Increasing the Effectiveness of Targeted Temperature Management.
Melissa Moreda, Pamela S Beacham, Angela Reese and 1 others
PMID 34595495WHAT IT FOUND
In targeted temperature management, shivering can eradicate neuroprotection.
Nurses assess shivering by observation and palpation, then use combined warming, medication, sedation, and neuromuscular blockade to lower shivering thresholds.
Key findings
01During targeted temperature management, 40% of patients shiver, and shivering can eradicate the neuroprotective effects of targeted temperature management.
02Shivering prevention uses warming blankets, socks, acetaminophen, buspirone, magnesium sulfate, then analgesia, sedation, and neuromuscular blockade; these interventions are reported to reduce thresholds by 1 to 2.5 °C, but the paper does not separate the effect of each component.
03Shivering assessment uses a scale such as the Bedside Shivering Assessment Scale, with observation and palpation of the neck, thorax, arms, and legs; a score greater than 1 requires further investigation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
No original methods or results are reported, so the paper is a narrative review rather than evidence from a new trial. Shivering prevention is described as a combined stepwise approach, so the paper does not show which single component is responsible for threshold reductions. The 40% shivering and approximately 50% fever figures are cited from prior literature, not from patients studied in this article.
The easy way to misread this
Do not conclude that any single shivering prevention measure is proven effective. The paper describes combined warming, medication, sedation, and neuromuscular blockade, and it does not separate their effects.