A retrospective study of clinical profile and outcomes of critically ill patients with heat-related illness

Abstract

Background and Aims:Heat-related illness (HRI) due to high ambient temperatures is a common feature during the Indian summer. HRI often results in Intensive Care Unit (ICU) admissions and are associated with significant morbidity and mortality. However, published report on the effects of HRI among the Indian population is lacking. This study was undertaken to identify the profile of patients admitted to ICU with clinical features of HRI and study their clinical outcomes.Methods:This was a retrospective case series of patients admitted with features of HRI during the summer of 2012 in our multidisciplinary ICU. Data on demographics, co-morbid illness, admission severity of illness (Acute Physiology and Chronic Health Evaluation II [APACHE II]), organ failure scores (Sequential Organ Failure Assessment [SOFA]) and neuroimaging studies were collected. Outcome data studied included mortality, ICU length of stay (LOS), ventilator days and hospital LOS. Statistical analysis was performed using Student's t-test, Chi-square test and multivariate analysis.Results:Twenty-six patients met the diagnostic criteria for HRI. Fifteen were males. The mean age was 53.12 ± 18.6 years. Mean APACHE II score was 19.6 ± 7.7 and mean SOFA score was 7.5 ± 2.6. The common presenting symptoms were fever with neurological impairment (100%) and gastrointestinal symptoms (30%). Major organ systems involvement include neurological (100%), renal (57%), hepatic (34%) and coagulation abnormalities (26%). Most common metabolic abnormality noted was hyponatraemia (73%). Magnetic resonance imaging findings suggestive of heat stroke were seen in 5 of 26 patients. Mortality rate was 34%. 8 of 17 survivors had residual neurological impairment.Conclusion:HRI carries a high mortality and significant neurological morbidity.

Hemostasis and Thrombosis in Extreme Temperatures (Hypo- and Hyperthermia)

“…5,23 In a retrospective study from India in 26 patients with heatstroke, 26% patients had signs of consumption coagulopathy, which was an independent predictor of an adverse outcome, including mortality. 28 Another retrospective study in 18 patients, who were admitted to a critical care unit in Paris during the 2003 heat wave that caused more than 15,000 excess deaths in France alone, showed that all patients had some degree of abnormality in coagulation, with 5 patients (28%) fulfilling the criteria for DIC. 13 The authors convincingly showed an association between inflammatory activity and occurrence of the coagulopathy.…”

Outcome of Patients Admitted with Exertional Heat Related Illness in Intensive Care Unit of Tertiary Care Hospital

“…Heat-related illness (HRI) due to high ambient temperature and humidity is a common feature in Terai (Southern) region 1 of Nepal during summer. HRI par cularly heat stroke results 2,3,4 in Intensive Care Unit (ICU) admissions and is associated 5,6 with significant morbidity and mortality. There has been 7 studies in marine corps recruits in United Kingdom and 8 military recruits in United States Army dealing with risk factors of heat related illness but none has described about its outcome.…”

“…Heat related illness (HRI) due to high ambient temperature and humidity are very common in tropical region of Nepal 1 during summer. Exer onal heat related illness par cularly heat stroke is a life threatening condi on that frequently 2,3,4 occur in young military trainee. Heat related illness occurs when there is failure of thermoregulatory response to maintain core body 5 temperature between 36° -38° C. Types of HRI are heat cramps (muscle cramping), heat syncope (fain ng), heat exhaus on (hypotension followed by collapse) and heat stroke which is the severe form where core body temperature 6 is >40°C leading to central nervous system dysfunc on.…”

Predictors of poor prognosis in patients with heat stroke

“…1,2 The increase in the occurrence of heat-related illness secondary to global warming has become a threat to public health, especially among the elderly population. 1,[3][4][5][6][7] Among heat-related illnesses (HRIs), heat stroke (HS) is classic and the most serious form of heat injury. 8 According to Kalaiselvan et al 5 the incidence of HS, a leading cause of hospital mortality related to global warming, is also increasing.…”

“…1,[3][4][5][6][7] Among heat-related illnesses (HRIs), heat stroke (HS) is classic and the most serious form of heat injury. 8 According to Kalaiselvan et al 5 the incidence of HS, a leading cause of hospital mortality related to global warming, is also increasing. 1,6 HS is defined as a core temperature greater than 40°C and the occurrence of central nervous system abnormalities.…”