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Shivering during targeted temperature modulation

Akash Jain, Maria Gray, Stephanie Slisz, Joseph Haymore, Neeraj Badjatia, Erik Kulstad
BACKGROUND: Shivering is common during targeted temperature management, and control of shivering can be challenging if clinicians are not familiar with the available options and recommended approaches. PURPOSE: The purpose of this review was to summarize the most relevant literature regarding various treatments available for control of shivering and suggest a recommended approach based on latest data. METHODS: The electronic databases PubMed/MEDLINE and Google Scholar were used to identify studies for the literature review using the following keywords alone or in combination: "shivering treatment," "therapeutic hypothermia," "core temperature modulation devices," and "targeted temperature management...
April 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Rishabh Charan Choudhary, Xiaofeng Jia
Targeted temperature management (TTM) has been recognized to protect tissue function and positively influence neurological outcomes after brain injury. While shivering during hypothermia nullifies the beneficial effect of TTM, traditionally, antishivering drugs or paralyzing agents have been used to reduce the shivering. The hypothalamic area of the brain helps in controlling cerebral temperature and body temperature through interactions between different brain areas. Thus, modulation of different brain areas either pharmacologically or by electrical stimulation may contribute in TTM; although, very few studies have shown that TTM might be achieved by activation and inhibition of neurons in the hypothalamic region...
September 2017: Therapeutic Hypothermia and Temperature Management
Ko-Eun Choi, Bomi Park, Asma M Moheet, Amanda Rosen, Shouri Lahiri, Axel Rosengart
Shivering is a common side effect of targeted temperature modulation and general anesthesia. Antishivering strategies often employ a stepwise approach involving both pharmacological and physical interventions. However, approaches to treat shivering are often empiric and vary widely across care environments. We evaluated the quality of published antishivering protocols and guidelines with respect to methodological rigor, reliability, and consistency of recommendations.Using 4 medical databases, we identified 4027 publications that addressed shivering therapy, and excluded 3354 due to lack of relevance...
May 2017: Anesthesia and Analgesia
Akilesh Honasoge, Braden Parker, Kelly Wesselhoff, Neal Lyons, Erik Kulstad
Therapeutic hypothermia or targeted temperature management has been used after cardiac arrest to improve neurological outcomes and mortality. However, a side effect of temperature modulation is a centrally mediated shivering response. The Columbia Anti-Shivering Protocol sets up a systematic method of intravenous (IV) and oral medication escalation to suppress this response and preserve the benefits of this therapy. We present the case of a 59-year-old male who began shivering after therapeutic hypothermia for cardiac arrest, leading to a persistent rise in core temperature despite adequate sedation...
March 2016: Therapeutic Hypothermia and Temperature Management
Chantal Gosselin, François Haman
The effects of epigallocatechin-3-gallate (EGCG) and caffeine on non-shivering thermogenesis (NST) during cold exposure is unknown. The purpose of the present study was to quantify the effects of co-ingesting EGCG and caffeine on the thermogenic responses of a 3 h cold exposure. A total of eight healthy males were exposed to mild cold, using a liquid-conditioned suit perfused with 158C water, on two occasions and consumed a placebo or an extract of 1600 mg of EGCG and 600 mg of caffeine (Green tea). Thermic, metabolic and electromyographic measurements were monitored at baseline and during the cold exposure...
July 28, 2013: British Journal of Nutrition
L A Urbano, Mauro Oddo
Experimental evidence demonstrates that therapeutic temperature modulation with the use of mild induced hypothermia (MIH, defined as the maintenance of body temperature at 32-35 °C) exerts significant neuroprotection and attenuates secondary cerebral insults after traumatic brain injury (TBI). In adult TBI patients, MIH has been used during the acute "early" phase as prophylactic neuroprotectant and in the sub-acute "late" phase to control brain edema. When used to control brain edema, MIH is effective in reducing elevated intracranial pressure (ICP), and is a valid therapy of refractory intracranial hypertension in TBI patients...
October 2012: Current Neurology and Neuroscience Reports
David B Seder, Thomas E Van der Kloot
OBJECTIVES: To review traditional and newer means of inducing, maintaining, and withdrawing therapeutic hypothermia and normothermia. To suggest treatment algorithms for temperature modulation and review neuromonitoring options. DESIGN: A review of current literature describing methods of performing therapeutic temperature management and neuromonitoring during the cooling, maintenance, and decooling periods. Algorithms for performing therapeutic temperature management are suggested...
July 2009: Critical Care Medicine
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