Abstract
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." Results: Nonpharmacologic methods were found to have a very low adverse effect profile and ease of use but some limitations in complete control of shivering. Pharmacologic methods can effectively control shivering, but some have adverse effects, such that risks and benefits to the patient have to be balanced. Conclusion: An approach is provided which suggests that treatment for shivering control in targeted temperature management should be initiated before the onset of therapeutic hypothermia or prior to any attempt at lowering patient core temperature, with medications including acetaminophen, buspirone, and magnesium sulfate, ideally with the addition of skin counterwarming. After that, shivering intervention should be determined with the help of a shivering scale, and stepwise escalation can be implemented that balances shivering treatment with sedation, aiming to provide the most shivering reduction with the least sedating medications and reserving paralytics for the last line of treatment.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 63-67 |
| Number of pages | 5 |
| Journal | Journal of Neuroscience Nursing |
| Volume | 50 |
| Issue number | 2 |
| DOIs | |
| State | Published - Apr 1 2018 |
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Keywords
- core temperature modulation devices
- normothermia
- shivering control in targeted temperature management
- shivering control in TTM
- shivering scale
- shivering treatment
- targeted temperature management
- therapeutic hypothermia
- therapeutic normothermia
ASJC Scopus subject areas
- Surgery
- Endocrine and Autonomic Systems
- Clinical Neurology
- Medical–Surgical
Cite this
Shivering Treatments for Targeted Temperature Management : A Review. / Jain, Akash; Gray, Maria; Slisz, Stephanie; Haymore, Joseph; Badjatia, Neeraj; Kulstad, Erik.
In: Journal of Neuroscience Nursing, Vol. 50, No. 2, 01.04.2018, p. 63-67.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Shivering Treatments for Targeted Temperature Management
T2 - A Review
AU - Jain, Akash
AU - Gray, Maria
AU - Slisz, Stephanie
AU - Haymore, Joseph
AU - Badjatia, Neeraj
AU - Kulstad, Erik
PY - 2018/4/1
Y1 - 2018/4/1
N2 - 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." Results: Nonpharmacologic methods were found to have a very low adverse effect profile and ease of use but some limitations in complete control of shivering. Pharmacologic methods can effectively control shivering, but some have adverse effects, such that risks and benefits to the patient have to be balanced. Conclusion: An approach is provided which suggests that treatment for shivering control in targeted temperature management should be initiated before the onset of therapeutic hypothermia or prior to any attempt at lowering patient core temperature, with medications including acetaminophen, buspirone, and magnesium sulfate, ideally with the addition of skin counterwarming. After that, shivering intervention should be determined with the help of a shivering scale, and stepwise escalation can be implemented that balances shivering treatment with sedation, aiming to provide the most shivering reduction with the least sedating medications and reserving paralytics for the last line of treatment.
AB - 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." Results: Nonpharmacologic methods were found to have a very low adverse effect profile and ease of use but some limitations in complete control of shivering. Pharmacologic methods can effectively control shivering, but some have adverse effects, such that risks and benefits to the patient have to be balanced. Conclusion: An approach is provided which suggests that treatment for shivering control in targeted temperature management should be initiated before the onset of therapeutic hypothermia or prior to any attempt at lowering patient core temperature, with medications including acetaminophen, buspirone, and magnesium sulfate, ideally with the addition of skin counterwarming. After that, shivering intervention should be determined with the help of a shivering scale, and stepwise escalation can be implemented that balances shivering treatment with sedation, aiming to provide the most shivering reduction with the least sedating medications and reserving paralytics for the last line of treatment.
KW - core temperature modulation devices
KW - normothermia
KW - shivering control in targeted temperature management
KW - shivering control in TTM
KW - shivering scale
KW - shivering treatment
KW - targeted temperature management
KW - therapeutic hypothermia
KW - therapeutic normothermia
UR - http://www.scopus.com/inward/record.url?scp=85044054331&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044054331&partnerID=8YFLogxK
U2 - 10.1097/JNN.0000000000000340
DO - 10.1097/JNN.0000000000000340
M3 - Review article
C2 - 29278601
AN - SCOPUS:85044054331
VL - 50
SP - 63
EP - 67
JO - Journal of Neuroscience Nursing
JF - Journal of Neuroscience Nursing
SN - 0888-0395
IS - 2
ER -