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Cooling and hemodynamic management in heatstroke: practical recommendations.
Crit Care. 2007; 11(3):R54.CC

Abstract

INTRODUCTION

Although rapid cooling and management of circulatory failure are crucial to the prevention of irreversible tissue damage and death in heatstroke, the evidence supporting the optimal cooling method and hemodynamic management has yet to be established.

METHODS

A systematic review of all clinical studies published in Medline (1966 to 2006), CINAHL (Cumulative Index to Nursing & Allied Health Literature) (1982 to 2006), and Cochrane Database was performed using the OVID interface without language restriction. Search terms included heatstroke, sunstroke, and heat stress disorders.

RESULTS

Fourteen articles reported populations subjected to cooling treatment for classic or exertional heatstroke and included data on cooling time, neurologic morbidity, or mortality. Five additional articles described invasive monitoring with central venous or pulmonary artery catheters. The four clinical trials and 15 observational studies covered a total of 556 patients. A careful analysis of the results obtained indicated that the cooling method based on conduction, namely immersion in iced water, was effective among young people, military personnel, and athletes with exertional heatstroke. There was no evidence to support the superiority of any one cooling technique in classic heatstroke. The effects of non-invasive, evaporative, or conductive-based cooling techniques, singly or combined, appeared to be comparable. No evidence of a specific endpoint temperature for safe cessation of cooling was found. The circulatory alterations in heatstroke were due mostly to a form of distributive shock associated with relative or absolute hypovolemia. Myocardial failure was found to be rare.

CONCLUSION

A systematic review of the literature failed to identify reliable clinical data on the optimum treatment of heatstroke. Nonetheless, the findings of this study could serve as a framework for preliminary recommendations in cooling and hemodynamic management of heatstroke until more evidence-based data are generated.

Authors+Show Affiliations

Department of Comparative Medicine MBC-03, King Faisal Specialist Hospital & Research Centre, P,O, Box 3354, Riyadh 11211, Saudi Arabia. abouchama@kfshrc.edu.saNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

17498312

Citation

Bouchama, Abderrezak, et al. "Cooling and Hemodynamic Management in Heatstroke: Practical Recommendations." Critical Care (London, England), vol. 11, no. 3, 2007, pp. R54.
Bouchama A, Dehbi M, Chaves-Carballo E. Cooling and hemodynamic management in heatstroke: practical recommendations. Crit Care. 2007;11(3):R54.
Bouchama, A., Dehbi, M., & Chaves-Carballo, E. (2007). Cooling and hemodynamic management in heatstroke: practical recommendations. Critical Care (London, England), 11(3), R54.
Bouchama A, Dehbi M, Chaves-Carballo E. Cooling and Hemodynamic Management in Heatstroke: Practical Recommendations. Crit Care. 2007;11(3):R54. PubMed PMID: 17498312.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cooling and hemodynamic management in heatstroke: practical recommendations. AU - Bouchama,Abderrezak, AU - Dehbi,Mohammed, AU - Chaves-Carballo,Enrique, PY - 2007/02/03/received PY - 2007/04/12/revised PY - 2007/05/12/accepted PY - 2007/5/15/pubmed PY - 2008/3/18/medline PY - 2007/5/15/entrez SP - R54 EP - R54 JF - Critical care (London, England) JO - Crit Care VL - 11 IS - 3 N2 - INTRODUCTION: Although rapid cooling and management of circulatory failure are crucial to the prevention of irreversible tissue damage and death in heatstroke, the evidence supporting the optimal cooling method and hemodynamic management has yet to be established. METHODS: A systematic review of all clinical studies published in Medline (1966 to 2006), CINAHL (Cumulative Index to Nursing & Allied Health Literature) (1982 to 2006), and Cochrane Database was performed using the OVID interface without language restriction. Search terms included heatstroke, sunstroke, and heat stress disorders. RESULTS: Fourteen articles reported populations subjected to cooling treatment for classic or exertional heatstroke and included data on cooling time, neurologic morbidity, or mortality. Five additional articles described invasive monitoring with central venous or pulmonary artery catheters. The four clinical trials and 15 observational studies covered a total of 556 patients. A careful analysis of the results obtained indicated that the cooling method based on conduction, namely immersion in iced water, was effective among young people, military personnel, and athletes with exertional heatstroke. There was no evidence to support the superiority of any one cooling technique in classic heatstroke. The effects of non-invasive, evaporative, or conductive-based cooling techniques, singly or combined, appeared to be comparable. No evidence of a specific endpoint temperature for safe cessation of cooling was found. The circulatory alterations in heatstroke were due mostly to a form of distributive shock associated with relative or absolute hypovolemia. Myocardial failure was found to be rare. CONCLUSION: A systematic review of the literature failed to identify reliable clinical data on the optimum treatment of heatstroke. Nonetheless, the findings of this study could serve as a framework for preliminary recommendations in cooling and hemodynamic management of heatstroke until more evidence-based data are generated. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/17498312/Cooling_and_hemodynamic_management_in_heatstroke:_practical_recommendations_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/cc5910 DB - PRIME DP - Unbound Medicine ER -