Metabolic Impact of Shivering During Therapeutic Temperature Modulation

Badjatia, Neeraj; Strongilis, Evangelia; Gordon, Errol; Prescutti, Mary; Fernández, Luís; Fernandez, Andres; Buitrago, Manuel M.; Schmidt, J. Michael; Ostapkovich, Noeleen; Mayer, Stephan A.

doi:10.1161/strokeaha.108.523654

Cited by 279 publications

(173 citation statements)

References 24 publications

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“…We placed the Bedside Shivering Assessment Scale tool in our critical care electronic documentation to guide staff to use a standard approach to recognize shivering. 46 When clinical ability to assess shivering continued to vary widely, we implemented monitoring with a portable noninvasive bispectral index (BIS) monitoring system device to detect electromyographic facial shivering and potential seizure activity. The derived electromyographic value appears to correlate with shivering and is displayed as a quantitative bar.…”

Section: Induction/shivering Managementmentioning

confidence: 99%

From Door to Recovery: A Collaborative Approach to the Development of a Post–Cardiac Arrest Center

Williams

Calder²,

Cocchi³

et al. 2013

Critical Care Nurse

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Out-of-hospital cardiac arrest remains common and, despite advances in resuscitation practices, continues to carry a high mortality that may be influenced by several factors, including where a patient is cared for after the cardiac arrest. Implementing a post–cardiac arrest care guideline for survivors of out-of-hospital and in-hospital cardiac arrest involves a multidisciplinary approach with short-term and long-term strategies. Physician and nursing leaders must work in synergy to guide the implementation of an evidence-based plan of care. A collaborative approach was used at a hospital to develop processes, build consensus for protocols, and provide support to staff and teams. A joint approach has allowed the hospital to move from traditional silos of individual departmental care to a continuum of patient-focused management after cardiac arrest. This care coordination is initiated in the emergency department and follows the patient through to discharge.

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Section: Induction/shivering Managementmentioning

confidence: 99%

From Door to Recovery: A Collaborative Approach to the Development of a Post–Cardiac Arrest Center

Williams

Calder²,

Cocchi³

et al. 2013

Critical Care Nurse

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“…10 Shivering results in increased resting energy expenditure and oxygen consumption, impeding the induction of hypothermia and eliminating any potential benefits. 11 When shivering is uncontrolled, consequences include increased tissue ischemia. In addition, uncontrolled shivering counteracts the neuroprotective benefits of therapeutic hypothermia due to the reduction of cerebral metabolism.…”

Section: Shiveringmentioning

confidence: 99%

“…In addition, uncontrolled shivering counteracts the neuroprotective benefits of therapeutic hypothermia due to the reduction of cerebral metabolism. 11 For therapeutic hypothermia to be beneficial, shivering must be monitored frequently and controlled during the induction, maintenance, and rewarming phases of the therapy. Shivering is not always visible.…”

Section: Shiveringmentioning

confidence: 99%

“…A grading scale, such as the Bedside Shivering Assessment Scale (Table 1) developed and validated by Badjatia et al, 11 can also be useful in monitoring and controlling shivering. By assessing the correlation between the score on the scale and systemic metabolic stress defined by indirect calorimetric measurements, Badjatia et al determined that the score accurately represented the metabolic impact of shivering.…”

Section: Shiveringmentioning

confidence: 99%

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Optimal Management of Shivering During Therapeutic Hypothermia After Cardiac Arrest

Logan

Sangkachand²,

Funk

2011

Critical Care Nurse

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Both pharmacological and nonpharmacological methods are used to control shivering in therapeutic hypothermia. An evidence-based protocol based on the most current research has been developed for the management of shivering during therapeutic hypothermia. Meperidine is the drug of choice and provides the greatest reduction in the shivering threshold. Other effective pharmacological agents recommended for reducing the threshold include dexmedetomidine, midazolam, fentanyl, and magnesium sulfate. In addition, skin counterwarming techniques, such as use of an air-circulating blanket, are effective nonpharmacological methods for reducing shivering when used in conjunction with medication. As a last resort, neuromuscular blocking agents are considered appropriate therapy for management of refractory shivering.

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“…This difference creates a metabolic stress response aimed at restitution of temperature to the level prevailing before the start of cooling, and this stress response will continue as long as there is a difference between thermostat and body temperature. 32,33 Muscle shivering is a visible component in this stress response, but the stress also means an increase in the release of cathecholamines into the plasma. People who have been awake with severe sepsis, with relatively fast fluctuations of body temperature, have been witness to an excruciating amount of stress related to the period of increasing temperature towards the higher temperature stipulated by the thermostat.…”

Section: Hypothermia-induced Stress Responsementioning

confidence: 99%

Active cooling in traumatic brain‐injured patients: a questionable therapy?

Grände

Reinstrup

Romner

2009

Acta Anaesthesiol Scand

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Hypothermia is shown to be beneficial for the outcome after a transient global brain ischaemia through its neuroprotective effect. Whether this is also the case after focal ischaemia, such as following a severe traumatic brain injury (TBI), has been investigated in numerous studies, some of which have shown a tendency towards an improved outcome, whereas others have not been able to demonstrate any beneficial effect. A Cochrane report concluded that the majority of the trials that have already been published have been of low quality, with unclear allocation concealment. If only high-quality trials are considered, TBI patients treated with active cooling were more likely to die, a conclusion supported by a recent high-quality Canadian trial on children. Still, there is a belief that a modified protocol with a shorter time from the accident to the start of active cooling, longer cooling and rewarming time and better control of blood pressure and intracranial pressure would be beneficial for TBI patients. This belief has led to the instigation of new trials in adults and in children, including these types of protocol adjustments. The present review provides a short summary of our present knowledge of the use of active cooling in TBI patients, and presents some tentative explanations as to why active cooling has not been shown to be effective for outcome after TBI. We focus particularly on the compromised circulation of the penumbra zone, which may be further reduced by the stress caused by the difference in thermostat and body temperature and by the hypothermia-induced more frequent use of vasoconstrictors, and by the increased risk of contusional bleedings under hypothermia. We suggest that high fever should be reduced pharmacologically.

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Metabolic Impact of Shivering During Therapeutic Temperature Modulation

Cited by 279 publications

References 24 publications

From Door to Recovery: A Collaborative Approach to the Development of a Post–Cardiac Arrest Center

From Door to Recovery: A Collaborative Approach to the Development of a Post–Cardiac Arrest Center

Optimal Management of Shivering During Therapeutic Hypothermia After Cardiac Arrest

Active cooling in traumatic brain‐injured patients: a questionable therapy?

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