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(Stroke. 2003;34:1736.)
© 2003 American Heart Association, Inc.

Original Contributions

Neither Arm nor Face Warming Reduces the Shivering Threshold in Unanesthetized Humans

Anthony G. Doufas, MD, PhD; Anupama Wadhwa, MD; Chun-Ming Lin, MD; Yunus M. Shah, MD; Keith Hanni, BS Daniel I. Sessler, MD

From the Outcomes Research Institute (A.G.D., A.W., C.-M.L., Y.M.S., D.I.S.), Department of Anesthesiology (A.G.D., A.W., C.-M.L., Y.M.S., D.I.S.), and School of Medicine (K.H.), University of Louisville, Louisville, Ky; Department of Anesthesiology, Chang Gung Memorial Hospital (C.M.L.), Taipei, Taiwan; and Ludwig Boltzmann Institute, University of Vienna, Vienna, Austria (D.I.S.).

Correspondence to Dr A.G. Doufas, Department of Anesthesiology, University of Louisville Hospital, 530 S Jackson St, Louisville, KY 40202. E-mail agdoufas{at}louisville.edu

Background and Purpose— Hand warming and face warming, combined with inhalation of heated air, are reported to suppress shivering. However, hand or face temperature contributes only a few percent to control of shivering. Thus, it seems unlikely that manipulating hand or facial skin temperature alone would be sufficient to permit induction of therapeutic hypothermia. We tested the hypothesis that focal arm (forearm and hand) warming or lower facial warming, combined with inhalation of heated and humidified gas, only minimally reduces the shivering threshold (triggering core temperature).

Methods— We studied 8 healthy male volunteers (18 to 40 years of age) on 3 days: (1) control (no warming), (2) arm warming with forced air at 43°C, and (3) face warming with 21 L/min of air at 42°C at a relative humidity of 100%. Fluid at 4°C was infused via a central venous catheter to decrease tympanic membrane temperature 1°C/h to 2°C/h; mean skin temperature was maintained at 31°C. A sustained increase in oxygen consumption quantified the shivering threshold.

Results— Shivering thresholds did not differ significantly between the control (36.7±0.1°C), arm-warming (36.5±0.3°C), or face-warming (36.5±0.3°C; analysis of variance, P=0.34) day. The study was powered to have a 95% probability of detecting a difference of 0.5±0.5°C (mean±SD) between control and either of the 2 treatments at =0.05.

Conclusions— Focal arm or face warming did not substantially reduce the shivering threshold in unanesthetized volunteers. It thus seems unlikely that these nonpharmacological modalities will substantially facilitate induction of therapeutic hypothermia.

Key Words: body temperature regulation • shivering

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