Abstract:
A thermal therapy garment that covers at least the lower extremities of a patient. The garment has an air impermeable outer layer and an air permeable inner layer. An inflatable air chamber is defined between the inner and outer layers. An inlet port connects to the chamber to allow inflation with conditioned air, which is exhausted through the inner layer over a selected region of the patient&#39;s lower body. A gown has a length sufficient to overlap a waist portion of the garment, The gown has an opening that coincides with the inlet port, thereby allowing a hose to pass through the gown and connect to the inlet port. In one embodiment, the gown has sleeves and/or a posterior portion that are heat reflective whereby the extremities are warmed to minimize the core to peripheral temperature gradient.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of U.S. Provisional Application No. 61/376,824, filed Aug. 25, 2010. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
       [0002]    Not Applicable 
       BACKGROUND 
       [0003]    1. Field of Invention 
         [0004]    This invention relates to a system for warming the body of a human to prevent redistribution hypothermia. More particularly, this invention pertains to passive warming and active warming before, during, and after surgery or other medical procedures without increasing the core to peripheral temperature gradient. 
         [0005]    2. Description of the Related Art 
         [0006]    Inflatable thermal blankets that are used to communicate a conditioned gas, such as heated or cooled air, to a patient are known in the art. Such thermal blankets typically have an inflatable portion provided with an inlet port for placing the inflatable portion in fluid communication with a source of pressurized, conditioned gas such that the inflatable portion can be selectively inflated. The inflatable portion generally has an inner surface that is positioned next to the patient. The inner surface is gas permeable or is otherwise adapted to communicate the conditioned gas used to inflate the blanket to the user. Such thermal blankets are often used to treat conditions such as hypothermia or used to reduce the body temperature of a user in circumstances where the body temperature is inappropriately high. For example, where a patient is being treated for hypothermia, at least a portion of the patient&#39;s body is covered with the thermal blanket, and warm air is pumped into the inflatable portion. The warm air used to inflate the inflatable portion is thereafter communicated through the inner surface of the inflatable portion so as to bath the body portion covered by the blanket in warm air. U.S. Patent Application Publication Number 2007/0093885, titled “Multifunction warming device with an upper body convective apparatus,” is an example of medical warming devices that are representative of the art. The published application discloses a prior art blanket that fits over a prone patient and a thermal device inside a gown. Another representative example is U.S. Patent Application Publication Number 2006/0184217, titled “Warming device for perioperative use.” 
         [0007]    Generally, inflatable thermal blankets cover substantially the whole body of the patient or portions of the body when the patient is lying on a surface. Inflatable thermal devices that treat selected portions of the body are known. For example, U.S. Pat. No. 5,980,561, titled “Applying thermal therapy to living tissue” and issued to Kolen on Nov. 9, 1999, discloses a therapy pad that fits around a portion of a patient&#39;s leg. The therapy pad circulates conditioned water through a fluid loop in a pad configured to be positioned adjacent a body part. Such a pad is used to apply heat or cold to tissue to heal and rehabilitate injuries, such as, bruises, sprains, or other trauma to bone, muscle, ligaments, tendons, and skin. 
         [0008]    In a medical environment, body conforming drapes are known. For example, U.S. Pat. No. 3,494,356, titled “Disposable obstetrical and surgical drapes” issued to Melges on Feb. 10, 1970, discloses a drape that fits around a leg of the patient lying on a table. The drape has a bag-shape configured to receive the leg of a patient. The drape disclosed in the Melges patent is a passive device and does not receive a conditioned fluid. 
       BRIEF SUMMARY 
       [0009]    According to one embodiment of the present invention, a lower body garment for warming a patient that includes pants that enclose the legs is provided. The pants include an outer section and an inner section. The outer section includes a port, a torso portion and two leg portions extending distally from the torso portion to the feet. The inner section includes a torso portion and two leg portions extending distally from the torso portion to the feet. The outer section and the inner section are joined at the waist hem of the torso portion and at the distal end of each leg portion to form an enclosed region within the pants. The port of the outer section is configured to receive a nozzle from a hose. The leg portions of the inner section include a material for distributing the air within the pants. In one embodiment, the distributing material is air permeable. In another embodiment, the material includes perforations. The leg portions of the outer section and the inner section include releasable seams for accessing the legs of the patient. 
         [0010]    In one embodiment, a gown encloses the patient&#39;s upper body and the torso portion of the lower body garment. The gown includes a body portion and two sleeves. The body portion encloses the torso and includes a neck opening and an opening for accessing the port of the pants. The sleeves extend from the body and enclose the arms. The sleeves and posterior portion of the gown include a heat reflective material. The anterior of the thorax, or chest, portion of the gown is non-reflective. The reflective coating (such as alumina) at the arms and back reduces the heat loss by radiation. The fabric at the thorax is uncoated to reduce the increase in core temperature due to the supplied heated air. 
         [0011]    In one such embodiment, hand enclosures are provided for enclosing the hands of the patient. In one such embodiment, the hand enclosures include a heat reflective material. In another such embodiment, foot enclosures are provided for enclosing the feet of the patient. In one such embodiment, the foot enclosures include a heat reflective material. 
         [0012]    The lower body garment and gown described herein focus on maintaining and controlling the temperature of the limbs to prevent redistribution hypothermia and for optimal heat storage in the patient&#39;s body. Forced air heated full body blankets are very effective in warming the limbs. However, no distinction is made between the thorax and the limbs. The heat flow to the thorax often leads to an increase of the core temperature and a reduction of comfort, and thus sweating. Furthermore, patient mobility is restricted by full body blankets. 
         [0013]    The system operates to reduce the core-to-peripheral temperature gradient to prevent redistribution hypothermia, and also to increase the heat content of peripheral compartments (heat accumulation) to compensate for the heat loss during anesthesia. 
         [0014]    One embodiment of the system includes a lower body garment and a gown. A blower and a hose connects to the lower body garment. Heat is supplied by heated forced air which is created in the blower. From the blower the heated, forced air is transferred to the lower body garment via a hose. The heated forced air enters the lower body garment in the waist portion. From the waist portion, the heated air is transferred to the legs. The heated air flows along the legs and leaves the lower body garment at the feet, and at the waist opening. 
         [0015]    In one embodiment, the fabric of the lower body garment and the gown is bio-degradable. 
         [0016]    Medical requirements for the lower body garment and gown prescribe that the heated air flowing through the gown must be above 36° C. to prevent hypothermia. Heated forced air is created in a compact blower with a high rpm fan and a heat exchanger. To prevent unintended cooling of the patient, the output temperature of the blower is adjusted to a range of 36-43° C. The patient can adjust the output volume flow of the blower manually to a comfortable level. The compact blower is supplied with a bed mounting mechanism. By means of an optional battery pack, the blower can be kept in operation while the patient is transported. 
         [0017]    The lower body garment is supplied with a port at the front side waist level. The hose is connected through the port in the lower body garment. 
         [0018]    The system provides effective heating of the legs and/or arms while maintaining a constant core temperature. Furthermore, the patient&#39;s freedom of movement is not restricted as with heated mattresses and blankets. Besides prewarming, the pants and gown provides patient warming during surgery and during postoperative warming. The seam at the back portion of the gown is openable such that the gown can be draped optimally during treatment. 
     
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS 
         [0019]    The above-mentioned features will become more clearly understood from the following detailed description read together with the drawings in which: 
           [0020]      FIG. 1  is a perspective view of one embodiment of a warming garment worn by a patient who is standing. 
           [0021]      FIG. 2  is a cross sectional view of the warming garment of  FIG. 1 . 
           [0022]      FIG. 3  is an exploded perspective diagram showing one embodiment of the warming garment as in  FIG. 1 . 
           [0023]      FIG. 4  is a perspective view of one embodiment of a releasable opening for the warming garment of  FIG. 3 . 
           [0024]      FIG. 5  is an illustration of one embodiment of a warming garment. 
           [0025]      FIG. 6  is an illustration of a second embodiment of a warming garment. 
           [0026]      FIG. 7  is an illustration of a third embodiment of a warming garment. 
           [0027]      FIG. 8  is an illustration of a fourth embodiment of a warming garment. 
           [0028]      FIG. 9  is an illustration of a warming system including a warming garment and a gown. 
           [0029]      FIG. 10  is a posterior view of a gown as in  FIG. 9 . 
       
    
    
     DETAILED DESCRIPTION 
       [0030]    A garment  100  for warming a patient and preventing redistribution hypothermia is disclosed. The garment  100  provides passive warming and active warming of patients before, during and/or after surgery or other medical procedures. 
         [0031]      FIG. 1  illustrates a perspective view of one embodiment of a garment  100  worn by a patient  102  who is standing.  FIG. 1  shows the garment  100  in a first, or passive, configuration that is suitable for a patient  102  who is mobile. The first configuration allows the patient  102  to stand, walk, sit, or otherwise move or position himself. In the illustrated embodiment, the garment  100  is pants. 
         [0032]    The garment  100  includes a waist portion  104 , two leg portions  106 , and two releasable openings  116 . The waist portion  104  encloses a portion of the patient&#39;s abdomen. The waist portion  104  includes a waist hem  108 , a fastener  110 , and a port  112 . The waist hem  108  defines an opening in the waist region of the garment  100 . The fastener  110  secures the waist portion  104  around the abdomen of the patient  102 . In the illustrated embodiment, the fastener  110  is a drawstring. In other embodiments, the fastener  110  includes straps, hook and loop fasteners, elastomeric material, buttons, snaps, and/or connectors that releasably secure the waist opening around the patient&#39;s abdomen. With the patient  102  in an upright or standing position, the garment  100  is supported by the fastener  110  that secures the garment  100  around the waist of the patient  102 . 
         [0033]    Proximate the waist hem  108  of the garment  100  is a port  112 . The port  112  provides access to an opening in the anterior waist portion  104  of the garment  100 . The port  112  includes a collar with an opening to receive a nozzle of a hose. The port  112  is fastened to the garment  100  at the opening to provide an air tight seal. In one embodiment, the collar of the port  112  is fastened to the garment  100  by heat welding. In another embodiment, the collar of the port  112  is fastened to the garment  100  by gluing. 
         [0034]    The leg portions  106  of the garment  100  extend distally toward the feet of the patient  102 . In the illustrated embodiment, the leg portions  106  extend as far as the ankles of the patient  102 . The feet of the patient  102  extend through an opening in each respective leg portion  106 . The opening in the respective leg portion  106  is defined by a leg hem  114 , which is the distal end of each respective leg portion  106 . In one embodiment, the leg hems  114  include an elastomeric material, such as an elastic band, to elastically reduce the size of the opening. The elastic band maintains the leg hem  114  snugly against the leg. In other embodiments, the leg hems  114  include drawstrings, adhesive tape, hook and loop fasteners and/or connectors that releasably secure the leg hem  114  around the leg to a desired level of closure and/or openness. The leg portions  106  enclose a portion of the lower extremities of the patient  102  without hindering the mobility of the patient  102  when the patient  102  is walking or otherwise moving about. 
         [0035]    In one embodiment, a releasable opening  116  extends distally along each lateral portion of the garment  100  from the waist hem  108  to the leg hem  114 . Each releasable opening extends distally from the waist hem  108 , along a lateral portion of the waist portion  104 , along a lateral portion of a leg portion  106 , to a leg hem  114 . The releasable opening  116  provides access to the legs of the patient  102 . For example, the releasable opening  116  is used to place the garment  100  on or to take the garment  100  off a prone patient  102 . In another embodiment, the releasable opening extends from the distal end of the garment  100  for only a portion of its length. In yet another embodiment, the releasable opening  116  extends along the inside seam from one leg hem  114 , up through the crotch region  118 , and down to the other leg hem  114 . 
         [0036]      FIG. 2  illustrates a cross sectional view of one embodiment of the garment  100 . The garment  100  includes a chamber  202  defined by the space between an outer portion  204  of fabric and an inner portion  206  of fabric. The anterior section of the outer portion  204  of the garment  100  includes a port  112 . The chamber  202  is configured to receive a gas, such as forced heated air, through the port  112 . When a gas is forced into the chamber  202  through the port  112 , the chamber  202  expands up to its available volume as the gas flows throughout the chamber  202 . 
         [0037]    In one embodiment, the chamber  202  is formed from the outer portion  204  and at least one inner portion  206  of fabric. In one such embodiment, the inner portion  206  is configured such that the chamber  202  extends throughout the inside of the garment  100 . Such a chamber  202  is formed of fabric that fits within both leg portions  106  and the waist portion  104  of the garment  100 . In another embodiment, the chamber  202  is formed from an inner portion  206  that includes multiple flow channels. 
         [0038]    In one embodiment, the chamber  202  extends distally from the waist hem  108 , through the leg portions  106 , to the leg hems  114  of the garment  100 . In one such embodiment, the air chamber  202  provides flow between the anterior and posterior portions of the chamber  202  through the crotch area of the garment  100 . 
         [0039]    In the illustrated embodiment, the anterior portion of the chamber  202  is separate from the posterior portion of the chamber  202  at each releasable opening  116  along the lateral edges of the garment  100 . In such an embodiment, there is no flow path between the anterior and posterior portions of the chamber  202  at the lateral edges of the garment  100 . In another embodiment, the releasable openings  116  extend for only a portion of the length of the garment  100 . In such an embodiment, flow paths are provided between the anterior and posterior portions of the chamber  202 . 
         [0040]      FIG. 3  is an exploded perspective diagram illustrating one embodiment of the garment  100 . The garment  100  includes a chamber  202 , an inner section  302  of fabric, and an outer section  304  of fabric. The chamber  202  is defined by an inner section  302  within an outer section  304 . The outer section  304  conforms substantially to the description of the garment  100  above. The inner section  302  does not include a port  112 , but otherwise conforms to the description of the garment  100 . 
         [0041]    In one embodiment of the inner section  302  of the garment  100 , each leg portion  106 -A,  106 -B includes a plurality of perforations  306 , such as triangular, or V-shaped, slits in the fabric. Such slits form a V-shaped flap that allows a gas, such as air, to flow through the flap. In another embodiment, each leg portion  106 -A,  106 -B of the inner section  302  is an air permeable material, such as a non-woven fabric or melt blown polypropylene. In such embodiments, the warmed air flows directly to the legs to provide convective heating. The remainder of the chamber  202  provides conductive heating within the garment  100 . 
         [0042]    In one embodiment, the inner section  302  and the outer section  304  are joined at their respective perimeters to define the chamber  202 . In such an embodiment, the inner section  302  and the outer section  304  are joined at the waist hems  108 , the leg hems  114  at the distal ends of the leg portions  106 , and at the releasable openings  106  at the lateral edges of the leg portions  106 . In one such embodiment, the waist portion  104 -A and leg portions  106 -A,  106 -B of the inner section  302  fit within the respective waist portion  104 -B and leg portions  106 -C,  106 -D of the outer section  304 . 
         [0043]    The waist hem  108 -B of the outer section corresponds to the waist hem  108 -A in the inner section  302  of the garment  100 . The waist hem  108 -B of the outer section  304  is joined to the waist hem  108 -A of the inner section  302  so that the opening in the outer section  304  corresponds to the opening in the inner section  302 . Joined together, the waist hems  108 -A,  108 -B define an opening in the waist region of the garment  100 . The waist hems  108 -A,  108 -B are joined together to form an air tight seal. In one embodiment, the waist hems  108 -A,  108 -B are fastened together via heat welding. In another embodiment, the waist hems  108 -A,  108 -B are fastened together via gluing. 
         [0044]    Each leg hem  114 -C,  114 -D for the outer section  304  is joined to the corresponding leg hems  114 -A,  114 -B of the inner section  302 . That is, leg hem  114 -C is joined to leg hem  114 -A and leg hem  114 -D is joined to leg hem  114 -B. The leg hems  114 -C,  114 -D of the outer section  304  are joined to the corresponding leg hems  114 -A,  114 -B of the inner section  302  to form an air tight seal at the distal end of each leg portion  106 . In one embodiment, the leg hems  114  are fastened together via heat welding. In another embodiment, the leg hems  114  are fastened together via gluing. 
         [0045]    The anterior and posterior portions of each releasable opening  116 -C,  116 -D of the outer section  304  are joined to the corresponding anterior and posterior portions of each releasable opening  116 -A,  116 -B of the inner section  302  to form an air tight seal. In one embodiment, the corresponding releasable openings  116  are fastened together via heat welding. In another embodiment, the corresponding releasable openings  116  are fastened together via gluing. 
         [0046]    The inner section  302  is secured to the perimeter of the outer section  304  of the garment  100 . In one embodiment, the inner section  302  is secured to the outer section  304  at the corresponding waist hems  108 , the corresponding leg hems  114  and the corresponding releasable openings  116 . In one such embodiment, the crotch areas of the inner section  302  and the outer section  304  are not joined. This provides for flow between the anterior and posterior portions of the chamber  202 . In such an embodiment, the garment  100  includes a chamber  202  between the inner section  302  and the outer section  304 . The chamber  202  receives a gas, such as heated air, through the port  112 . The gas flows throughout the chamber  202  and is exhausted via the inner section  302  to the legs of the patient  102 . 
         [0047]    In another embodiment, the inner section  302  is not congruent with the outer section  304 . For example, the inner section  302  is smaller dimensionally than the outer section  304 . In one such embodiment, the waist portion  104 -A of the inner section  302  is shorter than the waist portion  104 -B of the outer section  304 . The hem  108 -A of the inner section  302  does not mate with the hem  108 -B of the outer section  304 , but the hem  108 -A is attached medially to the waist portion  104 -B of the outer section  304  to form an air tight seal. The waist portion  104 -B of the outer section  304  extends past the waist portion  104 -A of the inner section  302  and is secured around the patient&#39;s waist. In another such embodiment, the leg portions  106 -A,  106 -B of the inner section  302  are shorter than the corresponding leg portions  106 -C,  106 -D of the outer section  302 . The leg hems  114 -A,  114 -B are attached medially to the corresponding leg portions  106 -A,  106 -B of the outer section  304  to form air tight seals. For example, the embodiment of the garment  100 -B illustrated in  FIG. 6  has an outer section  304  that covers a portion of the torso and includes shoulder straps  606 -A. The inner section  302  for such an embodiment of the garment  100 -B in one embodiment is as illustrated in  FIG. 3  with the inner hem  108 -A attached between the waist portion  104 -C and the elongated portion  104 -D. 
         [0048]    In yet another embodiment, the inner section  302  is secured to the outer section  304  at locations medially between the edges of the two sections  302 ,  304 . In this way, channels are formed in the chamber  202 . The channels in various embodiments direct the air in the chamber  202  and/or restrict the inflatable volume of the chamber  202  to specific locations. 
         [0049]      FIG. 4  is a perspective diagram illustrating a partially open releasable opening  116  along one leg  106  of the garment  100 . The lateral portion of each leg portion  106  of the garment  100  has such a releasable opening  116 . The releasable opening  116  is secured via fasteners  402 ,  404  at the anterior and posterior sections of each respective leg portion  106 . In the illustrated embodiment, the fasteners  402 ,  404  include adhesive tape that extends the length of the releasable opening  116 . In other embodiments, the fasteners include zippers, hook and loop fasteners, straps, buttons, snaps, and/or connectors that releasably secure the anterior portion of each leg portion  106  to the posterior portion of the respective leg portion  106 . In one embodiment, the fasteners  402 ,  404  extend for separate portions of the releasable opening  116 . 
         [0050]    In the illustrated embodiment, the releasable opening  116  is partially opened and shows the perforations  306  on the inner section  302  of the garment  100 . 
         [0051]      FIG. 5  illustrates an embodiment of a garment  100 -A in an active configuration with a patient  102  wearing the garment  100 -A. In the illustrated embodiment, the garment  100 -A is pants. The pants  100 -A conform substantially to the description of the garment  100  described above. In the illustrated embodiment, the waist portion  104 -C extends from proximate the waist region to the legs of the patient  102  and does not enclose the thorax region. The garment  100 -A has openings at the waist hem  108  and the leg hems  114 . The garment  100 -A is also adjustably openable along the releasable openings  116  of the leg portions  106 . In one embodiment, the garment  100 -A includes a chamber  202  that extends substantially throughout the inside of the garment  100 -A. 
         [0052]    In the active configuration, a hose  502  is connected to the port  112  of the garment  100 -A. A gas  504 , such as heated forced air, is provided to the hose  502  by a blower (not illustrated). The air  504  enters the chamber  202  through the port  112 . As air  504  is forced into the chamber  202 , the chamber  202  expands and exhausts the air  504  convectively in the leg portions  106 . Conductive heating is provided in the waist portion  104 -C. In this way, active heating is provided throughout the garment  100 -A. The active configuration is suitable for a patient  102  before, during, and/or after surgery or other medical procedure. With a portable supply connected to the hose  502 , the active configuration of the garment  100 -A does not hinder patient  102  mobility. 
         [0053]    As air is forced into the chamber  202 , the chamber  202  expands. The air from the chamber  202  is exhausted into the volume defined by the inner section  302 . As air flows into the pants  100 -A, the air is exhausted through the waist opening via waist flow  506 , and through the openings at the leg hems  114  via leg flow  508 . 
         [0054]    Waist flow  506 , is dependent on the type fastener  110  and also how tightly the fastener  110  secures the waist hem  108  around the waist of the patient  102 . For example, an elastic fastener  110  secures the waist opening very snugly and closes off a substantial portion of the waist flow  506 , so that very little air  504  escapes at the waist of the patient  102 . A drawstring fastener  110  is adjustable to be loose or even untied so that the waist opening is as loose as is possible in the particular circumstances. A loose-fitting waist results in increased waist flow  506 . In various embodiments, different fasteners  110  are used to provide varying degrees of adjustability in the waist flow  506 . 
         [0055]    Waist flow  506  is also affected by the waist size of the patient  102 . For example, a large waist on some patients  102  relative to the size of the hem  108  significantly limits the waist flow  506  even when the fastener  110  is adjusted as open as possible for the particular size garment  100 -A. Similarly, a very small waist on some patients  102  causes difficulty in limiting the waist flow  506  even when the fastener is adjusted as snugly as possible for the particular patient  102  and size garment  100 -A. 
         [0056]    Air exiting the pants  100 -A is adjustable so that both waist flow  506 , and leg flow  508  are independently controlled via the respective openings. In this way, control is provided for the warming of the legs and for the air that escapes from the garment  100 -A. 
         [0057]    The pants  100 -A are not typically used in isolation, however. In one embodiment, the pants  100 -A are utilized for surgery or other medical procedure involving the upper body, such as the head, thorax, or arms. In such embodiments, a surgical drape or blanket covers the patient  102 . In this way, a cavity or enclosed area is created which covers the thorax and/or other body portions. When more heat is necessary in the thorax or other upper body region, the waist flow  506  is increased via adjusting or otherwise opening the fastener  110 . In this way, more warmed air exits the pants  100 -A via waist flow  506 . When less heat is necessary, the waist flow  506  is decreased by adjusting or otherwise closing the fastener  110 . 
         [0058]    Leg flow  508 , is adjustable via the leg hems  114  and also via the releasable openings  116  on each lateral portion of the leg portions  106 . Increasing the air exiting the pants  100 -A through leg flow  508  reduces the amount of air available for waist flow  506 . Conversely, the waist flow  506  is increased by reducing the leg flow  506  exiting the pants  100 -A. For example, elastic leg hems  114  secure the leg openings very snugly and close off a substantial portion of the leg flow  508 . Other type leg hems  114 , such as drawstrings or hook and loop fasteners, for example, provide for adjustability in providing varying amounts of closure for the leg opening. In this way, the leg flow  508  is adjustable to provide for a desired level of air escaping through the leg portions  106 . 
         [0059]    Leg flow  508  is also adjustable by opening or closing the releasable openings  116  of each leg portion  106  of the garment  100 -A. In various embodiments, the fasteners  402 ,  404  are adjustable to be open, closed, or partially open along the length of the releasable openings  116 . 
         [0060]      FIG. 6  illustrates another embodiment of the garment  100 -B in an active configuration. In the illustrated embodiment, the garment  100 -B includes shoulder straps  606 -A and an elongated portion  104 -D extending from the waist portion  104 -C. Otherwise, the waist portion  104 -C and the leg portions  106  are substantially as described above with reference to the pants  100 -A. The shoulder straps  606 -A extend from the anterior portion of the thorax opening  602 -A of the elongated portion  104 -D, across the shoulders, and attach to the posterior portion of the thorax opening  602 -A. The elongated portion  104 -D, and thus the garment  100 -B, is supported by the shoulder straps  606 -A with the patient  102  in a standing position. 
         [0061]    The elongated portion  104 -D is an extension of the waist portion  104 -C. Due to this extension, the garment  100 -B encloses a portion of the thorax while retaining accessibility to the upper chest, head, neck, and arms of the patient  102 . In one embodiment, the elongated portion  104 -D and the waist portion  104 -C are formed from the same fabric. In other embodiments, the elongated portion  104 -D is a separate material joined to the waist portion  104 . In one such embodiment, the elongated portion  104 -D and the waist portion  104 -C are fastened together via heat welding. In another embodiment, the elongated portion  104 -D and the waist portion  104 -C are fastened together via gluing. In some such embodiments, a waist hem  108  defines a border between the elongated portion  104 -D and the waist portion  104 -C. 
         [0062]    The elongated portion  104 -D and the shoulder straps together  606 -A define a thorax opening  602 -A and two arm openings  604 . The thorax opening  602 -A is in the thorax, or chest, region proximate the underarm area of the patient  102 . The garment  100 -B includes two openings at the leg hems  114  which are substantially as described with reference to garment  100 -A above. The garment  100 -B is also adjustably openable along the releasable openings  116  of the leg portions  106 . 
         [0063]    In one embodiment, the garment  100 -B includes a chamber  202  that extends from the waist portion  104 -C, through the leg portions  106 , and to the leg hems  114 . For such an embodiment, the chamber  202  is substantially as described above with respect to the pants  100 -A and does not extend into the elongated portion  104 -D. For example, the inner section  302  is as described in  FIG. 3  above and the hem  108 -A is attached to waist portion  104 -C. In another embodiment, the chamber  202  extends into the elongated portion  104 -D. That is, the garment  100 -B includes a chamber  202  that extends substantially throughout the inside of the garment  100 -B. In such an embodiment, the chamber  202  extends distally from the thorax opening  602 -A, through the elongated portion  104 -D, through the waist portion  104 -C, through the leg portions  106 , to the leg hems  114 . 
         [0064]    Air  504  is forced into the chamber  202  as above. As air is exhausted from the chamber  202 , the garment  100 -B expands and the legs are warmed convectively. The waist region is warmed conductively via the waist portion  104 -C. In some embodiments, the thorax region is also warmed conductively by the elongated portion  104 -D. As air exits the chamber  202 , it flows throughout the remainder of the garment  100 -B. The air exits the garment  100 -B through the thorax opening  602 -A via the thorax flow  608 -A, and via arm flow  510  through the arm openings  604 . The elongated region  104 -D of the garment  100 -B is less restrictive around the thorax region than the pants  100 -A are around the waist region of the patient  102 . This reduced restriction provides increased thorax flow  608 -A and arm flow  510 . This increases the flow exiting the garment  100 -B. In this way, increased warming of the thorax region of the patient  102  is provided by the garment  100 -B. 
         [0065]    The air exiting the garment  100 -B via thorax flow  608 -A and arm flow  510  is also increased by closing off the leg flow  508  as discussed above. Conversely, increasing the leg flow  508  reduces the amount of air exiting the garment  100 -B via thorax flow  608 -A and arm flow  510 . 
         [0066]    The increased coverage of the thorax region in the garment  100 -B provides thorax flow  608 -A and arm flow  510  through the thorax region. In this way, more warm air is confined in a close region to the patient  102  than for either a gown or a blanket. 
         [0067]    In some instances, the size of the stomach or thorax region of a larger patient  102  alters the exit flow from the garment  100 -B. In those instances, the size of the patient  102  is such that the thorax opening  602 -A and arm openings  604  are partially or completely closed off and the garment  100 -B retains even more warm air than if it were less restricted. 
         [0068]    As with the pants  100 -A, the garment  100 -B is not typically used in isolation. In various embodiments, the garment  100 -B is utilized for surgery or other medical procedures. In such embodiments, a surgical drape or blanket covers at least part of the patient  102 . In this way, a cavity or enclosed area is created which covers the patient  102 . The garment  100 -B confines a portion of warm air in close proximity to the patient  102 . This warming effect provides for placement of the surgical drape or blanket in those areas not directly warmed by the garment  100 -B. 
         [0069]      FIG. 7  illustrates another embodiment of the garment  100 -C in an active configuration. In the illustrated embodiment, the garment  100 -C includes shoulder straps  606 -B and an elongated portion  104 -E extending from the waist portion  104 -C. The shoulder straps  606 -B and the elongated portion  104 -E combine to form a thorax opening  602 -B in the anterior thorax region proximate the neck. The opening extends similarly in the posterior thorax region of the garment  100 -C. The thorax opening  602 -B is smaller than the thorax opening  602 -A described above in respect to the garment  100 -B. 
         [0070]    As above, the elongated portion  104 -E is an extension of the waist portion  104 -C. Due to this extension, the garment  100 -C encloses the legs and a portion of the thorax while retaining accessibility to the head, arms, neck, and a portion of the chest of the patient  102 . In comparison to the garment  100 -B, the thorax opening  602 -B is reduced in size so that the elongated portion  104 -E covers a larger portion of the thorax region. Otherwise the waist portion  104 -C and the leg portions  106  of the garment  100 -C are substantially as described above with reference to the pants  100 -A and the garment  100 -B. 
         [0071]    The thorax region is more enclosed by the elongated region  104 -E than by the elongated region  104 -D discussed above. For this reason, the thorax flow  608 -B exiting at the thorax opening  602 -B is more restricted by comparison. Thorax flow  608 -B is slightly restricted compared with thorax flow  608 -A, which results in slightly less air flow  608 -B and increased pressure in the chamber  202  unless leg flow  508  is increased. As above, adjustments to air flow can also be made by increasing or decreasing leg flow  508 , as appropriate. The increased coverage of the thorax region in the garment  100 -C over the garment  100 -B provides for confining more warm air in a close region to the patient  102  than the garment  100 -B, a gown, or a blanket. 
         [0072]    As above, the size of larger patients  102  alters the exit flow from the garment  100 -C so that the thorax opening  602 -B and arm openings  604  are partially or completely closed off. In such situations, the garment  100 -C retains even more warm air than described above. 
         [0073]    As described above, the garment  100 -C is sometimes utilized for surgery or other medical procedures. The warming effect of the garment  100 -C provides for placement of a surgical drape or blanket in those areas not directly warmed by the garment  100 -C. 
         [0074]      FIG. 8  illustrates another embodiment of the garment  100 -D in an active configuration. In the illustrated embodiment, the garment  100 -D includes a neck opening  802  and an elongated portion  104 -F that extends from the waist portion  104 -C. The neck opening  802  in the elongated portion  604 -D is such that essentially the entire thorax, or chest, region of the patient  102  is enclosed. The elongated portion  104 -F includes two arm openings  510 . 
         [0075]    As above, the elongated portion  104 -F is an extension of the waist portion  104 -C. The elongated portion  104 -F is such that the garment  100 -D encloses the legs, waist, and thorax while retaining accessibility to the head, neck and arms of the patient  102 . In comparison to the garments  100 -B,  100 -C the neck opening  802  is smaller than the thorax openings  602 -A,  602 -B so that the elongated portion  104 -F encloses the entire thorax region. Otherwise the waist portion  104 -C and the leg portions  106  of the garment  100 -D are substantially as described above with reference to the garments  100 -A,  100 -B,  100 -C. 
         [0076]    The thorax region is entirely enclosed by the elongated region  104 -F. For this reason, the neck flow  804  exiting at the neck opening  802  is reduced by comparison with the thorax openings  608 -A,  608 -B described above. Similarly, the arm flow  510  is also reduced. For an otherwise similar configuration, the air flow exiting garment  100 -C is reduced in comparison to the air flow exiting the garments  100 -B,  100 -C described above. As above, adjustments to air flow can also be made by increasing or decreasing leg flow  508 , where appropriate. 
         [0077]    The complete enclosure of the thorax region in the garment  100 -D over the garments  100 -B,  100 -C provides for confining more warm air in a region close to the patient  102  than either the garments  100 -B,  100 -C, a gown, or a blanket. 
         [0078]    As above, the size of larger patients  102  alters the exit flow from the garment  100 -D so that the neck opening  802  and arm openings  604  are partially or completely closed off. In such situations, the garment  100 -D retains even more warm air than described above. 
         [0079]    As also described above, the garment  100 -D is sometimes utilized for surgery or other medical procedures. The warming effect of the garment  100 -D with complete thorax enclosure provides for placement of a surgical drape or blanket in those areas not directly warmed by the garment  100 -D. 
         [0080]      FIG. 9  illustrates an embodiment of a warming system  900 . The system  900  includes a garment  100 , a gown  902 , hand enclosures  918 , and foot enclosures  920 .  FIG. 10  illustrates a posterior view of the gown  902 .  FIG. 9  shows the garment  100  and gown  902  in an active configuration, with a hose  502  attached. The system  900  is suitable for a patient  102  before, during, and/or after surgery or other medical procedure. With a portable supply connected to the hose  502 , the active configuration of the system  900  does not hinder patient  102  mobility. 
         [0081]    The gown  902  includes a body  904  and a pair of sleeves  908 . The body  904  extends distally toward the feet of the patient  102  to a body opening  912 . The legs of the patient  102  extend through the body opening  112 . The body  904  of the gown  902  is sized and configured to fit loosely around the thorax and waist of the patient  102 . The body  904  of the gown  902  encloses the thorax and the waist by encircling the patient&#39;s body. The body  904  has an opening  906  through which the neck of the patient  102  extends. With the patient  102  upright, such as when standing or sitting, the gown  902  is supported by resting on the shoulders of the patient  102 . 
         [0082]    The gown  902  includes an anterior opening  910 . The anterior opening  910  corresponds to the port  112  of the garment  100 . The anterior opening  910  includes a cover  916 . In one embodiment, the cover  916  is a flap  916 . The flap  916  is open to provide access to the anterior opening  910 . In another embodiment, the anterior opening  910  includes a slit in the outer surface of the gown  902  with the hose  502  passing through the slit. The anterior opening  910  provides access to the port  112  of the garment  100 . In the illustrated embodiment, a hose  502  extends through the anterior opening  910  and is attached to the port  112 . In a passive configuration, a hose  502  is not present. 
         [0083]    The pair of sleeves  908  extend from the body  904  of the gown  902 . In one embodiment, the sleeves  908  have a length that is sufficient to enclose the arms of the patient  102  from the shoulders to the wrists of the patient  102 . The hands of the patient  102  extend through an opening  914  distal from the shoulders of the patient  102 . In another embodiment, the sleeves  908  have a longer length that is sufficient to also enclose the hands of the patient  102 . In such an embodiment, the hands, including the fingers of the patient  102 , are contained inside the sleeves  908  and subject to the warming effects of the gown  902 . In another embodiment, hand enclosures  918  are included to enclose the hands of the patient  102 . In various embodiments, the hand enclosures  918  include mittens, gloves, and the like. 
         [0084]    The gown  902  encloses the thorax and waist of the patient  102  front to back. The gown  902  has a posterior opening  1002  that extends from the neck opening  906  to the body opening  912 . The posterior opening  1002  is formed from a pair of flaps  1004 . The pair of flaps  1004  are the posterior portion of the gown  902  and extend from the neck opening to the body opening  912 . The posterior opening  1002  is partially closed by joining the edges of the pair of flaps  1004  at one or more locations. In one embodiment, the flaps  1004  are joined or connected by straps  1006 , on each flap  1004 . A first pair of straps  1006  closes the neck opening  906  of the gown  902 , and a second pair of straps  1006  closes a second location medial to the gown  902 . In other embodiments, the flaps  1004  are joined or connected by string, buttons, snaps, hook and loop fasteners, and/or connectors that releasably secure the flaps  1004  together. 
         [0085]    In one embodiment, the gown  902  is made of a non-woven material that is air permeable. In one such embodiment, the material is bio-degradable. In one embodiment, the sleeves  908  and the posterior portion of the body  904  are heat reflective or include a material that is heat reflective. This heat reflective material provides passive warming when heated air is forced into those portions of the gown  902 . The anterior portion of the gown  902  in the thorax region does not include the heat reflective material. The heat reflective material has a low emissivity such that the heat proximate the patient  102  is not substantially reflected or radiated away from the patient  102 , which tends to prevent cooling of the patient  102  by heat radiation losses. 
         [0086]    In another embodiment, foot enclosures  920  are provided to enclose the feet of the patient  102 . In various embodiments, the foot enclosures  920  include medical footwear, nursing shoes, footies, and the like. 
         [0087]    When heated air is supplied to the inside of the garment  100 , the heated air flows throughout the garment  100  and air flows, such as waist flow  506 , arm flow  510 , thorax flow  608 , and/or neck flow  804 , are exhausted from the garment  100  into the gown  902 . Air that is exhausted into the gown  902  provides warming to the patient  102 . Air flow exits the gown via neck flow  926  through the neck opening  906 . Air flow exits the gown via arm flow  922  through the arm openings  914 . Air flow exits the gown via body flow  924  through the body opening  912 . The amount of air flow in each instance is dependent on which garment  100  is utilized with the gown  902 . 
         [0088]    In operation, a patient  102  is outfitted with garment  100  prior to surgery or some other medical procedure. This typically occurs with the patient  102  in a standing position. A hose  502  is not connected to the port  112 . The patient  102  is free to walk around or sit as the need arises while waiting for the procedure to begin. The garment  100  is in the passive configuration because warming is accomplished passively by the material of the garment  100 . 
         [0089]    For the active configuration, the patient  102  is typically situated in a restricted mobility position by being tethered to the hose  502 . The nozzle of a hose  502  is inserted through the port  112  of the garment  100 . Heated, forced air is generated by a blower attached to the hose  502 . To prevent unintended cooling of the patient  102 , the temperature of the air from the blower is typically adjusted to a range from 36-43° C. 
         [0090]    The heated air  504  enters the garment  100  from the hose  502 . As the heated air  504  enters the garment  100 , the chamber  202  expands. The heated air  504  is exhausted by the chamber  202  into the remainder of the garment  100 . For the pants  100 -A, the heated air leaves the garment  100  through the waist opening  108  and the openings at the leg hems  114 . 
         [0091]    When the pants  100 -A are used in combination with a covering for the patient  102 , such as a surgical drape or blanket, an enclosed area is created over the thorax and/or other portions of the patient  102 . The warming effects of the pants  100 -A provide for placement of a surgical drape or gown  902  in those areas not directly warmed by the pants  100 -A. Additional warming is provided in the area under the drape by increasing the flow of air exiting the waist and/or the legs. The air flow is adjusted from the waist by opening or closing the fastener  110  as necessary. Similarly, the air flow is adjusted from the legs by opening and/or closing the leg hems  114  or the releasable openings  116  as necessary. 
         [0092]    In other embodiments of the garment  100 -B,  100 -C,  100 -D air flow through the thorax region is increased in comparison with the pants  100 -A. The amount of warm air retained in very close proximity to the patient  102  is variable and adjustable by selecting a particular garment  100 -B,  100 -C,  100 -D, and/or by adjusting the flow within the selected garment  100 -B,  100 -C,  100 -D. The air flow is partially adjusted from the legs by opening and/or closing the leg hems  114  or the releasable openings  116  as necessary. 
         [0093]    Each elongated portion  104 -D,  104 -E,  104 -F of the respective garments  100 -B,  100 -C,  100 -D encloses progressively more of the thorax than the previously discussed embodiments while also maintaining access to at least a portion of the upper body of the patient  102 . The garments  100 -B,  100 -C,  100 -D provide direct warming to the thorax of the patient  102 . Additional warming is provided for by placement of a surgical drape or blanket in areas not directly warmed by the garment  100 -B,  100 -C,  100 -D. 
         [0094]    Air temperature is maintained at a desired level for the legs, and the core to peripheral temperature gradient is reduced. The core to peripheral temperature gradient is the difference in temperature between the core region of the patient  102 , that is, the chest or thorax, and the extremities, such as the legs. The difference in temperature between the thorax region and the legs is minimized. The air temperature of the patient  102  is maintained within the garment  100  before, during, and/or after surgery or any other medical procedure. 
         [0095]    When the gown  902  is used, the warming system  900  includes both the garment  100  and the gown  902 . The system  900  is operable for the gown  902  in combination with each of the above described embodiments of the garment  100 -A,  100 -B,  100 -C,  100 -D. As above, the patient  102  is free to walk around or sit as the need arises while waiting for the procedure to begin with the garment  100  in the passive or active configuration. 
         [0096]    With no hose  502  connected, the system  900  is in the passive configuration. The passive heating properties of the gown  902  come into play. The reflective materials of the sleeves  908  and the anterior portion of the body  904  of the gown  902  reduce the loss of the body heat of the patient  102 . The anterior portion of the body of the gown  902  in the thorax region has no heat reflective material and the body heat generated by the patient&#39;s torso is radiated through the anterior portion of the body  904  of the gown  902 . In this way, the gown  902  prevents redistribution hypothermia when the patient  102  is mobile. 
         [0097]    In the active configuration, air  504  is forced into the garment  100 . The nozzle of a hose  502  is inserted through the anterior opening  910  of the gown  902  into the port  112  of the garment  100 . 
         [0098]    The heated, forced air  504  enters the chamber  202  of the garment  100 . The chamber  202  exhausts the air into the garment  100  as above. The garment  100  provides active heating to the patient  102  as described above for the particular embodiment of the garment  100 -A,  100 -B,  100 -C,  100 -D. For the pants  100 -A, the heated air leaves gradually through the waist opening and/or openings in the leg portions  106 . As the air exits the pants  100 -A, it flows into and throughout the gown  902 . Passive heating is provided to the patient  102  by the reflective materials of the gown  902 . The heated air gradually leaves the gown  902  through the neck opening  906 , the body opening  904 , and the arm openings  914 . 
         [0099]    In other embodiments, air flow through the thorax region of the garment  100 -B,  100 -C,  100 -D is increased relative to that provided by the pants  100 -A. In each instance, progressively increased warming is achieved in the thorax region. As discussed above, the amount of warm air retained in very close proximity to the patient  102  is adjustable by selecting a particular garment  100 -B,  100 -C,  100 -D and/or by adjusting the flow within that garment  100  as necessary. 
         [0100]    In embodiments with or without the gown  902 , air temperature is maintained at a desired level for the legs, and the core to peripheral temperature gradient is reduced. That is, the difference in temperature between the chest or thorax region and the legs is minimized. The air temperature of the patient  102  is maintained within the garment  100  before, during, and/or after surgery or any other medical procedure. In this way, redistribution hypothermia is prevented in the arms and legs while the patient  102  is undergoing surgery or other medical procedures. 
         [0101]    From the foregoing description, it will be recognized by those skilled in the art that systems and methods for providing a garment  100  with both passive and active warming are presented. 
         [0102]    While the present invention is illustrated by description of several embodiments and the illustrative embodiments are described in considerable detail, applicant does not intend to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications will readily appear to those skilled in the art. The invention in its broader aspects is therefore not limited to the specific details, representative apparatus and methods, and illustrative examples shown and described. Accordingly, departures may be made from such details without departing from the spirit or scope of applicant&#39;s general inventive concept.