Pharmacological Management of Therapeutic Hypothermia-Induced Shivering

The role of therapeutic moderate hypothermia (32 to 34oC) has evolved in the past decade and become an essential part of management following post-cardiac arrest resuscitation.1 Additionally, this practice has gained momentum as a potential neuroprotective measure in patients following acute brain injury. However, achieving and maintaining the target temperature is challenging. The human body maintains a core temperature of 36.6 ± 0.4oC. When body temperature is lowered, the physiologic response is to prevent further heat loss through vasoconstriction. When vasoconstriction is no longer effective, shivering occurs to counterbalance heat loss. In the context of induced hypothermia, shivering is undesirable because it causes patient discomfort and increases body temperature and metabolic demands, resulting in an increased need for oxygen and additional energy sources. Shivering also increases intraocular and intracranial pressures.2, 3