{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T22:43:59Z","timestamp":1751496239577,"version":"3.40.5"},"reference-count":52,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T00:00:00Z","timestamp":1700438400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Maintenance of normothermia is a crucial part of enhanced recovery after colorectal surgery. Dry\u2010cold carbon dioxide (CO<jats:sub>2<\/jats:sub>) traditionally used for insufflation in laparoscopic surgery and negative pressure operating theatres has been associated with intraoperative hypothermia. Studies suggest that use of warmed\u2010humidified CO<jats:sub>2<\/jats:sub> may promote normothermia. However, due to a scarcity of high\u2010quality studies demonstrating a proven benefit on intraoperative core body temperature, its use in colorectal surgery remains limited. Therefore, the aim of this review was to evaluate the effects of warmed\u2010humidified CO<jats:sub>2<\/jats:sub> compared to traditional dry\u2010cold CO<jats:sub>2<\/jats:sub>, or ambient air in operating theatres, during colorectal surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A search of Medline, EMBASE, and CENTRAL was performed. Randomised controlled trials (RCTs) that compared patients receiving warmed\u2010humidified CO<jats:sub>2<\/jats:sub> with either dry\u2010cold CO<jats:sub>2<\/jats:sub> insufflation in laparoscopic procedures or no insufflation during open surgery were included. The primary outcome was change in intraoperative core body temperature. Secondary outcomes included length of stay, operating time, return of gastrointestinal function, wound infection, and postoperative pain. A pairwise meta\u2010analysis was performed using inverse variance random effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the six RCTs included, 208 patients received warmed\u2010humidified CO<jats:sub>2<\/jats:sub> (42.3% female, mean age: 65.8\u2009years) and 210 patients received either dry\u2010cold CO<jats:sub>2<\/jats:sub> in laparoscopic procedures or no gas insufflation during open procedures (46.2% female, mean age: 66.1\u2009years). No significant difference was found for change in intraoperative core body temperature (MD\u2009=\u20090.01, 95% CI:\u2009\u22120.1, 0.11, <jats:italic>p<\/jats:italic>\u2009=\u20090.90, very low certainty). Patients in the warmed\u2010humidified CO<jats:sub>2<\/jats:sub> group had significantly higher pain scores on postoperative day 1 (MD\u2009=\u20091.61, 95% CI:\u20090.91, 2.31, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05, very low certainty). No significant differences were found in any of the other secondary outcomes studied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients undergoing colorectal surgery receiving warmed\u2010humidified CO<jats:sub>2<\/jats:sub> do not experience any clinically meaningful difference in core body temperature change compared to their counterparts receiving dry\u2010cold CO<jats:sub>2<\/jats:sub> insufflation or no insufflation. However, patients may report greater pain scores on postoperative day 1 with warmed\u2010humidified CO<jats:sub>2<\/jats:sub>. There is likely no clinically important difference between warmed\u2010humidified CO<jats:sub>2<\/jats:sub> and dry\u2010cold CO<jats:sub>2<\/jats:sub> for patients undergoing colorectal surgery. Patient, clinician, and institution factors should be considered when deciding between these two insufflation modalities.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.16798","type":"journal-article","created":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T22:55:37Z","timestamp":1700607337000},"page":"7-21","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The role of <scp>warmed\u2010humidified<\/scp> carbon dioxide insufflation in colorectal surgery: A systematic review and <scp>meta\u2010analysis<\/scp>"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8268-014X","authenticated-orcid":false,"given":"Sahil","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Surgery McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7668-4096","authenticated-orcid":false,"given":"Tyler","family":"McKechnie","sequence":"additional","affiliation":[{"name":"Department of Surgery McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jigish","family":"Khamar","sequence":"additional","affiliation":[{"name":"Michael G. DeGroote School of Medicine McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathy","family":"Wu","sequence":"additional","affiliation":[{"name":"Michael G. DeGroote School of Medicine McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Surgery McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3920-066X","authenticated-orcid":false,"given":"Cagla","family":"Eskicioglu","sequence":"additional","affiliation":[{"name":"Department of Surgery McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,11,20]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010018\u20104844\u2010y"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102044.2007.05021.x"},{"issue":"4","key":"e_1_2_11_4_1","first-page":"261","article-title":"Forced\u2010air warming and fluid warming minimize core hypothermia during abdominal surgery","volume":"20","author":"Zhao J","year":"2005","journal-title":"Chin Med Sci J"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e31822b896d"},{"issue":"3","key":"e_1_2_11_6_1","first-page":"259","article-title":"Unintended perioperative hypothermia","volume":"11","author":"Hart SR","year":"2011","journal-title":"Ochsner J"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1089\/ther.2020.0038"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0002\u20109610(85)80046\u20105"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03540380041029"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.anes.0000296719.73450.52"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199605093341901"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/ases.12350"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mehy.2007.12.016"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404\u2010015\u20103717\u2010y"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0b013e3181a90846"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0b013e318187c96b"},{"issue":"3","key":"e_1_2_11_17_1","first-page":"189","article-title":"Desertification of the peritoneum by thin\u2010film evaporation during laparoscopy","volume":"7","author":"Ott DE","year":"2003","journal-title":"JSLS"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10397\u2010004\u20100019\u2010y"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10685"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0122838"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0195465"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007821.pub3"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/1553350617715834"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181d77a25"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs5.50227"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.15984"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000017520"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010022\u201012057\u20103"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"e_1_2_11_31_1","unstructured":"RoB 2: A revised Cochrane risk\u2010of\u2010bias tool for randomized trials | Cochrane Bias. 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