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Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion

Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison...

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Autores principales: Kanda, Jun, Nakahara, Shinji, Nakamura, Shunsuke, Miyake, Yasufumi, Shimizu, Keiki, Yokobori, Shoji, Yaguchi, Arino, Sakamoto, Tetsuya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8598059/
https://www.ncbi.nlm.nih.gov/pubmed/34788312
http://dx.doi.org/10.1371/journal.pone.0259441
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author Kanda, Jun
Nakahara, Shinji
Nakamura, Shunsuke
Miyake, Yasufumi
Shimizu, Keiki
Yokobori, Shoji
Yaguchi, Arino
Sakamoto, Tetsuya
author_facet Kanda, Jun
Nakahara, Shinji
Nakamura, Shunsuke
Miyake, Yasufumi
Shimizu, Keiki
Yokobori, Shoji
Yaguchi, Arino
Sakamoto, Tetsuya
author_sort Kanda, Jun
collection PubMed
description Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the “severe” group or the “mild-to-moderate” group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received “active cooling + rehydration” and patients who received “rehydration only,” with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21–8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92–5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness.
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spelling pubmed-85980592021-11-18 Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion Kanda, Jun Nakahara, Shinji Nakamura, Shunsuke Miyake, Yasufumi Shimizu, Keiki Yokobori, Shoji Yaguchi, Arino Sakamoto, Tetsuya PLoS One Research Article Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the “severe” group or the “mild-to-moderate” group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received “active cooling + rehydration” and patients who received “rehydration only,” with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21–8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92–5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness. Public Library of Science 2021-11-17 /pmc/articles/PMC8598059/ /pubmed/34788312 http://dx.doi.org/10.1371/journal.pone.0259441 Text en © 2021 Kanda et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kanda, Jun
Nakahara, Shinji
Nakamura, Shunsuke
Miyake, Yasufumi
Shimizu, Keiki
Yokobori, Shoji
Yaguchi, Arino
Sakamoto, Tetsuya
Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion
title Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion
title_full Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion
title_fullStr Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion
title_full_unstemmed Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion
title_short Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion
title_sort association between active cooling and lower mortality among patients with heat stroke and heat exhaustion
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8598059/
https://www.ncbi.nlm.nih.gov/pubmed/34788312
http://dx.doi.org/10.1371/journal.pone.0259441
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