Treatment of severe heat stroke in an intensive care unit: clinical course, acute outcome and implications for management

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Introduction

During the August 1998 heat wave in Tel Aviv, many patients were referred to the Tel Aviv Medical Center for acute heat-related illness. Of these, six patients were admitted to the Intensive Care Unit for severe heat stroke. We describe the clinical course during their first five days of hospitalization, response to treatment and implications for future management of this disorder.

Results

The six patients were admitted to the Intensive Care Unit in critical condition (mean APACHE II score 30± 3.5), coma (mean Glasgow Coma 3.5± 0.5), hypovolemic shock and respiratory failure necessitating mechanical ventilation. Despite early effective therapy (in all patients core temperature was reduced to less than 39°C in less than 1 h from admission to the hospital), one patient died (mortality 15%) and four patients required further intensive care for life-threatening multiple organ failure.

Conclusion

During a heat wave such as that experienced in Tel Aviv during August 1998 a significant number of referrals for acute heat-related illness, possibly overwhelming the admission capacity of regional intensive-care units, must be anticipated. Severe heat stroke complicated by multiple organ failure may occur and is not necessarily related to physical activity prior to symptom onset. Although important in determining prognosis, early treatment does not prevent severe complications in this disorder. Mechanisms regulating body heat may remain disturbed for days following early treatment and apparent stabilization, mandating careful observation of ample duration in hospital.