Abstract

• The most effective modality for cold application and the length of the application have not been determined despite many studies about the use of cold. A quasi-experimental study was conducted to examine the most effective modality among three methods of cold application, the most effective length of time for the application and the continuing effect after each type of cold application. Thirty adult patients admitted to medical and neurnsurgical unit and with high fever (above 38.2 degrees C) were assigned randomly to each of three cold application methods: (a) ice bag; (b) cold compress; and (c) tepid water sponge bath. Each method was applied to the whole anterior surface except the face and neck with the patient in the supine position. Rectal temperatures and skin temperatures (mid chest, upper arm,thigh and leg) were measured before each application and every 10 minutes during each application for a period of 60 minutes. They were also measured every 10 minutes for 30 minutes after each cold application was finished. The experiments were carried out from Dec. 22. 1992 through Feb. 26,1993. The data were analyzed using means, ANCOVA, Sheffe test and Pearson's Correlation Coefficient. The results of this study are as follows: 1. There were no significant differences among the three cold application methods in the reduction of body temperature. 2. Among the ice bag, cold compress and tepid water sponge bath groups, the ice bag proved to be the most effective method for lowering skin temperature while the cold compress was least effective. 3. Both rectal and skin temperature continued to decrease during the 60 minutes of cold application, but the hunting phenomena was not observed at any of the cold application sites. 4. There were no significant correlations between mean rectal and skin temperatures. 5. Skin temperatures according to the cold application sites decreased to a range of 3.46 degrees C to 5.20 degrees C (mid chest), a range of 4.48 degrees C 4.96 degrees C (upper arm), a range of 3.86 degrees C to 5.05 degrees C (thigh), and a range of 5. 42 degrees C -7.12 degrees C(leg). 6. In continuing effect after the cold applications were finished, rectal temperatures according to ice bag, cold compress and tepid sponge bath decreased to 0.29 degrees C, 0.23 degrees C and 0.09 degrees C respectively,while the mean skin temperatures increased to 2.39 degrees C, 2.04 degrees C aud 2.22 degrees C respectively. In this experiment the ice bag was the most-effective modality for lowering skin temperature, whenever cold is applied for systemic effect, the continuing effect of cold should be considered. The determination of the most effective length of time for cold application needs further study.

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