title: Comparison of Distal Limb Warming With Fluidotherapy and Warm Water Immersion for Mild Hypothermia Rewarming.
abstract: OBJECTIVE
  The purpose of the study was to determine the effectiveness of Fluidotherapy rewarming through the distal extremities for mildly hypothermic, vigorously shivering subjects. Fluidotherapy is a dry heat modality in which cellulose particles are suspended by warm air circulation.
  
  
  METHODS
  Seven subjects (2 female) were cooled on 3 occasions in 8˚C water for 60 minutes, or to a core temperature of 35°C. They were then dried and rewarmed in a seated position by 1) shivering only; 2) Fluidotherapy applied to the distal extremities (46 ± 1°C, mean ± SD); or 3) water immersion of the distal extremities (44 ± 1°C). The order of rewarming followed a balanced design. Esophageal temperature, skin temperature, heart rate, oxygen consumption, and heat flux were measured.
  
  
  RESULTS
  The warm water produced the highest rewarming rate, 6.1°C·h(-1), 95% CI: 5.3-6.9, compared with Fluidotherapy, 2.2°C·h(-1), 95% CI: 1.4-3.0, and shivering only, 2.0°C·h(-1), 95% CI: 1.2-2.8. The Fluidotherapy and warm water conditions increased skin temperature and inhibited shivering heat production, thus reducing metabolic heat production (166 ± 42 W and 181 ± 45 W, respectively), compared with shivering only (322 ± 142 W). Warm water provided a significantly higher net heat gain (398.0 ± 52 W) than shivering only (288.4 ± 115 W).
  
  
  CONCLUSIONS
  Fluidotherapy was not as effective as warm water for rewarming mildly hypothermic subjects. Although Fluidotherapy is more portable and technically simpler, it provides a lower rate of rewarming that is similar to shivering only. It does help decrease shivering heat production, lowering energy expenditure and cardiac work, and could be considered in a hospital setting, if convenient.
authors.affiliation: Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada (all authors); and the Gupta Faculty of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, Manitoba, Canada (Mr McDonald).
authors.forename: Parveen
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada (all authors); and the Gupta Faculty of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, Manitoba, Canada (Mr McDonald).
authors.forename: Gerren K
authors.initials: GK
authors.lastname: McDonald
authors.affiliation: Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada (all authors); and the Gupta Faculty of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, Manitoba, Canada (Mr McDonald).
authors.forename: Radhika
authors.initials: R
authors.lastname: Chitkara
authors.affiliation: Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada (all authors); and the Gupta Faculty of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, Manitoba, Canada (Mr McDonald).
authors.forename: Alan M
authors.initials: AM
authors.lastname: Steinman
authors.affiliation: Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada (all authors); and the Gupta Faculty of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, Manitoba, Canada (Mr McDonald).
authors.forename: Phillip F
authors.initials: PF
authors.lastname: Gardiner
authors.affiliation: Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada (all authors); and the Gupta Faculty of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, Manitoba, Canada (Mr McDonald). Electronic address: giesbrec@cc.umanitoba.ca.
authors.forename: Gordon G
authors.initials: GG
authors.lastname: Giesbrecht
mesh_terms: D000328:Adult; D005260:Female; D006358:Hot Temperature; D006801:Humans; D007035:Hypothermia / Q000628:therapy*; D007101:Immersion; D008297:Male; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D017694:Rewarming / Q000295:instrumentation / Q000379:methods*; D012768:Shivering; D055813:Wilderness Medicine / Q000295:instrumentation / Q000379:methods*
keywords: afterdrop; effective perfused mass; hospital treatment; shivering heat production; thermal core