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Objective:

To determine the impact of counter warming (CW) with an air circulating blanket on shivering and metabolic profile during therapeutic temperature modulation (TTM).

Design:

A prospective observational study.

Setting:

An 18-bed neurologic intensive care unit.

Patients:

Fifty mechanically ventilated patients with brain injury undergoing TTM with automated surface and intravascular devices.

Interventions:

Fifty indirect calorimetry (IDC) measurements with and without CW during TTM.

Measurements and Main Results:

IDC was continuously performed for 10-15 minutes at baseline with CW (phase I), off CW (phase II), and again after the return of CW (phase III). Shivering severity during each phase was scored on a scale of 0− 3 using the Bedside Shivering Assessment Scale (BSAS). Resting energy expenditure (REE), oxygen consumption, and carbon dioxide production were determined by IDC; 56% were women …