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Respuestas clínicas Cochrane

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Study flow diagram
Figuras y tablas -
Figure 1

Study flow diagram

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

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Forest plot of comparison: 2 Core temperature, outcome: 2.1 Change in core temperature
Figuras y tablas -
Figure 4

Forest plot of comparison: 2 Core temperature, outcome: 2.1 Change in core temperature

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Forest plot of comparison: 2 Core temperature, outcome: 2.2 Change in core temperature for low risk of bias studies
Figuras y tablas -
Figure 5

Forest plot of comparison: 2 Core temperature, outcome: 2.2 Change in core temperature for low risk of bias studies

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Forest plot of comparison: 1 Core temperature, outcome: 1.5 Change in core temperature in heated, humidified vs cold groups with OR > 120 Minutes
Figuras y tablas -
Figure 6

Forest plot of comparison: 1 Core temperature, outcome: 1.5 Change in core temperature in heated, humidified vs cold groups with OR > 120 Minutes

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Forest plot of comparison: 2 Core temperature, outcome: 2.3 Change in core temperature in heated, humidified vs cold groups with external warming
Figuras y tablas -
Figure 7

Forest plot of comparison: 2 Core temperature, outcome: 2.3 Change in core temperature in heated, humidified vs cold groups with external warming

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Forest plot of comparison: 1 Core temperature, outcome: 1.4 Change in temperature in heated, humidified vs cold groups without external warming
Figuras y tablas -
Figure 8

Forest plot of comparison: 1 Core temperature, outcome: 1.4 Change in temperature in heated, humidified vs cold groups without external warming

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Forest plot of comparison: 1 Pain score, outcome: 1.1 Day 1 pain score
Figuras y tablas -
Figure 9

Forest plot of comparison: 1 Pain score, outcome: 1.1 Day 1 pain score

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Forest plot of comparison: 1 Pain score, outcome: 1.3 Day 1 pain score for low risk of bias study
Figuras y tablas -
Figure 10

Forest plot of comparison: 1 Pain score, outcome: 1.3 Day 1 pain score for low risk of bias study

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Forest plot of comparison: 1 Pain score, outcome: 1.2 Day 2 pain score
Figuras y tablas -
Figure 11

Forest plot of comparison: 1 Pain score, outcome: 1.2 Day 2 pain score

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Forest plot of comparison: 1 Pain score, outcome: 1.4 Day 2 pain score of low risk of bias studies
Figuras y tablas -
Figure 12

Forest plot of comparison: 1 Pain score, outcome: 1.4 Day 2 pain score of low risk of bias studies

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Forest plot of comparison: 3 Morphine consumption, outcome: 3.1 Up to 6 hours
Figuras y tablas -
Figure 13

Forest plot of comparison: 3 Morphine consumption, outcome: 3.1 Up to 6 hours

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Forest plot of comparison: 3 Morphine consumption, outcome: 3.2 Day 1 morphine
Figuras y tablas -
Figure 14

Forest plot of comparison: 3 Morphine consumption, outcome: 3.2 Day 1 morphine

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Forest plot of comparison: 3 Morphine consumption, outcome: 3.3 Day 2 morphine
Figuras y tablas -
Figure 15

Forest plot of comparison: 3 Morphine consumption, outcome: 3.3 Day 2 morphine

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Forest plot of comparison: 4 Hospital stay, outcome: 4.1 Hospital stay
Figuras y tablas -
Figure 16

Forest plot of comparison: 4 Hospital stay, outcome: 4.1 Hospital stay

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Forest plot of comparison: 7 Recovery room stay, outcome: 7.1 Recovery time
Figuras y tablas -
Figure 17

Forest plot of comparison: 7 Recovery room stay, outcome: 7.1 Recovery time

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Forest plot of comparison: 7 Recovery room stay, outcome: 7.2 Recovery time for low risk of bias studies
Figuras y tablas -
Figure 18

Forest plot of comparison: 7 Recovery room stay, outcome: 7.2 Recovery time for low risk of bias studies

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Forest plot of comparison: 5 Lens fogging, outcome: 5.1 Lens fogging
Figuras y tablas -
Figure 19

Forest plot of comparison: 5 Lens fogging, outcome: 5.1 Lens fogging

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Forest plot of comparison: 6 Operative time, outcome: 6.1 Operative time
Figuras y tablas -
Figure 20

Forest plot of comparison: 6 Operative time, outcome: 6.1 Operative time

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Funnel plot of comparison: 2 Core temperature, outcome: 2.1 Change in core temperature
Figuras y tablas -
Figure 21

Funnel plot of comparison: 2 Core temperature, outcome: 2.1 Change in core temperature

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Funnel plot of comparison: 1 Pain Score, outcome: 1.1 Day 1 pain score
Figuras y tablas -
Figure 22

Funnel plot of comparison: 1 Pain Score, outcome: 1.1 Day 1 pain score

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Funnel plot of comparison: 3 Morphine consumption, outcome: 3.2 Day 1 morphine
Figuras y tablas -
Figure 23

Funnel plot of comparison: 3 Morphine consumption, outcome: 3.2 Day 1 morphine

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Funnel plot of comparison: 4 Hospital stay, outcome: 4.1 Hospital stay
Figuras y tablas -
Figure 24

Funnel plot of comparison: 4 Hospital stay, outcome: 4.1 Hospital stay

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Funnel plot of comparison: 6 Operative time, outcome: 6.1 Operative time
Figuras y tablas -
Figure 25

Funnel plot of comparison: 6 Operative time, outcome: 6.1 Operative time

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Comparison 1 Core temperature (ºC), Outcome 1 Change in core temperature.
Figuras y tablas -
Analysis 1.1

Comparison 1 Core temperature (ºC), Outcome 1 Change in core temperature.

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Comparison 1 Core temperature (ºC), Outcome 2 Change in core temperature for low risk of bias studies.
Figuras y tablas -
Analysis 1.2

Comparison 1 Core temperature (ºC), Outcome 2 Change in core temperature for low risk of bias studies.

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Comparison 1 Core temperature (ºC), Outcome 3 Change in core temperature for operations > 120 Minutes.
Figuras y tablas -
Analysis 1.3

Comparison 1 Core temperature (ºC), Outcome 3 Change in core temperature for operations > 120 Minutes.

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Comparison 1 Core temperature (ºC), Outcome 4 Change in core temperature with external warming.
Figuras y tablas -
Analysis 1.4

Comparison 1 Core temperature (ºC), Outcome 4 Change in core temperature with external warming.

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Comparison 1 Core temperature (ºC), Outcome 5 Change in temperature without external warming.
Figuras y tablas -
Analysis 1.5

Comparison 1 Core temperature (ºC), Outcome 5 Change in temperature without external warming.

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Comparison 2 Pain score (0 to 10‐point VAS scale), Outcome 1 Day 1 pain score.
Figuras y tablas -
Analysis 2.1

Comparison 2 Pain score (0 to 10‐point VAS scale), Outcome 1 Day 1 pain score.

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Comparison 2 Pain score (0 to 10‐point VAS scale), Outcome 2 Day 1 pain score for low risk of bias studies.
Figuras y tablas -
Analysis 2.2

Comparison 2 Pain score (0 to 10‐point VAS scale), Outcome 2 Day 1 pain score for low risk of bias studies.

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Comparison 2 Pain score (0 to 10‐point VAS scale), Outcome 3 Day 2 pain score.
Figuras y tablas -
Analysis 2.3

Comparison 2 Pain score (0 to 10‐point VAS scale), Outcome 3 Day 2 pain score.

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Comparison 2 Pain score (0 to 10‐point VAS scale), Outcome 4 Day 2 pain score of low risk of bias studies.
Figuras y tablas -
Analysis 2.4

Comparison 2 Pain score (0 to 10‐point VAS scale), Outcome 4 Day 2 pain score of low risk of bias studies.

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Comparison 3 Morphine consumption (morphine equivalent daily doses), Outcome 1 Up to 6 hours.
Figuras y tablas -
Analysis 3.1

Comparison 3 Morphine consumption (morphine equivalent daily doses), Outcome 1 Up to 6 hours.

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Comparison 3 Morphine consumption (morphine equivalent daily doses), Outcome 2 Day 1 morphine.
Figuras y tablas -
Analysis 3.2

Comparison 3 Morphine consumption (morphine equivalent daily doses), Outcome 2 Day 1 morphine.

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Comparison 3 Morphine consumption (morphine equivalent daily doses), Outcome 3 Day 2 morphine.
Figuras y tablas -
Analysis 3.3

Comparison 3 Morphine consumption (morphine equivalent daily doses), Outcome 3 Day 2 morphine.

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Comparison 4 Hospital stay (days), Outcome 1 Hospital stay.
Figuras y tablas -
Analysis 4.1

Comparison 4 Hospital stay (days), Outcome 1 Hospital stay.

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Comparison 5 Recovery room stay (minutes), Outcome 1 Recovery time.
Figuras y tablas -
Analysis 5.1

Comparison 5 Recovery room stay (minutes), Outcome 1 Recovery time.

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Comparison 5 Recovery room stay (minutes), Outcome 2 Recovery time for low risk of bias studies.
Figuras y tablas -
Analysis 5.2

Comparison 5 Recovery room stay (minutes), Outcome 2 Recovery time for low risk of bias studies.

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Comparison 6 Lens fogging, Outcome 1 Times cleaned.
Figuras y tablas -
Analysis 6.1

Comparison 6 Lens fogging, Outcome 1 Times cleaned.

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Comparison 7 Operative time (minutes), Outcome 1 Operative time.
Figuras y tablas -
Analysis 7.1

Comparison 7 Operative time (minutes), Outcome 1 Operative time.

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Summary of findings for the main comparison. Core temperature

Heated CO2 with or without humidification for laparoscopic abdominal surgery

Patient or population: Laparoscopic abdominal surgery (core temperature)
Setting: Operating room
Intervention: Heated gas
Comparison: Cold gas

Outcomes

Anticipated absolute effects* (95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with cold gas

Risk with heated gas

Change in core temperature (ºC)

The mean change in core temperature was ‐0.22 °C

The mean change in core temperature in the intervention group was 0.21 °C higher (0.06 to 0.36)

1100
(19 RCTs)

⨁⨁◯◯
LOW 1 2

Negative temperature indicates core temperature dropped during surgery

Change in core temperature: heated, humidified vs cold

The mean change in core temperature: heated, humidified vs cold was ‐0.25 °C

The mean change in core temperature: heated, humidified vs cold in the intervention group was 0.31 °C higher (0.09 to 0.53)

885
(14 RCTs)

⨁⨁◯◯
LOW 1 2

Change in core temperature: heated only vs cold

The mean change in core temperature: heated vs cold was ‐0.19 °C

The mean change in core temperature: heated vs cold in the intervention group was 0.02 °C higher (‐0.16 to 0.20)

215
(7 RCTs)

⨁⨁◯◯
LOW 1 2

Change in core temperature for known low risk of bias studies

The mean change in core temperature for low risk of bias studies was ‐0.10 °C

The mean change in core temperature for low risk of bias studies in the intervention group was 0.16 °C higher (‐0.01 to 0.33)

653
(10 RCTs)

⨁⨁⨁◯
MODERATE4

Change in core temperature for known low risk of bias studies: heated, humidified vs cold

The mean change in core temperature for low risk of bias studies: heated, humidified vs cold was ‐0.09 °C

The mean change in core temperature for low risk of bias studies: heated, humidified vs cold in the intervention group was 0.18 °C higher (‐0.04 to 0.39)

561
(8 RCTs)

⨁⨁⨁◯
MODERATE4

Change in core temperature for low risk of bias studies: heated only vs cold

The mean change in core temperature for low risk of bias studies: heated vs cold was ‐0.10 °C

The mean change in core temperature for low risk of bias studies: heated vs cold in the intervention group was 0.12 °C higher (‐0.15 to 0.39)

92
(3 RCTs)

⨁⨁⨁◯
MODERATE 2

Change in core temperature with external warming

The mean change in core temperature with external warming was ‐0.14 °C

The mean change in core temperature with external warming in the intervention group was 0.29 °C higher (0.05 to 0.52)

545
(8 RCTs)

⨁⨁⨁◯
MODERATE1

Change in core temperature without external warming

The mean change in core temperature without external warming was ‐0.40 °C

The mean change in core temperature without external warming in the intervention group was 0.32 °C higher (‐0.11 to 0.75)

340
(6 RCTs)

⨁⨁⨁◯
MODERATE1

Change in core temperature for operations > 120 min

The mean change in core temperature for operations > 120 min was ‐0.74 °C

The mean change in core temperature for operations > 120 min in the intervention group was 0.70 °C higher (0.10 to 1.30)

194
(4 RCTs)

⨁⨁⨁◯
MODERATE 1

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

  1. Risk of bias not clear

  2. Inconsistent effect

  3. Low‐risk studies only

  4. Wide confidence intervals
Figuras y tablas -
Summary of findings for the main comparison. Core temperature
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Summary of findings 2. Pain score

Heated CO2 with or without humidification for laparoscopic abdominal surgery

Patient or population: Laparoscopic abdominal surgery (pain score)
Setting: Hospital
Intervention: Heated gas
Comparison: Cold gas

Outcomes

Anticipated absolute effects* (95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with cold gas

Risk with heated gas

Day 1 pain score (0 to 10‐point VAS)

The mean day 1 pain score was 2.8

The mean day 1 pain score in the intervention group was 0.04 fewer (‐0.42 to 0.34)

991
(14 RCTs)

⨁⨁◯◯
LOW 1 2

Higher score indicates more pain for participants

Day 1 pain score: heated, humidified vs cold (abdominal)

The mean day 1 pain score: heated, humidified vs cold (abdominal) was 4

The mean day 1 pain score: heated, humidified vs cold (abdominal) in the intervention group was 0.14 fewer (‐0.6 to 0.33)

670
(10 RCTs)

⨁⨁◯◯
LOW 1 2

Day 1 pain score: heated, humidified vs cold (shoulder)

The mean day 1 pain score: heated, humidified vs cold (shoulder) was 2

The mean day 1 pain score: heated, humidified vs cold (shoulder) in the intervention group was 0.35 fewer (‐1.75 to 1.05)

171
(3 RCTs)

⨁◯◯◯
VERY LOW 1 2 4

Day 1 pain score: heated only vs cold

The mean day 1 pain score: heated vs cold was 2.8

The mean day 1 pain score: heated vs cold in the intervention group was 0.5 more (‐0.11 to 1.12)

150
(3 RCTs)

⨁⨁⨁◯
MODERATE 1

Day 2 pain score

The mean day 2 pain score was 2.2

The mean day 2 pain score in the intervention group was 0.28 fewer (‐0.78 to 0.21)

695
(10 RCTs)

⨁⨁◯◯
LOW 1 2

Day 2 pain score: heated, humidified vs cold (abdominal)

The mean day 2 pain score: heated, humidified vs cold (abdominal) was 3.2

The mean day 2 pain score: heated, humidified vs cold (abdominal) in the intervention group was 0.4 fewer (‐1.07 to 0.28)

442
(7 RCTs)

⨁⨁◯◯
LOW 1 2

Day 2 pain score: heated, humidified vs cold (shoulder)

The mean day 2 pain score: heated, humidified vs cold (shoulder) was 1.5

The mean day 2 pain score: heated, humidified vs cold (shoulder) in the intervention group was 0.88 fewer (‐2.93 to 1.17)

111
(2 RCTs)

⨁◯◯◯
VERY LOW 1 2 4

Day 2 pain score: heated only vs cold

The mean day 2 pain score: heated vs cold was 1.9

The mean day 2 pain score: heated vs cold in the intervention group was 0.41 more (‐0.44 to 1.27)

142
(3 RCTs)

⨁⨁◯◯
LOW 1 2

Day 1 pain score for low risk of bias studies

The mean day 1 pain score for low risk of bias studies was 2.7

The mean day 1 pain score for low risk of bias studies in the intervention group was 0.17 more (‐0.21 to 0.55)

570
(7 RCTs)

⨁⨁⨁⨁
HIGH3

Day 1 pain score for low risk of bias studies: heated, humidified vs cold (abdominal)

The mean day 1 pain score for low risk of bias studies: heated, humidified vs cold (abdominal) was 4.3

The mean day 1 pain score for low risk of bias studies: heated, humidified vs cold (abdominal) in the intervention group was 0.17 more (‐0.29 to 0.63)

460
(7 RCTs)

⨁⨁⨁⨁
HIGH3

Day 1 pain score for low risk of bias studies: heated, humidified vs cold (shoulder)

The mean day 1 pain score for low risk of bias studies: heated, humidified vs cold (shoulder) was 1.2

The mean day 1 pain score for low risk of bias studies: heated, humidified vs cold (shoulder) in the intervention group was 0.25 more (‐0.81 to 1.31)

110
(2 RCTs)

⨁⨁⨁◯
MODERATE 4

Day 2 pain score for low risk of bias studies

The mean day 2 pain score for low risk of bias studies was 3.5

The mean day 2 pain score for low risk of bias studies in the intervention group was 0.29 fewer (‐0.65 to 0.07)

380
(5 RCTs)

⨁⨁⨁⨁
HIGH3

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

  1. Risk of bias not clear

  2. Inconsistent effect

  3. Low‐risk studies only

  4. Wide confidence intervals
Figuras y tablas -
Summary of findings 2. Pain score
Ir a la tabla de la revisión
Summary of findings 3. Morphine consumption

Heated CO2 with or without humidification for laparoscopic abdominal surgery

Patient or population: Laparoscopic abdominal surgery (morphine consumption)
Setting: Post‐operative
Intervention: Heated gas
Comparison: Cold gas

Outcomes

Anticipated absolute effects* (95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with cold gas

Risk with heated gas

Up to 6 h

The mean up to 6 h morphine consumption was 12.6 mg

The mean up to 6 h in the intervention group was 0.45 mg more (‐1.19 to 2.08)

231
(4 RCTs)

⨁⨁⨁◯
MODERATE 1

Morphine consumption was presented as equivalent daily dose

Day 1 morphine

The mean day 1 morphine consumption was 32.4 mg

The mean day 1 morphine consumption in the intervention group was 0.64 mg less (‐4.48 to 3.20)

573
(9 RCTs)

⨁⨁⨁◯
MODERATE 1

Day 1 morphine: heated, humidified vs cold

The mean day 1 morphine consumption: heated, humidified vs cold was 31.2 mg

The mean day 1 morphine consumption: heated, humidified vs cold in the intervention group was 1.66 mg less (‐4.79 to 1.46)

481
(7 RCTs)

⨁⨁◯◯
LOW 14

Day 1 morphine: heated only vs cold

The mean day 1 morphine consumption: heated vs cold was 33.6 mg

The mean day 1 morphine consumption: heated vs cold in the intervention group was 11.93 mg more (0.92 to 22.94)

92
(3 RCTs)

⨁⨁◯◯
LOW 12

Day 2 morphine

The mean day 2 morphine consumption was 22.1 mg

The mean day 2 morphine consumption in the intervention group was 0.61 mg less (‐2.79 to 1.57)

532
(7 RCTs)

⨁⨁⨁◯
MODERATE 1

Day 2 morphine: heated, humidified vs cold

The mean day 2 morphine consumption ‐ Heated, humidified vs cold was 21.3 mg

The mean day 2 morphine consumption: heated, humidified vs cold in the intervention group was 0.94 mg less (‐1.9 to 0.01)

410
(6 RCTs)

⨁⨁⨁◯
MODERATE 1

Day 2 morphine: heated only vs cold

The mean day 2 morphine consumption: heated vs cold was 23 mg

The mean day 2 morphine consumption: heated vs cold in the intervention group was 9.79 mg more (1.58 to 18.00)

122
(2 RCTs)

⨁⨁◯◯
LOW 12

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1. Risk of bias not clear
2. Wide confidence intervals

Figuras y tablas -
Summary of findings 3. Morphine consumption
Ir a la tabla de la revisión
Summary of findings 4. Hospital stay

Heated CO2 with or without humidification for laparoscopic abdominal surgery

Patient or population: Laparoscopic abdominal surgery (hospital stay)
Setting: Hospital
Intervention: Heated gas
Comparison: Cold gas

Outcomes

Anticipated absolute effects* (95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with cold gas

Risk with heated gas

Hospital stay (days)

The mean hospital stay was 2.7 days

The mean hospital stay in the intervention group was 0.06 days less (‐0.31 to 0.19)

685
(10 RCTs)

⨁⨁⨁◯
MODERATE 1

Hospital stay: heated, humidified vs cold

The mean hospital stay: heated, humidified vs cold was 2.9 days

The mean hospital stay: heated, humidified vs cold in the intervention group was 0.13 days less (‐0.44 to 0.18)

563
(9 RCTs)

⨁⨁⨁◯
MODERATE 1

Hospital stay: heated only vs cold

The mean hospital stay: heated vs cold was 2.6 days

The mean hospital stay: heated vs cold in the intervention group was 0.20 days more (‐0.23 to 0.62)

122
(2 RCTs)

⨁⨁⨁◯
MODERATE 1

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1. Risk of bias not clear
Figuras y tablas -
Summary of findings 4. Hospital stay
Ir a la tabla de la revisión
Summary of findings 5. Recovery time

Heated CO2 with or without humidification for laparoscopic abdominal surgery

Patient or population: Laparoscopic abdominal surgery (recovery time)
Setting: Hospital
Intervention: Heated gas
Comparison: Cold gas

Outcomes

Anticipated absolute effects* (95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with cold gas

Risk with heated gas

Recovery time (minutes)

The mean recovery time was 106.8 min

The mean recovery time in the intervention group was 26.79 min less (‐51.34 to ‐2.25)

327
(6 RCTs)

⨁⨁◯◯
LOW 12

Recovery time for low risk of bias studies

The mean recovery time for low risk of bias studies was 90.1 min

The mean recovery time for low risk of bias studies in the intervention group was 1.22 min less (‐6.62 to 4.17)

277
(5 RCTs)

⨁⨁⨁◯
MODERATE2

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1. Risk of bias not clear
2. Wide confidence intervals

Figuras y tablas -
Summary of findings 5. Recovery time
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Summary of findings 6. Lens fogging

Heated CO2 with or without humidification for laparoscopic abdominal surgery

Patient or population: Laparscopic abdominal surgery (lens fogging)
Setting: Operating room
Intervention: Heated Gas
Comparison: Cold Gas

Outcomes

Anticipated absolute effects* (95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with cold gas

Risk with heated gas

Times cleaned

The mean frequency of cleaning was 1.8 times

The mean times cleaned in the intervention group was 0.73 times more (‐0.32 to 1.77)

341
(7 RCTs)

⨁⨁◯◯
LOW 1 2

The frequency of lens cleaning during surgery

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1. Risk of bias not clear
2. Inconsistent effect

Figuras y tablas -
Summary of findings 6. Lens fogging
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Summary of findings 7. Operative time

Heated CO2 with or without humidification for laparoscopic abdominal surgery

Patient or population: Laparoscopic abdominal surgery (operative time)
Setting: Operating room
Intervention: Heated gas
Comparison: Cold gas

Outcomes

Anticipated absolute effects* (95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with cold gas

Risk with heated gas

Operative time (minutes)

The mean operative time was 76.6 min

The mean operative time in the intervention group was 0.44 min less (‐3.91 to 3.04)

1318
(20 RCTs)

⨁◯◯◯
VERY LOW 1 2 3

Operative time: heated, humidified vs cold

The mean operative time: heated, humidified vs cold was 94.3 min

The mean operative time: heated, humidified vs cold in the intervention group was 2.01 min less (‐7.15 to 3.13)

1033
(15 RCTs)

⨁◯◯◯
VERY LOW 1 2 3

Operative time: heated only vs cold

The mean operative time: heated vs cold was 58.8 min

The mean operative time: heated vs cold in the intervention group was 0.91 min more (‐4.02 to 5.83)

285
(7 RCTs)

⨁⨁◯◯
LOW 13

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1. Risk of bias not clear
2. Inconsistent effect
3. Wide confidence intervals

Figuras y tablas -
Summary of findings 7. Operative time
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Table 1. Demographics of included studies

Study

Number of participants

Mean age (years)

% Female

Mean BMI (kg/m2) or weight (kg)

Agaev 2013

150

52

72.7

Backlund 1998

26

49W/53C

42.3

25W/25C (BMI)

Champion 2006

50

41.5WH/44C

86

50W/52.9C (BMI)

Davis 2006

44

42.3WH/40.6W/44.8H/42.5C

47.2WH/49.1W/48.5H/52.4C (BMI)

Demco 2001

40

100

Farley 2004

117 (16 excluded)

52

68.3

29.5W/29.7C (BMI)

Hamza 2005

50 (6 excluded)

44WH/45C

89.1

125W/128C (weight)

Kissler 2004

90 (53 with data)

37WH/33W/36C

100

63WH/63W/65C (weight)

Klugsberger 2014

148

55.7

69.6

28.56 (BMI)

Lee 2011

30

60.1W/55.1C

36.7

Manwaring 2008

60

30WH/30C

100

25W/24C (BMI)

Mouton 1999

32

23‐89 (range)

Nelskyla 1999

37

46W/47C

100

63W/66C (weight)

Nguyen 2002

20

43WH/45C

45

Ott 1998

72 (50 with data)

100

Puttick 1999

30

46.2W/53.7C

Saad 2000

20

62W/51C

60

75W/83C (weight)

Sammour 2010

82 (8 excluded)

71WH/69C

57.1W/59C

26.5W/25.5C (BMI)

Savel 2005

30

41WH/39C

80

50.6W/52.3C (BMI)

Slim 1999

108 (8 excluded)

52W/53C

58

26.9W/25.7C (BMI)

Wills 2001

41 (1 excluded)

47.5W/52.2C

45

27W/29.2C (BMI)

Yu 2013

195 (5 excluded)

12

36.8

49.6W/50.3C (weight)

W = warmed cohort, C = cold cohort, H = humidified cohort, WH = warmed and humidified cohort

Figuras y tablas -
Table 1. Demographics of included studies
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Table 2. Methodology of included studies

Study

Procedures

Method of temperature measurement

Insufflation gas

Gas temperature (°C)

Heating device

Humidification (%)

Duration of surgery (minutes)

External warming

Agaev 2013

110 laparoscopic cholecystectomy, 40 laparoscopic fundoplication

Carbon dioxide

WISAP Flow Thermo

Not specified

42WH/56C

None

Backlund 1998

Laparoscopic fundoplication, hernioplasty, sigmoid colon resection, rectopexy

Pulmonary artery catheter

Carbon dioxide

37

WISAP Flow Thermo

None

161W/163C

Warm blanket/ warm waterbath mattress

Champion 2006

Laparoscopic Roux‐en‐Y gastric bypass

Rectal thermometer

Carbon dioxide

35

Lexion Insuflow

95

61.7WH/61.7C

None

Davis 2006

Laparoscopic Roux‐en‐Y gastric bypass

Foley catheter for bladder temperature

Carbon dioxide

37

Lexion Insuflow

95

78‐84 (range)

None

Demco 2001

Awake laparoscopy

Carbon dioxide

35

Lexion Insuflow

95

None

Farley 2004

Laparoscopic cholecystectomy

Oesophageal probe

Carbon dioxide

35

Lexion Insuflow

95

91.2

Bair Hugger forced air warmer (32 °CW/34 °C C)

Hamza 2005

Laparoscopic Roux‐en‐Y gastric bypass

Oesophageal/ tympanic membrane

Carbon dioxide

37

Lexion Insuflow

95

120WH/132C

Warm cotton blankets

Kissler 2004

Laparoscopic gynaecologic surgery

Intravesical temperature

Carbon dioxide

38

Laparo‐CO2‐Pneu2232

95‐100

62WH/51W/45C

None

Klugsberger 2014

Laparoscopic cholecystectomy

Rectal probe

Carbon dioxide

35

Storz Optitherm

95

63.88

None

Lee 2011

Laparoscopic low anterior resection, colectomy, gastrectomy

Oesophageal temperature probe

Carbon dioxide

37

WISAP Flow Thermo

None

212W/230C

Bair Hugger forced air warmer/ warming mattress with circulating water at 38 °C

Manwaring 2008

49 laparoscopy for endometriosis, 16 laparoscopy for adhesions

Carbon dioxide

37

Fisher & Paykel

100

49.6WH/46.8C

Upper body warming blanket

Mouton 1999

Laparoscopic cholecystectomy

Oesophageal thermoresistor

Carbon dioxide

34‐37

LINS‐1000

88‐90

40WH/48.3WH

None

Nelskyla 1999

Laparoscopic hysterectomy

Tympanic and nasopharyngeal infrared technique

Carbon dioxide

37

None

56W/51C

None

Nguyen 2002

Laparoscopic Nissen fundoplication

Oesophageal probe

Carbon dioxide

37

Georgia BioMedical Insuflow

95

35.6WH/35.6C

Bair Hugger forced air warmer

Ott 1998

Laparoscopic gynaecologic surgery

Endotracheal temperature probe

Carbon dioxide

36.2

Insuflow

95

38‐262 (range)

None

Puttick 1999

Laparoscopic cholecystectomy

Oesophageal probe

Carbon dioxide

37

WISAP Flow Thermo

None

31.5W/32.1C

None

Saad 2000

Laparoscopic cholecystectomy

Oesophageal probe

Carbon dioxide

37

WISAP Flow Thermo

None

56W/61C

None

Sammour 2010

Laparoscopic colon resection

Oesophageal probe

Carbon dioxide

37

Fisher & Paykel

98

176.3WH/184.7C

Bair Hugger forced air warmer

Savel 2005

Laparoscopic Roux‐en‐Y gastric bypass

Oesophageal probe

Carbon dioxide

35

Lexion Insuflow

95

76WH/101C

Bair Hugger forced air warmer at discretion of blinded anaesthesiologist

Slim 1999

Laparoscopic cholecystectomy, fundoplication, myotomy

Subdiaphragmatic thermometric probe

Carbon dioxide

37

ThermoFlator

None

73W/67C

None

Wills 2001

Laparoscopic fundoplication

Nasopharyngeal thermistor

Carbon dioxide

37

Cook LINS‐2000

None

69W/72C

Bair Hugger forced air warmer

Yu 2013

Laparoscopic appendectomy

Naso‐oesophageal probe

Carbon dioxide

37

Fisher & Paykel

98

69.8WH/71.6C

Forced‐air warming blanket

W = warmed cohort, C = cold cohort, H = humidified cohort, WH = warmed and humidified cohort

Figuras y tablas -
Table 2. Methodology of included studies
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Table 3. Outcomes of included studies

Study

Mean change in core temperature (°C)

Adverse events (Clavien‐Dindo ≥ III)

Heated and humidified

Heated only

Cold

Heated and humidified

Heated only

Cold

Agaev 2013

0.49

‐0.06

Not reported

Not reported

Backlund 1998

0.2

‐0.1

Not reported

Not reported

Champion 2006

‐0.4

‐0.4

Not reported

Not reported

Davis 2006

0.4

0.2

0.4

Not reported

Not reported

Not reported

Demco 2001

Not reported

Not reported

Not reported

Not reported

Farley 2004

0.29

‐0.03

Not reported

Not reported

Hamza 2005

‐0.7

‐1.7

Not reported

Not reported

Kissler 2004

‐0.5

‐0.6

‐0.4

Not reported

Not reported

Not reported

Klugsberger 2014

Not reported

Not reported

0

0

Lee 2011

‐0.4

‐0.7

Not reported

Not reported

Manwaring 2008

‐0.2

‐0.13

Not reported

Not reported

Mouton 1999

‐0.25

‐0.3

0

0

Nelskyla 1999

‐0.2

0

Not reported

Not reported

Nguyen 2002

0.4

0.3

0

0

Ott 1998

‐0.3

‐1.64

0

0

Puttick 1999

‐0.24

‐0.42

Not reported

Not reported

Saad 2000

0

‐0.1

Not reported

Not reported

Sammour 2010

0.64

0.48

3 (8.6%)

5 (12.8%)

Savel 2005

0.4

‐0.3

Not reported

Not reported

Slim 1999

Not reported

Not reported

0

0

Wills 2001

0.2

0

0

1 (4.8%)

Yu 2013

0.1

0.1

3 (10.3%)

0
Figuras y tablas -
Table 3. Outcomes of included studies
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Comparison 1. Core temperature (ºC)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Change in core temperature Show forest plot

19

1100

Mean Difference (IV, Random, 95% CI)

0.21 [0.06, 0.36]

1.1 Heated, humidified vs cold

14

885

Mean Difference (IV, Random, 95% CI)

0.31 [0.09, 0.53]

1.2 Heated only vs cold

7

215

Mean Difference (IV, Random, 95% CI)

0.02 [‐0.16, 0.20]

2 Change in core temperature for low risk of bias studies Show forest plot

10

653

Mean Difference (IV, Random, 95% CI)

0.16 [‐0.01, 0.33]

2.1 Heated, humidified vs cold

8

561

Mean Difference (IV, Random, 95% CI)

0.18 [‐0.04, 0.39]

2.2 Heated vs cold

3

92

Mean Difference (IV, Random, 95% CI)

0.12 [‐0.15, 0.39]

3 Change in core temperature for operations > 120 Minutes Show forest plot

4

194

Mean Difference (IV, Random, 95% CI)

0.70 [0.10, 1.30]

4 Change in core temperature with external warming Show forest plot

8

545

Mean Difference (IV, Random, 95% CI)

0.29 [0.05, 0.52]

5 Change in temperature without external warming Show forest plot

6

340

Mean Difference (IV, Random, 95% CI)

0.32 [‐0.11, 0.75]
Figuras y tablas -
Comparison 1. Core temperature (ºC)
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Comparison 2. Pain score (0 to 10‐point VAS scale)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Day 1 pain score Show forest plot

14

991

Mean Difference (IV, Random, 95% CI)

‐0.04 [‐0.42, 0.34]

1.1 Heated, humidified vs cold (abdominal)

10

670

Mean Difference (IV, Random, 95% CI)

‐0.14 [‐0.60, 0.33]

1.2 Heated, humidified vs cold (shoulder)

3

171

Mean Difference (IV, Random, 95% CI)

‐0.35 [‐1.75, 1.05]

1.3 Heated vs cold

3

150

Mean Difference (IV, Random, 95% CI)

0.50 [‐0.11, 1.12]

2 Day 1 pain score for low risk of bias studies Show forest plot

7

570

Mean Difference (IV, Random, 95% CI)

0.17 [‐0.21, 0.55]

2.1 Heated, humidified vs cold (abdominal)

7

460

Mean Difference (IV, Random, 95% CI)

0.17 [‐0.29, 0.63]

2.2 Heated, humidified vs cold (shoulder)

2

110

Mean Difference (IV, Random, 95% CI)

0.25 [‐0.81, 1.31]

3 Day 2 pain score Show forest plot

10

695

Mean Difference (IV, Random, 95% CI)

‐0.28 [‐0.78, 0.21]

3.1 Heated, humidified vs cold (abdominal)

7

442

Mean Difference (IV, Random, 95% CI)

‐0.40 [‐1.07, 0.28]

3.2 Heated, humidified vs cold (shoulder)

2

111

Mean Difference (IV, Random, 95% CI)

‐0.88 [‐2.93, 1.17]

3.3 Heated vs cold

3

142

Mean Difference (IV, Random, 95% CI)

0.41 [‐0.44, 1.27]

4 Day 2 pain score of low risk of bias studies Show forest plot

5

380

Mean Difference (IV, Random, 95% CI)

‐0.29 [‐0.65, 0.07]
Figuras y tablas -
Comparison 2. Pain score (0 to 10‐point VAS scale)
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Comparison 3. Morphine consumption (morphine equivalent daily doses)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Up to 6 hours Show forest plot

4

231

Mean Difference (IV, Random, 95% CI)

0.45 [‐1.19, 2.08]

2 Day 1 morphine Show forest plot

9

573

Mean Difference (IV, Random, 95% CI)

‐0.64 [‐4.48, 3.20]

2.1 Heated, humidified vs cold

7

481

Mean Difference (IV, Random, 95% CI)

‐1.66 [‐4.79, 1.46]

2.2 Heated vs cold

3

92

Mean Difference (IV, Random, 95% CI)

11.93 [0.92, 22.94]

3 Day 2 morphine Show forest plot

7

532

Mean Difference (IV, Random, 95% CI)

‐0.61 [‐2.79, 1.57]

3.1 Heated, humidified vs cold

6

410

Mean Difference (IV, Random, 95% CI)

‐0.94 [‐1.90, 0.01]

3.2 Heated vs cold

2

122

Mean Difference (IV, Random, 95% CI)

9.79 [1.58, 18.00]
Figuras y tablas -
Comparison 3. Morphine consumption (morphine equivalent daily doses)
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Comparison 4. Hospital stay (days)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Hospital stay Show forest plot

10

685

Mean Difference (IV, Random, 95% CI)

‐0.06 [‐0.31, 0.19]

1.1 Heated, humidified vs cold

9

563

Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.44, 0.18]

1.2 Heated vs cold

2

122

Mean Difference (IV, Random, 95% CI)

0.20 [‐0.23, 0.62]
Figuras y tablas -
Comparison 4. Hospital stay (days)
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Comparison 5. Recovery room stay (minutes)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Recovery time Show forest plot

6

327

Mean Difference (IV, Random, 95% CI)

‐26.79 [‐51.34, ‐2.25]

2 Recovery time for low risk of bias studies Show forest plot

5

277

Mean Difference (IV, Random, 95% CI)

‐1.22 [‐6.62, 4.17]
Figuras y tablas -
Comparison 5. Recovery room stay (minutes)
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Comparison 6. Lens fogging

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Times cleaned Show forest plot

7

341

Mean Difference (IV, Random, 95% CI)

0.73 [‐0.32, 1.77]
Figuras y tablas -
Comparison 6. Lens fogging
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Comparison 7. Operative time (minutes)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Operative time Show forest plot

20

1318

Mean Difference (IV, Random, 95% CI)

‐0.44 [‐3.91, 3.04]

1.1 Heated, humidified vs cold

15

1033

Mean Difference (IV, Random, 95% CI)

‐2.01 [‐7.15, 3.13]

1.2 Heated vs cold

7

285

Mean Difference (IV, Random, 95% CI)

0.91 [‐4.02, 5.83]
Figuras y tablas -
Comparison 7. Operative time (minutes)
Ir a la tabla de la revisión