• H Alex Choi, Sang-Bae Ko, Mary Presciutti, Luis Fernandez, Amanda M Carpenter, Christine Lesch, Emily Gilmore, Rishi Malhotra, Stephan A Mayer, Kiwon Lee, Jan Claassen, J Michael Schmidt, and Neeraj Badjatia.
• The Neurological Institute of New York, Columbia University College of Physicians and Surgeons, New York, NY, USA.
• Neurocrit Care. 2011 Jun 1;14(3):389-94.

BackgroundAs the practice of aggressive temperature control has become more commonplace, new clinical problems are arising, of which shivering is the most common. Treatment for shivering while avoiding the negative consequences of many anti-shivering therapies is often difficult. We have developed a stepwise protocol that emphasizes use of the least sedating regimen to achieve adequate shiver control.MethodsAll patients treated with temperature modulating devices in the neurological intensive care unit were prospectively entered into a database. Baseline demographic information, daily temperature goals, best daily GCS, and type and cumulative dose of anti-shivering agents were recorded.ResultsWe collected 213 patients who underwent 1388 patient days of temperature modulation. Eighty-nine patients underwent hypothermia and 124 patients underwent induced normothermia. In 18% of patients and 33% of the total patient days only none-sedating baseline interventions were needed. The first agent used was most commonly dexmeditomidine at 50% of the time, followed by an opiate and increased doses of propofol. Younger patients, men, and decreased BSA were factors associated with increased number of anti-shivering interventions.ConclusionsA significant proportion of patients undergoing temperature modulation can be effectively treated for shivering without over-sedation and paralysis. Patients at higher risk for needing more interventions are younger men with decreased BSA.

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