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Cited by 52Thermal Regulation in MedicineThermoregulation and physiological responsesCardiac Arrest and Resuscitation

Predictors and clinical implications of shivering during therapeutic normothermia

Badjatia, Neeraj, Kowalski, Robert G., Schmidt, J. Michael, Voorhees, Marc E., Claassen, Jan, Ostapkovich, Noeleen D., Presciutti, Mary, Connolly, E. Sander +3 more·2007·Neurocritical Care
DOI 10.1007/s12028-007-0011-2
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Abstract

Background Shivering during induced normothermia (IN) remains a therapeutic limitation. We investigated potential risk factors and clinical implications of shivering during IN.Methods Post hoc analysis was performed on 24 patients enrolled in a clinical trial of an automated surface cooling system to achieve IN. Hyponatremia was defined as serum levels <136 mmol/L and hypomagnesaemia as levels <1.5 mg/dL. Continuous heat energy transfer (kcal/h) was averaged hourly. Glasgow Coma Scale (GCS) scores were recorded every 2 h. Shivering status was documented hourly. Mixed effects modeling was used to determine clinical measures associated with shivering. Generalized estimating equation (GEE) models were used to compare baseline-adjusted repeated-measures GCS scores.Results About of 24 (39%) patients demonstrated shivering. Shivering was associated with men (67% vs. 21%, P = 0.03), hyponatremia (44% vs. 7%, P = 0.03), and hypomagnesaemia (56% vs. 7%, P = 0.02). The average kcal/h (158 +/- 645 kcal/h vs. 493 +/- 645 kcal/h, P = 0.03) was greater in shivering patients. Shivering was positively associated with increases in heart rate (P < 0.001), respiratory rate (P < 0.001), and kcal/h (P < 0.001). Non-shivering patients showed a greater increase from baseline GCS (GEE, P = 0.02) at 24 h. No differences in sedative doses or fever burden were noted between shiverers and non-shiverers.Conclusions Men, hyponatremia, and hypomagnesaemia may predispose febrile patients treated with IN to shivering. Shivering dramatically increases the amount of heat transfer required to maintain normothermia, and may be associated with adverse effects on level of consciousness.

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Crossref · 10.1007/s12028-007-0011-2

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  • Shivering thermogenesis is highly variable, usually of short duration, and not a likely method for therapeutic intervention.

    “Up to 250 kcal per hour are consumed by shivering 113, but this response is highly variable, usually of short duration, and not a likely method for therapeutic intervention.”

    From Cellular bioenergetics as a target for obesity therapy (2010) · cites this paper as [113]

  • Up to 250 kcal per hour are consumed by shivering.

    “Up to 250 kcal per hour are consumed by shivering 113, but this response is highly variable, usually of short duration, and not a likely method for therapeutic intervention.”

    From Cellular bioenergetics as a target for obesity therapy (2010) · cites this paper as [113]

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Authors
Badjatia, N., Kowalski, R. G., Schmidt, J. M., Voorhees, M. E., Claassen, J., Ostapkovich, N. D., Presciutti, M., Connolly, E. S., Palestrant, D., Parra, A., & Mayer, S. A.
Affiliations
  • Columbia University Irving Medical Center (US)
  • Columbia University (US)
Corresponding author
Badjatia, Neeraj
ORCID
Venue
Neurocritical Care
Publisher
Springer Science and Business Media LLC
Published
2007-05-30
Volume
6
Issue
3
Pages
186-191
ISSN
  • 1541-6933 (ISSN-L)
  • 1556-0961
DOI
10.1007/s12028-007-0011-2
OpenAlex
W2025660653
Cited by
52
References
28
Citations by year
2026: 2 · 2025: 1 · 2023: 1 · 2021: 4 · 2020: 2 · 2018: 2 · 2017: 6 · 2016: 6 · 2015: 2 · 2014: 5 · 2013: 3 · 2012: 6
FWCI
2.58
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Neurocritical Care (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Thermal Regulation in Medicine
  • Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
  • Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
Keywords
shivering, febrile patients, hyponatremia, hypomagnesemia, Glasgow Coma Scale, level of consciousness, risk factors, sedation
MeSH terms
Adult, Aged, Aged, 80 and over, Automation, Body Temperature, Energy Transfer, Female, Fever, Heart Rate, Hot Temperature, Humans, Hyponatremia, Magnesium, Male, Middle Aged, Risk Factors, Sex Factors, Shivering, Glasgow Coma Scale, Respiratory Mechanics, Linear Models, Cryotherapy

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