Metabolic Cost of Shivering

Fever Management in Intensive Care Patients with Infections

“…In humans, generating fever through shivering increases the metabolic rate above basal levels by six-fold [4]. In critically ill patients with fever, cooling reduces oxygen consumption by about 10 % per °C decrease in core temperature and signifi cantly reduces cardiac output and minute ventilation [5].…”

“…If this is the case, then fever probably emerged as an evolutionary response more than 350 million years ago [13]. As the febrile response comes at a signifi cant metabolic cost [4], [5], its persistence across such a broad range of species provides strong circumstantial evidence that the response has some evolutionary advantage. Furthermore, given that the response appears ubiquitous, it logically follows that the components of the immune system would have evolved to function optimally in the physiological febrile range.…”

Hipotermia intravascular prolongada en un paciente con hipertensión endocraneana refractaria

“…De hecho, su uso requiere el empleo de una sedación profunda y muchas veces asociada a bloqueo neuromuscular, para evitar los calofríos que aumentan signifi cativamente el consumo de oxígeno 7,20 . Sólo la sedación y el bloqueo neuromuscular, administrados en forma protocolizada contra un objetivo de sedación moderada, han demostrado reducir el número de días en ventilación mecánica 21 y la probabilidad de neumonía asociada al ventilador mecánico (NAV) 22 .…”

Perioperative temperature measurement and management: moving beyond the Surgical Care Improvement Project

“…A higher rate of metabolism increases oxygen demand and causes a depletion of glycogen in the muscles [30] and high-energy phosphate stores [31]. Hypothermia is also associated with up to a 250% increase in minute ventilation [32], which may be detrimental in certain subsets of patients such as those with underlying lung disease. Increased metabolism, minute ventilation, and activation of the sympathetic system make avoidance of shivering necessary.…”