Systematic Quality Assessment of Published Antishivering Protocols.

Area of Science:

• Anesthesiology
• Critical Care Medicine

Background:

• Shivering is a common adverse effect of targeted temperature modulation and general anesthesia.
• Current antishivering strategies are often empirical and inconsistent across healthcare settings.

Purpose of the Study:

• To evaluate the methodological rigor, reliability, and consistency of published antishivering protocols and guidelines.
• To identify areas for improvement in the development of evidence-based antishivering treatment algorithms.

Main Methods:

• A systematic search of four medical databases identified 4027 publications on shivering therapy.
• Eighteen relevant protocols/guidelines were assessed using a modified Appraisal of Guidelines for Research and Evaluation II (mAGREE II) instrument.
• Quality was evaluated across 23 items within 6 domains.

Main Results:

• Only 3 of 18 protocols incorporated systematically reviewed recommendations; 15 focused on practice standardization.
• Protocols for shivering during therapeutic cooling, commonly citing skin counterwarming and meperidine, scored in the lowest tertile (median mAGREE II score of 5).
• The American Society of Anesthesiologists guidelines for postanesthetic shivering scored highest (14 points), but overall quality remains low, with the best fulfilling only 60% of quality items.

Conclusions:

• Published antishivering protocols and guidelines generally lack methodological rigor, reliability, and strength.
• Future antishivering treatment algorithms require enhanced methodological rigor and transparency to align with evidence-based development processes.