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Neurocritical Care

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01-02-2010 | Original Article

Effect of Shivering on Brain Tissue Oxygenation During Induced Normothermia in Patients With Severe Brain Injury

Authors: Mauro Oddo, Suzanne Frangos, Eileen Maloney-Wilensky, W. Andrew Kofke, Peter D. Le Roux, Joshua M. Levine

Published in: Neurocritical Care | Issue 1/2010

Abstract

Background

We analyzed the impact of shivering on brain tissue oxygenation (PbtO₂) during induced normothermia in patients with severe brain injury.

Methods

We studied patients with severe brain injury who developed shivering during induced normothermia. Induced normothermia was applied to treat refractory fever (body temperature [BT] ≥38.3°C, refractory to conventional treatment) using a surface cooling device with computerized adjustment of patient BT target to 37 ± 0.5°C. PbtO₂, intracranial pressure, mean arterial pressure, cerebral perfusion pressure, and BT were monitored continuously. Circulating water temperature of the device system was measured to assess the intensity of cooling.

Results

Fifteen patients (10 with severe traumatic brain injury, 5 with aneurysmal subarachnoid hemorrhage) were treated with induced normothermia for an average of 5 ± 2 days. Shivering caused a significant decrease in PbtO₂ levels both in SAH and TBI patients. Compared to baseline, shivering was associated with an overall reduction of PbtO₂ from 34.1 ± 7.3 to 24.4 ± 5.5 mmHg (P < 0.001). A significant correlation was found between the magnitude of shivering-associated decrease of PbtO₂ (ΔPbtO₂) and circulating water temperature (R = 0.82, P < 0.001).

Conclusion

In patients with severe brain injury treated with induced normothermia, shivering was associated with a significant decrease of PbtO₂, which correlated with the intensity of cooling. Monitoring of therapeutic cooling with computerized thermoregulatory systems may help prevent shivering and optimize the management of induced normothermia. The clinical significance of shivering-induced decrease in brain tissue oxygenation remains to be determined.

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Title: Effect of Shivering on Brain Tissue Oxygenation During Induced Normothermia in Patients With Severe Brain Injury
Authors: Mauro Oddo
Suzanne Frangos
Eileen Maloney-Wilensky
W. Andrew Kofke
Peter D. Le Roux
Joshua M. Levine
Publication date: 01-02-2010
Publisher: Humana Press Inc
Published in: Neurocritical Care / Issue 1/2010
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-009-9280-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effect of Shivering on Brain Tissue Oxygenation During Induced Normothermia in Patients With Severe Brain Injury

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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