia in adult patients at a university-based, tertiary care hospital in Thailand. BMC Anesthesiol. 2023 Apr 25;23(1):137. doi: 10.1186/s12871-023-02084-2.

    PubMed 37098492
  • Okgun Alcan A, Aygun H, Kurt C. Resistive Warming Mattress, Forced-Air Warming System, or a Combination of the Two in the Prevention of Intraoperative Inadvertent Hypothermia: A Randomized Trial. J Perianesth Nurs. 2023 Aug;38(4):611-615. doi: 10.1016/j.jopan.2022.11.007. Epub 2023 Apr 6.

    PubMed 37031060
  • Sandoval MF, Mongan PD, Dayton MR, Hogan CA. Safety and efficacy of resistive polymer versus forced air warming in total joint surgery. Patient Saf Surg. 2017 Apr 14;11:11. doi: 10.1186/s13037-017-0126-0. eCollection 2017.

    PubMed 28416968
  • John M, Crook D, Dasari K, Eljelani F, El-Haboby A, Harper CM. Comparison of resistive heating and forced-air warming to prevent inadvertent perioperative hypothermia. Br J Anaesth. 2016 Feb;116(2):249-54. doi: 10.1093/bja/aev412.

    PubMed 26787794
  • Brandt S, Oguz R, Huttner H, Waglechner G, Chiari A, Greif R, Kurz A, Kimberger O. Resistive-polymer versus forced-air warming: comparable efficacy in orthopedic patients. Anesth Analg. 2010 Mar 1;110(3):834-8. doi: 10.1213/ANE.0b013e3181cb3f5f. Epub 2009 Dec 30.

    PubMed 20042442

Questions about this trial

What is this clinical trial studying?

A study testing Forced-air warming and Resistive conductive warming in people with Perioperative Hypothermia and Inadvertent Perioperative Hypothermia, run by Masarykova Nemocnice v Usti nad Labem, Krajska Zdravotni a.s. at 1 site in Czechia.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 2 Nov 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Czechia. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Michal Kalina, MD, PhD, MBA (+420773628756, michal.kalina@kzcr.eu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of hypothermia on PACU arrival (time frame: Onf arrival in the PACU max up to 5 minutes from arrival). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07909252, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Nov 2026.

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