Department of Emergency and Critical Care Medicine, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
Department of Critical Care and Traumatology, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
Crit Care Med. 2018 Jul;46(7):e670-e676. doi: 10.1097/CCM.0000000000003153.
Heat stroke is a life-threatening condition with high mortality and morbidity. Although several cooling methods have been reported, the feasibility and safety of treating heat stroke using intravascular temperature management are unclear. This study evaluated the efficacies of conventional treatment with or without intravascular temperature management for severe heat stroke.
Prospective multicenter study.
Critical care and emergency medical centers at 10 tertiary hospitals.
Patients with severe heat stroke hospitalized during two summers.
Conventional cooling with or without intravascular temperature management.
Cooling efficacy, Sequential Organ Failure Assessment score, occurrence rate of serious adverse events, and prognosis based on the modified Rankin Scale and Cerebral Performance Category. Patient outcomes were compared between five centers that were prospectively assigned to perform conventional cooling (control group: eight patients) and five centers that were assigned to perform conventional cooling plus intravascular temperature management (intravascular temperature management group: 13 patients), based on equipment availability. Despite their higher initial temperatures, all patients in the intravascular temperature management group reached the target temperature of 37°C within 24 hours, although only 50% of the patients in the control group reached 37°C (p < 0.01). The intravascular temperature management group also had a significant decrease in the Sequential Organ Failure Assessment score during the first 24 hours after admission (4.0 vs 1.5; p = 0.04). Furthermore, the intravascular temperature management group experienced fewer serious adverse events during their hospitalization, compared with the control group. The percentages of favorable outcomes at discharge and 30 days after admission were not statistically significant.
The combination of intravascular temperature management and conventional cooling was safe and feasible for treating severe heat stroke. The results indicate that better temperature management may help prevent organ failure. A large randomized controlled trial is needed to validate our findings.
中暑是一种危及生命的疾病，具有高死亡率和高发病率。尽管已经报道了几种降温方法，但使用血管内温度管理治疗中暑的可行性和安全性尚不清楚。本研究评估了常规治疗联合或不联合血管内温度管理治疗重症中暑的疗效。
前瞻性多中心研究。
10 家三级医院的重症监护和急诊医学中心。
在两个夏季住院的重症中暑患者。
常规降温联合或不联合血管内温度管理。
降温效果、序贯器官衰竭评估评分、严重不良事件发生率以及根据改良 Rankin 量表和脑功能分类的预后。根据设备可用性，将五个前瞻性分配进行常规降温的中心（对照组：8 例）和五个分配进行常规降温加血管内温度管理的中心（血管内温度管理组：13 例）患者的结局进行比较。尽管血管内温度管理组的初始温度较高，但所有患者在 24 小时内均达到 37°C 的目标温度，而对照组仅 50%的患者达到 37°C（p<0.01）。血管内温度管理组在入院后 24 小时内的序贯器官衰竭评估评分也显著下降（4.0 比 1.5；p=0.04）。此外，血管内温度管理组在住院期间发生严重不良事件的比例低于对照组。出院时和入院后 30 天的良好结局比例无统计学意义。
血管内温度管理联合常规降温治疗重症中暑是安全可行的。结果表明，更好的体温管理可能有助于预防器官衰竭。需要进行大规模的随机对照试验来验证我们的发现。
