PDF(Pubmed)
Abstract：
BACKGROUND: Prehospital care for cold-stressed and hypothermic patients focuses on effective insulation and rewarming. When encountering patients wearing wet clothing, rescuers can either remove the wet clothing before isolating the patient or isolate the patient using a vapor barrier. Wet clothing removal increases skin exposure but avoids the need to heat the wet clothing during rewarming. Leaving wet clothing on will avoid skin exposure but is likely to increase heat loss during rewarming. This study aimed to evaluate the effect of wet clothing removal compared to containing the moisture using a vapor barrier on skin temperature in a prehospital setting.
METHODS: This randomized crossover experimental field study was conducted in a snow cave in Hemsedal, Norway. After an initial cooling phase of 30 min while wearing wet clothes, the participants were subjected to one of two rewarming scenarios: (1) wet clothing removal and wrapping in a vapor barrier, insulating blankets, and windproof outer shell (dry group) or (2) wrapping in a vapor barrier, insulating blankets, and windproof outer shell (wet group). The mean skin temperature was the primary outcome whereas subjective scores for both thermal comfort and degree of shivering were secondary outcomes. Primary outcome data were analyzed using the analysis of covariance (ANCOVA).
RESULTS: After an initial decrease in temperature during the exposure phase, the dry group had a higher mean skin temperature compared to the wet group after only 2 min. The skin-rewarming rate was highest in the initial rewarming stages for both groups, but increased in the dry group as compared to the wet group in the first 10 min. Return to baseline temperature occurred significantly faster in the dry group (mean 12.5 min [dry] vs. 28.1 min [wet]). No intergroup differences in the subjective thermal comfort or shivering were observed.
CONCLUSIONS: Removal of wet clothing in combination with a vapor barrier increases skin rewarming rate compared to encasing the wet clothing in a vapor barrier, in mild cold and environments without wind.
BACKGROUND: ClinicalTrials.gov ID NCT05996757, retrospectively registered 18/08/2023.
METHODS: This randomized crossover experimental field study was conducted in a snow cave in Hemsedal, Norway. After an initial cooling phase of 30 min while wearing wet clothes, the participants were subjected to one of two rewarming scenarios: (1) wet clothing removal and wrapping in a vapor barrier, insulating blankets, and windproof outer shell (dry group) or (2) wrapping in a vapor barrier, insulating blankets, and windproof outer shell (wet group). The mean skin temperature was the primary outcome whereas subjective scores for both thermal comfort and degree of shivering were secondary outcomes. Primary outcome data were analyzed using the analysis of covariance (ANCOVA).
RESULTS: After an initial decrease in temperature during the exposure phase, the dry group had a higher mean skin temperature compared to the wet group after only 2 min. The skin-rewarming rate was highest in the initial rewarming stages for both groups, but increased in the dry group as compared to the wet group in the first 10 min. Return to baseline temperature occurred significantly faster in the dry group (mean 12.5 min [dry] vs. 28.1 min [wet]). No intergroup differences in the subjective thermal comfort or shivering were observed.
CONCLUSIONS: Removal of wet clothing in combination with a vapor barrier increases skin rewarming rate compared to encasing the wet clothing in a vapor barrier, in mild cold and environments without wind.
BACKGROUND: ClinicalTrials.gov ID NCT05996757, retrospectively registered 18/08/2023.
摘要：
背景：冷应激和低体温患者的院前护理侧重于有效的保温和复温。当遇到穿着湿衣服的病人时，救援人员可以在隔离病人之前脱下湿衣服，或者使用蒸汽屏障隔离病人。湿衣服去除增加了皮肤暴露,但避免了在复温期间加热湿衣服的需要。将湿衣服放在上面可以避免皮肤暴露，但可能会增加复温过程中的热量损失。这项研究旨在评估在院前设置中，与使用蒸汽屏障容纳水分相比，湿衣去除对皮肤温度的影响。
方法：这项随机交叉实验现场研究是在Hemsedal的一个雪洞中进行的，挪威。在穿着湿衣服的30分钟的初始冷却阶段之后，参与者经历了两种复温方案之一：（1）脱湿衣服并包裹在蒸汽屏障中，绝缘毯,和防风外壳（干燥组）或（2）包裹在蒸汽屏障中，绝缘毯,和防风外壳（湿组）。平均皮肤温度是主要结果，而热舒适和颤抖程度的主观评分是次要结果。主要结果数据使用协方差分析(ANCOVA)进行分析。
结果：在暴露阶段温度初始降低后，仅2分钟后，干燥组的平均皮肤温度高于湿润组。两组的皮肤复温率在初始复温阶段最高，但在前10分钟，干燥组比湿润组增加。在干燥组中，恢复到基线温度的速度明显更快（平均12.5分钟[干燥]vs.28.1min[湿])。没有观察到主观热舒适或颤抖的组间差异。
结论：与将湿衣服包裹在蒸汽屏障中相比，去除湿衣服与蒸汽屏障的组合可增加皮肤复温率，在温和的寒冷和没有风的环境中。
背景：ClinicalTrials.govIDNCT05996757，回顾性注册18/08/2023。
方法：这项随机交叉实验现场研究是在Hemsedal的一个雪洞中进行的，挪威。在穿着湿衣服的30分钟的初始冷却阶段之后，参与者经历了两种复温方案之一：（1）脱湿衣服并包裹在蒸汽屏障中，绝缘毯,和防风外壳（干燥组）或（2）包裹在蒸汽屏障中，绝缘毯,和防风外壳（湿组）。平均皮肤温度是主要结果，而热舒适和颤抖程度的主观评分是次要结果。主要结果数据使用协方差分析(ANCOVA)进行分析。
结果：在暴露阶段温度初始降低后，仅2分钟后，干燥组的平均皮肤温度高于湿润组。两组的皮肤复温率在初始复温阶段最高，但在前10分钟，干燥组比湿润组增加。在干燥组中，恢复到基线温度的速度明显更快（平均12.5分钟[干燥]vs.28.1min[湿])。没有观察到主观热舒适或颤抖的组间差异。
结论：与将湿衣服包裹在蒸汽屏障中相比，去除湿衣服与蒸汽屏障的组合可增加皮肤复温率，在温和的寒冷和没有风的环境中。
背景：ClinicalTrials.govIDNCT05996757，回顾性注册18/08/2023。
