All Shook-up: Managing Shivering in Therapeutic Hypothermia

Part of AACN Critical Care Webinar Series

Presenter(s): Mary Kay Bader, RN, MSN, CCNS, CCRN, CNRN, SCRN, FNCS, FAHA

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Webinar Summary

Targeted temperature management incorporates both normothermia and hypothermia. Using these modalities with critically ill patients can be challenging due to the troublesome side effect of shivering.

Shivering and accompanying vasoconstriction have been documented to increase oxygen consumption and pressure in the brain, increase pain in the postoperative elderly, and create a cellular cascade of damage within the central nervous system — all leading to poorer clinical outcomes.

This presentation reviews the pathophysiology of shivering, provides assessment tools and suggests interventions to counter shivering.


  • Identify the thermoregulatory process that is invovled with temperature management and shivering.
  • Demonstrate how to assess shivering using the Bedside Shivering Assessment Scale and physiologic monitoring.
  • Identify strategies to control shivering in normothermia and hypothermia.




Mary Kay Bader is a certified clinical nurse specialist (CNS) focused on neuroscience and critical care whose nursing career encompasses more than 35 years. Currently a CNS at Mission Hospital in Mission Viejo, Calif., she works collaboratively with neurosurgeons, trauma surgeons, neurologists, intensivists, nurses, therapists and pharmacists to optimize neurology-related patient outcomes. She also lectures nationally and internationally on subjects from traumatic brain and spinal cord injuries, stroke, and aneurysms to intracranial pressure, hypothermia, and neurointerventional therapy. In addition to her work as a CNS, Ms. Bader has served in key roles such as ICU staff nurse, trauma nurse responder, clinical educator and clinical faculty at teaching and community hospitals across the country, including Georgetown University and Loyola University of Chicago. She is the only nurse member of the editorial board for the journal Therapeutic Hypothermia and Temperature Management, sits on the editorial board of the American Journal of Critical Care and is a reviewer for Critical Care Nurse. She is also President of the American Association of Neuroscience Nurses (AANN).

Continuing Education Disclosure Statement

Successful Completion

Learners must attend/view/read the entire activity and complete the associated evaluation to be awarded the contact hours or CERP. No partial credit will be awarded.


This activity has been reviewed by the Nurse Planner. It has been determined that the material presented here shows no bias. Approval of a continuing education activity does not imply endorsement by AACN or ANCC of any commercial products displayed or discussed in conjunction with the activity.


The American Association of Critical-Care Nurses (AACN) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s (ANCC's) Commission on Accreditation, ANCC Provider Number 0012 (60 min contact hour). AACN has been approved as a provider of continuing education in nursing by the California State Board of Nursing, California Provider number CEP01036 for 0.6 contact hours (50 min contact hour).

AACN programming meets the standards for most states that require mandatory continuing education contact hours for license and/or certification renewal. AACN recommends consulting with your state board of nursing or credentialing organization before submitting CE to fulfill continuing education requirements.