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Objective: To determine if higher heated intraperitoneal chemotherapy (HIPEC) flow rates improves heating of the peritoneum.
Design: 43°C water was circulated at varying flow rates through a HIPEC model (30.8L cooler, extracorporeal pump, 26L of 37°C water (WB), 1L saline bag (SB) in a cooling sleeve). Time to goal temperature with and without the cooling sleeve heat sink (HS) were measured. Using a swine HIPEC model, time to goal outflow and peritoneal tempertaure and the minimum flow rate required to reach 43°C during HIPEC were recorded. The impact of flow rate on peritoneal heating during 20 clinical HIPECs was also reviewed.
Setting: Basic Science/Animal Lab.
Patients: See Design.
Intervention: Flow Rate.
Main Outcome Measure: Time to goal Temperature.
Results: Higher flow rates decreased the time for the (WB) and (SB) to reach 43°C (Table). With a HS, minimum flow rate for WB to reach 43°C was 1.75L/min. Temperature differences between the WB and SB were greater at higher flow rates. In the swine, 18 minutes were required to reach an outflow temperature of 43°C at 4L/min. As flow rate decreased from 4 to 0.5L/min, the outflow temperature decreased from 43°C to 40.4°C. Minimum flow rate to reach 43°C outflow temperature was 3.0L/min. Analysis of 20 clinical HIPECs showed that increased flow leads to higher intraperitoneal temperatures in less time.
Conclusions: Increased flow during HIPEC leads to better heating of the peritoneal cavity and affords greater temperature differences between peritoneum and viscera. HIPEC flow rates should be maximized.

Flow rate (L/min)	Time for WB to reach 43C (min)	Temperature difference between WB and SB when WB reached 43C without heat sink (degrees C)	Time for WB to reach 43C with heat sink (min)
1	54	0.8 C	NR
2	37	0.9 C	70
3	29	1.4 C	50
4	24	1.7 C	37

NR: Not Reached