Metabolic benefits of surface counter warming during therapeutic temperature modulation*

• DOI: 10.1097/ccm.0b013e31819fffd3
• Publication Date: 2009-05-21T16:44:44Z
• Authors: Neeraj Badjatia; Evangelia Strongilis; Mary Prescutti; Luis Fernandez; Andres Fernandez; Manuel Buitrago; J Michael Schmidt; Stephan A. Mayer
• Keywords: Shivering

To determine the impact of counter warming (CW) with an air circulating blanket on shivering and metabolic profile during therapeutic temperature modulation (TTM).A prospective observational study.An 18-bed neurologic intensive care unit.Fifty mechanically ventilated patients brain injury undergoing TTM automated surface intravascular devices.Fifty indirect calorimetry (IDC) measurements without CW TTM.IDC was continuously performed for 10-15 minutes at baseline (phase I), off II), again after return III). Shivering severity each phase scored a scale 0-3 using Bedside Assessment Scale (BSAS). Resting energy expenditure (REE), oxygen consumption, carbon dioxide production were determined by IDC; 56% women, mean age 61 +/- 15 years. At time IDC, 72% had signs (BSAS >0). All measures basal metabolism increased removal (from phases I II); REE 27% consumption 29% (both p < 0.002). A one-point increase in BSAS noted 55% (n = 23/42) from to II. In multivariate analysis, sedative use (p 0.03), moderate severe 0.04), lower serum magnesium levels 0.01) associated greater increases between II CW. Phase III reversal all variables.Surface provides beneficial control improves TTM.