2.50
Hdl Handle:
http://hdl.handle.net/10755/166250
Category:
Abstract
Type:
Presentation
Title:
Febrile shivering: Intervention effects and moderating variables
Author(s):
Holtzclaw, Barbara
Author Details:
Barbara Holtzclaw, PhD, Director, Office of Nursing Research, University of Texas Health Science Center at San Antonio, School of Nursing, San Antonio, Texas, USA, email: HOLTZCLAW@uthscsa.edu
Abstract:
Violent febrile shivering, known as rigors, affects nearly half the patients who receive the potent antifungal drug amphotericin B (AmB). Shaking chills, fever, and toxic effects of AmB are endured because of the drug's effectiveness against life threatening systemic fungal infections. As a pyrogen, AmB raises the thermostatic set point of the hypothalamus so existing internal and skin temperatures are sensed as cooler than normal. In the chill-phase of fever, shivering and vasoconstriction promote warming until temperatures rise to the new set point. Shivering raises oxygen consumption 3-5 fold above resting values and is poorly tolerated in anemic immunosuppressed patients with cancer. Intravenous meperidine is moderately effective in suppressing shivering, but introduces new drug-related problems. This study follows two preliminary investigations to test the efficacy of insulative wraps to prevent febrile shivering by diminishing heat loss from dominant thermoreceptors in the hands and feet. The report encompasses a 3 year grant period funded by the National Center for Nursing Research (NCNR). Study purposes were to determine: 1) if 3 layers of terry cloth toweling, applied to extremities prior to AmB infusions, significantly reduced total duration of shivering, 2) if the intervention reduced the need for narcotic shivering suppression, and 3) if the incidence of drug induced shivering was influenced by such other moderating variables as skin and core temperatures, drug dosage, day of treatment, and AmB drug lot number. Subjects included hospitalized adult patients with cancer (n = 64) receiving AmB therapy, randomly assigned to treatment or control groups. A subsample (n = 24) was studied over 3 days of therapy, using a crossover design with alternating treatment and control conditions. Study variables and measurements were 1) shivering detected by electromyogram, graded on a scale of increasing extent (0-4); 2) dosage of meperidine; 3) Core temperature from infrared tympanic membrane thermometer; 4) skin temperatures from skin probes; 5) AmB dosage; 6) day of AmB treatment and 7) pharmaceutical lot number from drug package. Chi-square analysis tested for differences in extent and frequency of shivering between groups. Mean shivering duration (min), drug dosages (mg), and temperatures were compared between groups by t tests. Pearson r correlations were determined between shivering duration and temperatures, and between shivering duration and drug dosages. Shivering duration between infusions were compared by repeated measures ANOVA. Mean amphotericin B dosage was similar between groups but variations occurred among patients. Shivering duration was shorter (t= 3.20, df = 62, p < .001) and amount of meperidine less (t = 2.66, df = 62, p < 0.005) among wrapped patients than controls. Wide gradients between skin and core temperatures predicted shivering in all subjects. No association between lot numbers or day of treatment was found. Findings continue to support the effectiveness of the intervention in diminishing drug related febrile shivering, but other moderating variables influencing the propensity to shiver have not been completely explained.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Host:
Southern Nursing Research Society
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleFebrile shivering: Intervention effects and moderating variablesen_GB
dc.contributor.authorHoltzclaw, Barbaraen_US
dc.author.detailsBarbara Holtzclaw, PhD, Director, Office of Nursing Research, University of Texas Health Science Center at San Antonio, School of Nursing, San Antonio, Texas, USA, email: HOLTZCLAW@uthscsa.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/166250-
dc.description.abstractViolent febrile shivering, known as rigors, affects nearly half the patients who receive the potent antifungal drug amphotericin B (AmB). Shaking chills, fever, and toxic effects of AmB are endured because of the drug's effectiveness against life threatening systemic fungal infections. As a pyrogen, AmB raises the thermostatic set point of the hypothalamus so existing internal and skin temperatures are sensed as cooler than normal. In the chill-phase of fever, shivering and vasoconstriction promote warming until temperatures rise to the new set point. Shivering raises oxygen consumption 3-5 fold above resting values and is poorly tolerated in anemic immunosuppressed patients with cancer. Intravenous meperidine is moderately effective in suppressing shivering, but introduces new drug-related problems. This study follows two preliminary investigations to test the efficacy of insulative wraps to prevent febrile shivering by diminishing heat loss from dominant thermoreceptors in the hands and feet. The report encompasses a 3 year grant period funded by the National Center for Nursing Research (NCNR). Study purposes were to determine: 1) if 3 layers of terry cloth toweling, applied to extremities prior to AmB infusions, significantly reduced total duration of shivering, 2) if the intervention reduced the need for narcotic shivering suppression, and 3) if the incidence of drug induced shivering was influenced by such other moderating variables as skin and core temperatures, drug dosage, day of treatment, and AmB drug lot number. Subjects included hospitalized adult patients with cancer (n = 64) receiving AmB therapy, randomly assigned to treatment or control groups. A subsample (n = 24) was studied over 3 days of therapy, using a crossover design with alternating treatment and control conditions. Study variables and measurements were 1) shivering detected by electromyogram, graded on a scale of increasing extent (0-4); 2) dosage of meperidine; 3) Core temperature from infrared tympanic membrane thermometer; 4) skin temperatures from skin probes; 5) AmB dosage; 6) day of AmB treatment and 7) pharmaceutical lot number from drug package. Chi-square analysis tested for differences in extent and frequency of shivering between groups. Mean shivering duration (min), drug dosages (mg), and temperatures were compared between groups by t tests. Pearson r correlations were determined between shivering duration and temperatures, and between shivering duration and drug dosages. Shivering duration between infusions were compared by repeated measures ANOVA. Mean amphotericin B dosage was similar between groups but variations occurred among patients. Shivering duration was shorter (t= 3.20, df = 62, p < .001) and amount of meperidine less (t = 2.66, df = 62, p < 0.005) among wrapped patients than controls. Wide gradients between skin and core temperatures predicted shivering in all subjects. No association between lot numbers or day of treatment was found. Findings continue to support the effectiveness of the intervention in diminishing drug related febrile shivering, but other moderating variables influencing the propensity to shiver have not been completely explained.en_GB
dc.date.available2011-10-27T14:43:19Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T14:43:19Z-
dc.conference.hostSouthern Nursing Research Societyen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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