The Role of Buspirone in Antishivering Protocols for Post-Cardiac Arrest Targeted Temperature Management: What...

Shivering is a common complication of targeted temperature management (TTM), which could undermine its neuroprotective benefits by increasing cerebral oxygen consumption and metabolic demand. Buspirone, a 5-HT1A receptor partial agonist, is incorporated into many antishivering protocols for TTM following cardiac arrest, despite limited evidence supporting its efficacy in critically ill patients. We conducted a targeted literature review using PubMed to assess the evidence in favor of the use of buspirone in antishivering protocols during TTM. Experimental, physiological, and clinical studies were reviewed with emphasis placed on study design, patient population, and relevance to critically ill individuals undergoing TTM. Experimental studies in animals and healthy human volunteers show that buspirone can modestly lower core temperature or shivering thresholds. Two small studies (n = 8 each) in healthy male volunteers demonstrated that buspirone reduced the shivering threshold by approximately 0.7°C. A retrospective cohort study (n = 131) in post-cardiac arrest patients showed a reduction in shivering with a multidrug protocol including buspirone, but the independent contribution of buspirone could not be isolated. No randomized controlled trials have evaluated buspirone's efficacy as a standalone antishivering agent in critically ill patients. Current evidence to support the buspirone's use in antishivering protocols is limited and largely extrapolated from noncritical care settings. Given that most patients undergoing TTM already receive sedatives and analgesics with more potent antishivering effects, the incremental benefit of buspirone remains unproven. Furthermore, it adds to the already high burden of polypharmacy in ICU patients and could, in theory, increase the risk of serotonin syndrome. Randomized trials comparing protocols with and without buspirone are needed to determine its clinical utility.