title: Assessment of Antishivering Medication Requirements During Therapeutic Normothermia: Effect of Cooling Methods.
abstract: Shivering during targeted temperature management (TTM) should be minimized because it can cause cerebral and metabolic stress. It has been proposed that surface cooling (SC) may result in more shivering than endovascular cooling (EC) methods. The purpose of this study was to compare antishivering medication requirements and degree of shivering in these groups during TTM to Normothermia (NT). This was a retrospective single-center cohort study of patients treated with protocolized TTM through SC and EC methods to achieve NT (37.0-37.5°C). The number of interventions and daily dose of antishivering medications, per institutional protocol, were compared between the two groups. The intensity of shivering was assessed with the Bedside Shivering Assessment Scale. Patients in the EC group (n = 23) had more antishivering interventions per patient day than those in the SC group (n = 43) (3.28 vs. 2.67, p = 0.002). Acetaminophen (81% vs. 59%, p < 0.001), buspirone (75% vs. 53%, p < 0.001), and magnesium infusions (52% vs. 36%, p = 0.012) were used on more patient days in the EC group. Patients treated with SC required more patient days of propofol (35% vs. 19%, p = 0.006) and higher average dexmedetomidine dosing per patient-day (0.70 vs. 0.56 μg/[kg·h], p = 0.03). Dosing of other medications was similar. There were no observed differences in degree or intensity of shivering. In our cohort, patients in EC group required more antishivering interventions, but less sedation, during TTM than patients in SC group. Optimizing nonsedating medications, such as acetaminophen, buspirone, and magnesium infusions, may decrease the requirement for sedatives to control shivering in both SC and EC.
authors.affiliation: 1 Department of Pharmacy, Mercy Fitzgerald Hospital , Darby, Pennsylvania.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kirk
authors.affiliation: 2 Department of Pharmacy, Thomas Jefferson University , Philadelphia, Pennsylvania.
authors.forename: Cara
authors.initials: C
authors.lastname: McDaniel
authors.affiliation: 2 Department of Pharmacy, Thomas Jefferson University , Philadelphia, Pennsylvania.
authors.forename: Dorota
authors.initials: D
authors.lastname: Szarlej
authors.affiliation: 3 Department of Neurosurgery, Thomas Jefferson University , Philadelphia, Pennsylvania.
authors.forename: Fred
authors.initials: F
authors.lastname: Rincon
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D058633:Antipyretics / Q000627:therapeutic use; D001831:Body Temperature / Q000187:drug effects*; D002065:Buspirone / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007036:Hypothermia, Induced / Q000379:methods*; D008274:Magnesium / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012768:Shivering / Q000187:drug effects*; D014883:Water-Electrolyte Imbalance / Q000139:chemically induced
chemical_list: D058633:Antipyretics; D006993:Hypnotics and Sedatives; D000082:Acetaminophen; D008274:Magnesium; D002065:Buspirone