Abstract
Background: The efficacy of skin counter warming (SCW) at extremities during targeted temperature management (TTM) in preventing shivering is still unclear. Methods: In this single-center, randomized, controlled study, adult patients who had undergone TTM for more than 24 hours either received SCW only at extremities or did not receive SCW. Extracorporeal membrane oxygenation (ECMO) or intravascular cooling devices were used as cooling methods. We assessed the occurrence of shivering every 1 hour. The primary outcome was the number of shivering for 24 hours after initiating SCW. Results: After randomization, 39 patients were included in the analysis (20 and 19 in SCW and non-SCW group, respectively). Median age was 60 years [IQR 52–73 years], 77% patients were males, and there were no differences in baseline characteristics. Skin temperature at all extremities was significantly increased 8 hours after initiation of SCW; however, no differences were observed in the number of shivering for 24 hours after initiating SCW (SCW group, median 1.5 [0–7] vs. non-SCW group, 6 [1–11]; P=0.18). Moreover, there was no change in the number of shivering and the Bedside Shivering Assessment Scale for every 8 hours, and in total 24-hour doses of sedatives and opioid in both groups. Conclusion: SCW only at extremities did not prevent shivering in patients who had undergone TTM.
