Peritoneal Lavage for Moderate to Severe Hypothermia
No, peritoneal lavage is not a first-line treatment for moderate to severe hypothermia—it is reserved 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
Treatment Algorithm by Severity
Moderate Hypothermia (28-32°C): First-Line Approaches
For moderate hypothermia, first-line treatment consists of active external rewarming combined with warmed IV fluids, NOT peritoneal lavage. 1, 3
- Remove wet clothing immediately and move to warm environment 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 1
- Administer warmed isotonic crystalloid (normal saline or Ringer's lactate) at 40-45°C, volumes of 500 mL to 30 mL/kg 3
- Provide humidified, warmed oxygen 1, 3
- Monitor core temperature every 5-15 minutes using esophageal or bladder catheter 1, 3
Severe Hypothermia (<28°C): When Peritoneal Lavage May Be Considered
Peritoneal lavage becomes an option only for severe hypothermia when the patient is hemodynamically unstable, in cardiac arrest, or when extracorporeal rewarming is unavailable. 2, 4
- Continue all measures for moderate hypothermia first 2
- Handle patient gently to avoid triggering ventricular fibrillation 2
- Consider active core rewarming methods including body cavity lavage only after external methods are initiated 5
- Peritoneal lavage with warm saline can be performed when extracorporeal life support (ECLS) is not available, particularly in cardiac arrest scenarios 4, 6
Critical Evidence on Peritoneal Lavage
The evidence demonstrates that peritoneal lavage is not standard first-line therapy but rather a salvage technique:
- A case report showed successful use of peritoneal lavage for a patient with 24°C core temperature and ventricular fibrillation when extracorporeal devices were unavailable 4
- Pediatric data suggests that active external rewarming can successfully manage profound hypothermia (<20°C) without invasive techniques like peritoneal lavage 6
- The treatment hierarchy clearly places peritoneal lavage after passive rewarming, active external rewarming, and warmed IV fluids 5
Rewarming Targets and Monitoring
- Target minimum core temperature of 36°C before considering the patient stable 1, 2
- Cease rewarming at 37°C, as higher temperatures are associated with poor outcomes 1, 2
- Monitor continuously for arrhythmias (particularly bradycardia and ventricular fibrillation), coagulopathy, rewarming shock, and electrolyte abnormalities 1, 3
Common Pitfalls
- Do not skip the hierarchy of rewarming methods—jumping directly to invasive core rewarming like peritoneal lavage without attempting less invasive methods first increases procedural risk unnecessarily 5
- Peritoneal lavage carries inherent risks including infection, bowel perforation, and bleeding, making it inappropriate as first-line therapy when safer alternatives exist 6
- The question of whether routine warm peritoneal lavage during trauma surgery improves temperature control has never been adequately studied 7