Airway warming devices in the context of single and multimodal strategies for intraoperative hypothermia: a network meta-analysis.

backgroundThis network meta-analysis (NMA) assessed the relative efficacy of airway warming devices and combined warming strategies for preventing intraoperative hypothermia.

methodsWe searched MEDLINE, EMBASE, CENTRAL, and Google Scholar to identify randomized controlled trials (RCTs) published through November 2025 that compared two or more warming strategies, including airway warming devices, in patients under general anesthesia. The primary outcome was intraoperative core temperature at the end of surgery. To establish the rank order of the evaluated warming strategies, frequentist and Bayesian NMAs were conducted and surface under the cumulative ranking curve (SUCRA) values were used.

resultsThe systematic review and NMA included 25 RCTs involving 1404 patients. At the end of surgery, heated humidifiers (HHs), HH + intravenous fluid warmer (IV), HH + IV + water mattress (WM), and the Mega Acer Kit® (MAK)-a heated-humidified breathing circuit with an integrated fluid warming unit-were associated with significantly higher core temperatures than the control group. Based on the SUCRA values, MAK ranked highest at the end of surgery, followed by HH + IV + WM. Multimodal interventions generally ranked higher than single warming methods across all assessed time points, suggesting the superiority of multimodal warming approaches. The SUCRA values from the frequentist and Bayesian models were closely aligned, indicating the robustness of the analysis.

conclusionBased on the available evidence, MAK may be the most effective among warming strategies involving airway warming devices. Overall, multimodal warming approaches may offer advantages over single-device strategies for perioperative temperature management, although the certainty of the evidence is limited. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024534439.