Nonpharmacologic approach to minimizing shivering during surface cooling: a proof of principle study Journal Article

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Authors: Shah, N. G.; Cowan, M. J.; Pickering, E.; Sareh, H.; Afshar, M; Fox, D.; Marron, J.; Davis, J.; Herold, K.; Shanholtz, C. B.; Hasday, J. D.
Article Title: Nonpharmacologic approach to minimizing shivering during surface cooling: a proof of principle study
Abstract: PURPOSE: This study had 2 objectives: (1) to quantify the metabolic response to physical cooling in febrile patients with systemic inflammatory response syndrome (SIRS) and (2) to provide proof for the hypothesis that the efficiency of external cooling and the subsequent shivering response are influenced by site and temperature of surface cooling pads. METHODS: To quantify shivering thermogenesis during surface cooling for fever, we monitored oxygen consumption (VO(2)) in 6 febrile patients with SIRS during conventional cooling with cooling blankets and ice packs. To begin to determine how location and temperature of surface cooling influence shivering, we compared 5 cooling protocols for inducing mild hypothermia in 6 healthy volunteers. RESULTS: In the patients with SIRS, core temperature decreased 0.67 degrees C per hour, all patients shivered, VO(2) increased 57.6%, and blood pressure increased 15% during cooling. In healthy subjects, cooling with the 10 degrees C vest was most comfortable and removed heat most efficiently without shivering or VO(2) increase. Cooling with combined vest and thigh pads stimulated the most shivering and highest VO(2) and increased core temperature. Reducing vest temperature from 10 degrees C to 5 degrees C failed to increase heat removal secondary to cutaneous vasoconstriction. Capsaicin, an agonist for the transient receptor potential cation channel subfamily V member 1 (TRPV1) warm-sensing channels, partially reversed this effect in 5 subjects. CONCLUSIONS: Our results identify the hazards of surface cooling in febrile critically ill patients and support the concept that optimization of cooling pad temperature and position may improve cooling efficiency and reduce shivering.
Journal Title: Journal of critical care
Volume: 27
Issue: 6
ISSN: 1557-8615; 0883-9441
Publisher: Elsevier Inc  
Journal Place: United States
Date Published: 2012
Start Page: 746.e1
End Page: 746.e8
Language: eng
DOI/URL:

10.1016/j.jcrc.2012.04.016
Notes: LR: 20141015; CI: Copyright (c) 2012; GR: HL085256/HL/NHLBI NIH HHS/United States; GR: HL69057/HL/NHLBI NIH HHS/United States; GR: R01 GM066855/GM/NIGMS NIH HHS/United States; GR: R01 HL069057/HL/NHLBI NIH HHS/United States; GR: R01 HL085256/HL/NHLBI NIH HHS/United States; JID: 8610642; NIHMS374522; OID: NLM: NIHMS374522; OID: NLM: PMC3494806; 2011/10/25 [received]; 2012/04/11 [revised]; 2012/04/15 [accepted]; 2012/07/02 [aheadofprint]; ppublish