title: Optimal management of shivering during therapeutic hypothermia after cardiac arrest.
abstract: 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.
authors.affiliation: Yale School of Nursing, Yale University, New Haven, Connecticut 06536-0740, USA. angela.logan@yale.edu
authors.forename: Angela
authors.initials: A
authors.lastname: Logan
authors.forename: Prasama
authors.initials: P
authors.lastname: Sangkachand
authors.forename: Marjorie
authors.initials: M
authors.lastname: Funk
mesh_terms: D002985:Clinical Protocols; D019317:Evidence-Based Medicine; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D008614:Meperidine / Q000494:pharmacology; D009294:Narcotics / Q000494:pharmacology; D016032:Randomized Controlled Trials as Topic; D017694:Rewarming / Q000379:methods; D012768:Shivering / Q000187:drug effects / Q000502:physiology; D012881:Skin Temperature / Q000502:physiology
chemical_list: D009294:Narcotics; D008614:Meperidine