Comparison of Distal Limb Warming With Fluidotherapy and Warm Water Immersion for Mild Hypothermia Rewarming Parveen Kumar, MPT, MSc, Gerren K. McDonald,

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Comparison of Distal Limb Warming With Fluidotherapy and Warm Water Immersion for Mild Hypothermia Rewarming Parveen Kumar, MPT, MSc, Gerren K. McDonald, BA, MSc, Radhika Chitkara, MPT, MSc, Alan M. Steinman, MD, MPH, Phillip F. Gardiner, MPE, PhD, Gordon G. Giesbrecht, BTh, PhD Wilderness & Environmental Medicine Volume 26, Issue 3, Pages 406-411 (September 2015) DOI: 10.1016/j.wem.2015.02.005 Copyright © 2015 Wilderness Medical Society Terms and Conditions

Figure 1 Distal extremity rewarming with Fluidotherapy (top panel) and warm water immersion (bottom panel). Distal extremities are exposed up to the elbows and knees. Note: the sleeping bag that is normally draped over the subject during Fluidotherapy was removed for easier visualization. Wilderness & Environmental Medicine 2015 26, 406-411DOI: (10.1016/j.wem.2015.02.005) Copyright © 2015 Wilderness Medical Society Terms and Conditions

Figure 2 Mean change in esophageal temperature (°C) during baseline, as long as 60 minutes of immersion in 8˚C water, and as long as 60 minutes of rewarming in the shivering only condition (solid line), Fluidotherapy condition (dotted line), and warm water condition (dashed like). Time 0 minutes and temperature 0˚C indicate exit from cold water (bars, SD). Six of the 7 subjects were immersed for the entire 60-minute cold water period in all conditions. The other subject reached the target esophageal temperature of 35°C within 38 to 46 minutes in all three immersions. To show what the whole group did at beginning and end of immersion, data for trials less than 60 minutes are presented for the first 20 minutes, with the remainder adjusted so that the exit time is lined up for everyone at time 0. As a result, n = 7 for data from −60 to −40 minutes and from −18 to 0 minutes. During the period between −40 and −18 minutes, n = 6 to 7. *Separates conditions that are significantly different from each other (P < .01). Abrupt decreases near the end of rewarming periods are an artifact caused by termination of subjects who completed warming earlier than the others. Wilderness & Environmental Medicine 2015 26, 406-411DOI: (10.1016/j.wem.2015.02.005) Copyright © 2015 Wilderness Medical Society Terms and Conditions

Figure 3 (Top panel) Metabolic heat production (W) and (bottom panel) net heat balance (W) during 60 minutes of rewarming (bars, SD). *Separates conditions that are significantly different from each other (P < .05). Solid lines, shivering only; dotted lines, Fluidotherapy; dashed lines, warm water. Wilderness & Environmental Medicine 2015 26, 406-411DOI: (10.1016/j.wem.2015.02.005) Copyright © 2015 Wilderness Medical Society Terms and Conditions