title: Efficacy of Nonpharmacological Antishivering Interventions: A Systematic Analysis.
abstract: OBJECTIVE
  We performed a systematic review of the published evidence regarding nonpharmacologic antishivering interventions in various clinical settings.
  
  
  METHODS
  Studies through November 2014 were identified using predefined search terms in electronic databases, including PubMed, the Cochrane Library, EMBASE: Excerpta Medica (Ovid), and Web of Science.
  
  
  METHODS
  All identified articles were critically analyzed by applying prespecified criteria. We included experimental trials with comparable baseline data investigating the antishivering efficacy of nonpharmacological interventions in subjects without underlying thermoregulatory dysfunction.
  
  
  METHODS
  Sixty-five publications (3,361 subjects) were analyzed by the type of clinical setting, intervention, comparison, and study design. In addition, each study underwent a standardized study quality assessment.
  
  
  RESULTS
  Nonpharmacological interventions consisted of active cutaneous warming (forced-air warming, electric heating pad/blanket, radiant heating, and water-circulating mattress), body core warming (fluid or gas warming system), passive cutaneous warming (space blankets or towels), and electroacupuncture. Identified clinical settings included perioperative settings without induced hypothermia (60 of 77 comparisons), perioperative settings with induced hypothermia (8 of 77), and induced hypothermia without anesthesia (9 of 77). Active cutaneous warming was the most commonly studied intervention, and it was associated with the highest prevalence of positive results when compared with controls in all three clinical settings. In contrast, passive cutaneous warming and body core warming showed conflicting efficacy. Comparison evaluations among different antishivering interventions were limited due to the paucity and heterogeneity of studies directly comparing different interventions against one another.
  
  
  CONCLUSIONS
  This systematic review of the effectiveness of nonpharmacological antishivering methods delineates active cutaneous warming as the most effective nonpharmacologic antishivering intervention in the perioperative and induced hypothermia settings.
authors.affiliation: 1Department of Neurology, Weill Cornell Medical College of Weill Cornell University, New York Presbyterian Hospital, New York, NY. 2Department of Neurosciences, Weill Cornell Medical College of Weill Cornell University, New York Presbyterian Hospital, New York, NY. 3Department of Pharmacy, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY. 4Department of Nursing, Weill Cornell Medical College of Weill Cornell University, New York Presbyterian Hospital, New York, NY. 5Department of Neurology, Neurosurgery and Biomedical Sciences, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Bomi
authors.initials: B
authors.lastname: Park
authors.forename: Taehoon
authors.initials: T
authors.lastname: Lee
authors.forename: Karen
authors.initials: K
authors.lastname: Berger
authors.forename: Sea Mi
authors.initials: SM
authors.lastname: Park
authors.forename: Ko-Eun
authors.initials: KE
authors.lastname: Choi
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Goodsell
authors.forename: Axel
authors.initials: A
authors.lastname: Rosengart
mesh_terms: D006801:Humans; D007035:Hypothermia / Q000503:physiopathology* / Q000517:prevention & control*; D007036:Hypothermia, Induced; D019990:Perioperative Care / Q000379:methods*; D012768:Shivering