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Veterinary Journal (London, England :... Apr 2022Pelvic limb movement disorders unrelated to lameness or proprioceptive ataxia have been described in horses for centuries. The two best described are Shivering and... (Review)
Review
Pelvic limb movement disorders unrelated to lameness or proprioceptive ataxia have been described in horses for centuries. The two best described are Shivering and Stringhalt. Shivering is unique in that it is primarily apparent when horses are asked to walk backward, without affecting forward gaits until quite advanced. Horses exhibit abduction and either hyperflexion or marked hyperextension of one or both pelvic limbs when walking backward, resulting in a pause at the peak of the stride cycle and reluctance to move backward. Generally, Stringhalt differs from Shivering in that it produces consistent hyperflexion without abduction in forward gaits including walk and trot. This review will focus on the two most common pelvic limb movement disorders, Shivering and Stringhalt, their clinical presentation, differential diagnosis, etiopathology, and treatment.
Topics: Animals; Biomechanical Phenomena; Forelimb; Gait; Hindlimb; Horse Diseases; Horses; Lameness, Animal; Movement Disorders; Shivering; Walking
PubMed: 35462036
DOI: 10.1016/j.tvjl.2022.105829 -
European Heart Journal. Acute... Aug 2023Management of sedation and shivering during targeted temperature management (TTM) after cardiac arrest is limited by a dearth of high-quality evidence to guide... (Review)
Review
Management of sedation and shivering during targeted temperature management (TTM) after cardiac arrest is limited by a dearth of high-quality evidence to guide clinicians. Data from general intensive care unit (ICU) populations can likely be extrapolated to post-cardiac arrest patients, but clinicians should be mindful of key differences that exist between these populations. Most importantly, the goals of sedation after cardiac arrest are distinct from other ICU patients and may also involve suppression of shivering during TTM. Drug metabolism and clearance are altered considerably during TTM when a low goal temperature is used, which can delay accurate neuroprognostication. When neuromuscular blockade is used to prevent shivering, sedation should be deep enough to prevent awareness and providers should be aware that this can mask clinical manifestations of seizures. However, excessively deep or prolonged sedation is associated with complications including delirium, infections, increased duration of ventilatory support, prolonged ICU length of stay, and delays in neuroprognostication. In this manuscript, we review sedation and shivering management best practices in the post-cardiac arrest patient population.
Topics: Humans; Shivering; Critical Care; Heart Arrest; Hypothermia, Induced; Intensive Care Units
PubMed: 37479475
DOI: 10.1093/ehjacc/zuad087 -
The Journal of Neuroscience Nursing :... Apr 2018Shivering is common during targeted temperature management, and control of shivering can be challenging if clinicians are not familiar with the available options and... (Review)
Review
BACKGROUND
Shivering is common during targeted temperature management, and control of shivering can be challenging if clinicians are not familiar with the available options and recommended approaches.
PURPOSE
The purpose of this review was to summarize the most relevant literature regarding various treatments available for control of shivering and suggest a recommended approach based on latest data.
METHODS
The electronic databases PubMed/MEDLINE and Google Scholar were used to identify studies for the literature review using the following keywords alone or in combination: "shivering treatment," "therapeutic hypothermia," "core temperature modulation devices," and "targeted temperature management."
RESULTS
Nonpharmacologic methods were found to have a very low adverse effect profile and ease of use but some limitations in complete control of shivering. Pharmacologic methods can effectively control shivering, but some have adverse effects, such that risks and benefits to the patient have to be balanced.
CONCLUSION
An approach is provided which suggests that treatment for shivering control in targeted temperature management should be initiated before the onset of therapeutic hypothermia or prior to any attempt at lowering patient core temperature, with medications including acetaminophen, buspirone, and magnesium sulfate, ideally with the addition of skin counterwarming. After that, shivering intervention should be determined with the help of a shivering scale, and stepwise escalation can be implemented that balances shivering treatment with sedation, aiming to provide the most shivering reduction with the least sedating medications and reserving paralytics for the last line of treatment.
Topics: Body Temperature; Buspirone; Humans; Hypothermia, Induced; Serotonin Receptor Agonists; Shivering
PubMed: 29278601
DOI: 10.1097/JNN.0000000000000340 -
Handbook of Clinical Neurology 2018Humans have inherited complex neural circuits which drive behavioral, somatic, and autonomic thermoregulatory responses to defend their body temperature. While they are... (Review)
Review
Humans have inherited complex neural circuits which drive behavioral, somatic, and autonomic thermoregulatory responses to defend their body temperature. While they are well adapted to dissipate heat in warm climates, they have a reduced capacity to preserve it in cold environments. Consequently, heat production is critical to defending their core temperature. As in other large mammals, skeletal muscles are the primary source of heat production recruited in cold-exposed humans. This is achieved voluntarily in the form of contractions from exercising muscles or involuntarily in the form of contractions from shivering muscles and the recruitment of nonshivering mechanisms. This review describes our current understanding of shivering and nonshivering thermogenesis in skeletal muscles, from the neural circuitry driving their recruitment to the metabolic substrates that fuel them. The presence of these heat-producing mechanisms can be measured in vivo by combining indirect respiratory calorimetry with electromyography or biomedical imaging modalities. Indeed, much of what is known regarding shivering in humans and other animal models stems from studies performed using these methods combined with in situ and in vivo neurologic techniques. More recent investigations have focused on understanding the metabolic processes that produce the heat from both contracting and noncontracting mechanisms. With the growing interest in the potential therapeutic benefits of shivering and nonshivering skeletal muscle to counter the effects of neuromuscular, cardiovascular, and metabolic diseases, we expect this field to continue its growth in the coming years.
Topics: Body Temperature Regulation; Humans; Muscle, Skeletal; Oxygen Consumption; Shivering; Thermogenesis
PubMed: 30454588
DOI: 10.1016/B978-0-444-63912-7.00010-2 -
Regional Anesthesia and Pain Medicine 2008Shivering, which usually occurs as a thermoregulatory response to cold, may also occur following general or neuraxial anesthesia. Some of the causative factors of this... (Review)
Review
Shivering, which usually occurs as a thermoregulatory response to cold, may also occur following general or neuraxial anesthesia. Some of the causative factors of this type of shivering may be common to both, but some are particular to neuraxial anesthesia. Although shivering may have beneficial thermoregulatory effects, it places the body under increased physiological stress. In a broad sample of 21 studies, the median incidence of shivering related to neuraxial anesthesia in the control groups was 55%. Both pharmacological and nonpharmacological mechanisms have been found to be effective in reducing this shivering. This review aims to elucidate the mechanisms of the shivering that occurs during neuraxial anesthesia, and to examine strategies for prevention and treatment of this shivering.
Topics: Anesthesia, Epidural; Anesthesia, Spinal; Body Temperature Regulation; Humans; Shivering
PubMed: 18433676
DOI: 10.1016/j.rapm.2007.11.006 -
Physiological Reviews Jul 1963
Topics: Body Temperature Regulation; Nervous System Physiological Phenomena; Reflex; Shivering
PubMed: 13953667
DOI: 10.1152/physrev.1963.43.3.397 -
Neurocritical Care Dec 2023
Topics: Humans; Shivering; Body Temperature; Hypothermia, Induced
PubMed: 37537497
DOI: 10.1007/s12028-023-01810-5 -
AACN Clinical Issues 2004The hazards of thermoregulatory shivering in the critically ill are often overlooked by caregivers. Shivering may accompany heat loss from bathing, dressing, transport,... (Review)
Review
The hazards of thermoregulatory shivering in the critically ill are often overlooked by caregivers. Shivering may accompany heat loss from bathing, dressing, transport, and many therapeutic activities. Febrile shivering is common during chills of fever, blood product transfusions, administration of antigenic drugs, and chemotherapy. Many patients are at risk for shivering and its negative consequences that increase oxygen expenditure and cardiorespiratory effort. Learning how underlying thermoregulatory mechanisms are involved in shivering clarifies how temperature gradients and environmental stimuli induce the shivering response. Knowledge of the anatomical progression of shivering equips the nurse to recognize or prevent this energy-consuming response. This article discusses measures to prevent shivering as well as evidence-based interventions to manage shivering during fever, aggressive cooling, and postoperative recovery. Detailed information is presented on assessment and documentation of the extent and severity of shivering.
Topics: Acute Disease; Body Temperature Regulation; Critical Care; Disease Progression; Documentation; Education, Nursing, Continuing; Humans; Nursing Assessment; Risk Assessment; Shivering
PubMed: 15461043
DOI: 10.1097/00044067-200404000-00012 -
Lancet (London, England) Aug 1991
Topics: Anesthesia; Body Temperature Regulation; Doxapram; Humans; Hypothermia; Intraoperative Complications; Shivering
PubMed: 1678807
DOI: No ID Found -
Handbook of Clinical Neurology 2018Body core temperature of mammals is regulated by the central nervous system, in which the preoptic area (POA) of the hypothalamus plays a pivotal role. The POA receives... (Review)
Review
Body core temperature of mammals is regulated by the central nervous system, in which the preoptic area (POA) of the hypothalamus plays a pivotal role. The POA receives peripheral and central thermosensory neural information and provides command signals to effector organs to elicit involuntary thermoregulatory responses, including shivering thermogenesis, nonshivering brown adipose tissue thermogenesis, and cutaneous vasoconstriction. Cool-sensory and warm-sensory signals from cutaneous thermoreceptors, monitoring environmental temperature, are separately transmitted through the spinal-parabrachial-POA neural pathways, distinct from the spinothalamocortical pathway for perception of skin temperature. These cutaneous thermosensory inputs to the POA likely impinge on warm-sensitive POA neurons, which monitor body core (brain) temperature, to alter thermoregulatory command outflows from the POA. The cutaneous thermosensory afferents elicit rapid thermoregulatory responses to environmental thermal challenges before they impact body core temperature. Peripheral humoral signals also act on neurons in the POA to transmit afferent information of systemic infection and energy storage to induce fever and to regulate energy balance, respectively. This chapter describes the thermoregulatory afferent mechanisms that convey cutaneous thermosensory signals to the POA and that integrate the neural and humoral afferent inputs to the POA to provide descending command signals to thermoregulatory effectors.
Topics: Afferent Pathways; Animals; Autonomic Nervous System; Body Temperature Regulation; Humans; Neurons; Preoptic Area; Shivering; Skin
PubMed: 30454594
DOI: 10.1016/B978-0-444-63912-7.00016-3