Hypothermia can have several adverse effects on trauma patients, especially on patients with multiple trauma. In particular, it can potentially disturb haemostasis, leading to uncontrolled coagulopathy and haemorrhage, which is especially important in trauma patients. Furthermore, hyperglycaemia can occur in trauma patients with mild hypothermia as a result of catecholamine release. Insulin treatment in these patients can result in a hypoglycaemic patient during rewarming. Also, drug elimination times (e.g. of vecuronium, benzodiazepines, alcohol) are prolonged in mild hypothermic patients, which in itself might potentiate the already present hypothermia [
92]. Peri-operative hypothermia can thus result from exposure to the surgical environment, to the effects of anaesthetic agents or to certain drugs [
15,
93]. Furthermore, hypothermia affects leukocyte migration, neutrophil phagocytosis and cytokine production, causing a depression of the immune system and therefore a delay in wound healing [
94‐
96]. Until recently, the hypothesis was that these consequences—impaired immune function and delayed wound healing—increase the risk of SSI [
67,
95,
96]. Brown et al. recently countered this hypothesis, as they found no significant correlation between the development of SSI and peri-operative hypothermia. They point out that studies supporting the association between hypothermia and SSI often used multiple definitions for hypothermia, as well as single temperature measurement time points as variables. Their results were consistent with other recent studies investigating the importance of peri-operative normothermia [
97]. Nonetheless, given the other adverse effects of hypothermia on trauma patients, frequent peri-operative monitoring of temperature to avoid hypothermia is advisable. Peri-operative use of warming devices aiming for a core body temperature of > 36 °C is also recommended by the WHO [
15]. However, in this guideline, there is no recommendation regarding warming method. Different devices, forced-air warming or intravenous fluid warmers can be used to maintain body temperature [
95,
96]. The forced-air warmers are connected to specialised blankets with perforations on the underside through which the warm air can blow onto the patient’s skin (e.g. Bair Hugger) [
79]. These forced-air warmers are a potential risk for contamination originating from the pump and air-hose system [
93,
98]; they may also have a disruptive impact on clean airflow patterns over the surgical site [
98,
99]. Hence, forced-air warmers may contribute to an increased risk for SSIs, and this is a topic of ongoing research [
93]. We advise that if these devices are used in a trauma setting, the patient should first be surgically draped before the warm air is blown into the system. A possible alternative to forced-air warmers is conductive fabric warming, which is equally effective in preventing hypothermia [
99].