What are the intensive care unit (ICU) management strategies for heat stroke (Hyperthermia)?

From the Guidelines

Intensive care management of heat stroke requires immediate cooling and supportive care to prevent multi-organ failure and death, with the primary goal of rapidly decreasing body temperature and supporting the cardiovascular system 1. The patient should be cooled rapidly to a core temperature of 38-39°C using external cooling methods such as ice packs applied to the groin, axillae, and neck, cold water immersion if available, or evaporative cooling with misting and fans.

• Internal cooling methods like cold IV fluids and gastric, bladder, or peritoneal lavage with cold fluids may be used in severe cases.
• Continuous cardiac monitoring, airway management, and mechanical ventilation should be instituted as needed.
• Fluid resuscitation with isotonic crystalloids should be guided by hemodynamic parameters, with vasopressors like norepinephrine added for persistent hypotension, as hypotension is associated with a high mortality rate and poor outcome 1.
• The initial hemodynamic management should include fluid replacement sufficient to restore blood pressure and tissue perfusion, with careful fluid replacement recommended due to the high incidence of pulmonary edema during resuscitation of heatstroke 1.
• Seizures should be treated with benzodiazepines, and rhabdomyolysis requires aggressive hydration and maintaining urine output at 1-2 ml/kg/hr, with consideration of sodium bicarbonate to alkalinize urine if myoglobinuria is present.
• Coagulopathy may require blood product transfusions, and renal replacement therapy should be initiated for acute kidney injury with standard indications.
• Antipyretics like acetaminophen are ineffective in heat stroke as the condition results from thermoregulatory failure rather than a change in hypothalamic set point.
• Continuous monitoring of core temperature, vital signs, neurological status, and laboratory values is essential to guide therapy and prevent complications. The therapeutic approach recommended for hemodynamic management of sepsis can also be applied to heatstroke due to the pathophysiological similarities between the two diseases, with fluid resuscitation titrated to clinical endpoints of optimal heart rate, urine output, and blood pressure 1.

From the Research

ICU Management Strategies for Heat Stroke

The management of heat stroke in the intensive care unit (ICU) involves several key strategies, including:

• Rapid cooling to reduce body temperature and prevent organ damage 2, 3, 4, 5
• Support of organ-system function to prevent multiorgan failure 2, 4, 5
• Aggressive IV rehydration to prevent rhabdomyolysis-induced acute renal failure 2
• Treatment of heat cramps with fluid and salt replacement, and rest in a cool environment 2

Cooling Methods

Several cooling methods have been proposed, including:

• Immersion in an ice-water bath, which is the most effective cooling method 2, 3, 6
• Evaporative cooling, which is a rapid and effective alternative 2, 3
• Intravascular temperature management, which has been shown to be safe and feasible for treating severe heat stroke 4
• Ice pack application and pharmacological treatment, which may also be used in certain situations 3

Supportive Care

Supportive care is also crucial in the management of heat stroke, including:

• Monitoring of vital signs and organ function 2, 4, 5
• Management of complications, such as rhabdomyolysis and acute renal failure 2, 4
• Provision of a cool environment to prevent further heat stress 2, 6
• Multidisciplinary management, including involvement of emergency department and ICU staff 5