Metabolic Impact of Shivering During Therapeutic Temperature Modulation: The Bedside Shivering Assessment Scale

N. Badjatia, E. Strongilis, E. Gordon, M. Prescutti, L. Fernandez, A. Fernandez, M. Buitrago, J. M. Schmidt, N. D. Ostapkovich, S. A. Mayer
2008 Stroke  
and Purpose-Therapeutic temperature modulation is widely used in neurocritical care but commonly causes shivering, which can hamper the cooling process and result in increases in systemic metabolism. We sought to validate a grading scale to assist in the monitoring and control of shivering. Methods-A simple 4-point Bedside Shivering Assessment Scale was validated against continuous assessments of resting energy expenditure, oxygen consumption, and carbon dioxide production as measured by
more » ... t calorimetry. Therapeutic temperature modulation for fever control or the induction of hypothermia was achieved with the use of a surface or endovascular device. Expected energy expenditure was calculated using the Harris-Benedict equation. A hypermetabolic index was calculated from the ratio of resting of energy expenditure to energy expenditure. Results-Fifty consecutive cerebrovascular patients underwent indirect calorimetry between January 2006 and June 2007. Fifty-six percent were women, and mean age 63Ϯ16 years. The majority underwent fever control (nϭ40 [80%]) with a surface cooling device (nϭ44 [87%]) and had signs of shivering (Bedside Shivering Assessment Scale Ͼ0, 64% [nϭ34 of 50]). Low serum magnesium was independently associated with the presence of shivering (Bedside Shivering Assessment Scale Ͼ0; OR, 6.8; 95% CI, 1.7 to 28.0; Pϭ0.01). The Bedside Shivering Assessment Scale was independently associated with the hypermetabolic index (Wϭ16.3, PϽ0.001), oxygen consumption (Wϭ26.3, PϽ0.001), resting energy expenditure (Wϭ27.2, PϽ0.001), and carbon dioxide production (Wϭ18.2, PϽ0.001) with a high level of interobserver reliability ( w ϭ0.84, 95% CI, 0.81 to 0.86). Conclusion-The Bedside Shivering Assessment Scale is a simple and reliable tool for evaluating the metabolic stress of shivering. (Stroke. 2008;39:3242-3247.)
doi:10.1161/strokeaha.108.523654 pmid:18927450 fatcat:2ddsl4np75d37ldcn2omscb7bq