Barletta Jeffrey F, Palmieri Tina L, Toomey Shari A, Harrod Christopher G, Murthy Srinivas, Bailey Heatherlee
Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale Campus, AZ.
Burn Division, Department of Surgery, Shriners Hospitals for Children Northern California, Sacramento, CA.
Crit Care Med. 2024 Mar 1;52(3):362-375. doi: 10.1097/CCM.0000000000006170. Epub 2024 Jan 19.
The increasing frequency of extreme heat events has led to a growing number of heat-related injuries and illnesses in ICUs. The objective of this review was to summarize and critically appraise evidence for the management of heat-related illnesses and injuries for critical care multiprofessionals.
Ovid Medline, Embase, Cochrane Clinical Trials Register, Cumulative Index to Nursing and Allied Health Literature, and ClinicalTrials.gov databases were searched from inception through August 2023 for studies reporting on heat-related injury and illness in the setting of the ICU.
English-language systematic reviews, narrative reviews, meta-analyses, randomized clinical trials, and observational studies were prioritized for review. Bibliographies from retrieved articles were scanned for articles that may have been missed.
Data regarding study methodology, patient population, management strategy, and clinical outcomes were qualitatively assessed.
Several risk factors and prognostic indicators for patients diagnosed with heat-related illness and injury have been identified and reported in the literature. Effective management of these patients has included various cooling methods and fluid replenishment. Drug therapy is not effective. Multiple organ dysfunction, neurologic injury, and disseminated intravascular coagulation are common complications of heat stroke and must be managed accordingly. Burn injury from contact with hot surfaces or pavement can occur, requiring careful evaluation and possible excision and grafting in severe cases.
The prevalence of heat-related illness and injury is increasing, and rapid initiation of appropriate therapies is necessary to optimize outcomes. Additional research is needed to identify effective methods and strategies to achieve rapid cooling, the role of immunomodulators and anticoagulant medications, the use of biomarkers to identify organ failure, and the role of artificial intelligence and precision medicine.
极端高温事件的频率不断增加，导致重症监护病房（ICU）中与热相关的损伤和疾病数量不断上升。本综述的目的是总结并批判性评价针对重症监护多专业人员管理与热相关疾病和损伤的证据。
检索了Ovid Medline、Embase、Cochrane临床试验注册库、护理学与健康相关文献累积索引以及ClinicalTrials.gov数据库，检索时间从各数据库创建起至2023年8月，以查找关于ICU环境中与热相关损伤和疾病的研究报告。
优先审查英文系统评价、叙述性综述、荟萃分析、随机临床试验和观察性研究。对检索到的文章的参考文献进行扫描，以查找可能遗漏的文章。
对有关研究方法、患者群体、管理策略和临床结果的数据进行定性评估。
文献中已确定并报告了诊断为与热相关疾病和损伤的患者的若干风险因素和预后指标。对这些患者的有效管理包括各种降温方法和液体补充。药物治疗无效。多器官功能障碍、神经损伤和弥散性血管内凝血是中暑的常见并发症，必须相应进行处理。接触热表面或路面可能导致烧伤，严重时需要仔细评估并可能进行切除和植皮。
与热相关疾病和损伤的患病率正在上升，迅速启动适当治疗对于优化结局至关重要。需要进一步研究以确定实现快速降温的有效方法和策略、免疫调节剂和抗凝药物的作用、使用生物标志物识别器官衰竭以及人工智能和精准医学的作用。
