Adult Respiratory Distress Syndrome and Disseminated Intravascular Coagulation Complicating Heat Stroke

El-Kassimi, F.A.; Al-Mashhadani, Shihab A.; Algın, Abdullah; Akhtar, Jawaid

doi:10.1378/chest.90.4.571

Cited by 71 publications

(33 citation statements)

References 19 publications

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“…It has been proposed that heatstroke leads to increases in intravascular coagulation caused by the release of IL-1 or IL-6 into the systemic circulation with activation of microvascular thrombosis, which may trigger a respiratory distress syndrome (36,37). Studies in asthma suggest that breathing hot humid air may result in bronchoconstriction and increased airways resistance that is mediated via cholinergic pathways (38,39).…”

Section: Original Researchmentioning

confidence: 99%

Respiratory Effects of Indoor Heat and the Interaction with Air Pollution in Chronic Obstructive Pulmonary Disease

et al. 2016

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Rationale: There is limited evidence of the effect of exposure to heat on chronic obstructive pulmonary disease (COPD) morbidity, and the interactive effect between indoor heat and air pollution has not been established. Objectives:To determine the effect of indoor and outdoor heat exposure on COPD morbidity and to determine whether air pollution concentrations modify the effect of temperature.Methods: Sixty-nine participants with COPD were enrolled in a longitudinal cohort study, and data from the 601 participant days that occurred during the warm weather season were included in the analysis. Participants completed home environmental monitoring with measurement of temperature, relative humidity, and indoor air pollutants and simultaneous daily assessment of respiratory health with questionnaires and portable spirometry.Measurements and Main Results: Participants had moderate to severe COPD and spent the majority of their time indoors. Increases in maximal indoor temperature were associated with worsening of daily Breathlessness, Cough, and Sputum Scale scores and increases in rescue inhaler use. The effect was detected on the same day and lags of 1 and 2 days. The detrimental effect of temperature on these outcomes increased with higher concentrations of indoor fine particulate matter and nitrogen dioxide (P , 0.05 for interaction terms). On days during which participants went outdoors, increases in maximal daily outdoor temperature were associated with increases in Breathlessness, Cough, and Sputum Scale scores after adjusting for outdoor pollution concentrations.Conclusions: For patients with COPD who spend the majority of their time indoors, indoor heat exposure during the warmer months represents a modifiable environmental exposure that may contribute to respiratory morbidity. In the context of climate change, adaptive strategies that include optimization of indoor environmental conditions are needed to protect this high-risk group from the adverse health effects of heat.

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Section: Original Researchmentioning

confidence: 99%

Respiratory Effects of Indoor Heat and the Interaction with Air Pollution in Chronic Obstructive Pulmonary Disease

et al. 2016

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“…A different pathway linking heat exposure to respiratory health outcomes involves the clinical course of heatrelated illnesses such as heatstroke. In patients with heatstroke, acute lung inflammation and damage might occur [114] and heat may trigger a series of physiological changes in the lung leading to a severe respiratory distress syndrome [41,115]. Recent experimental evidence suggests that exposure to chronic heat stress could increase the susceptibility of animals to highly pathogenic respiratory viruses by reducing local immunity in the respiratory tract, i.e.…”

Section: Mechanisms and Vulnerable Subgroupsmentioning

confidence: 99%

Climate change, extreme weather events, air pollution and respiratory health in Europe

Sario¹,

Katsouyanni²,

Michelozzi³

2013

Eur Respir J

232

157

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Due to climate change and other factors, air pollution patterns are changing in several urbanised areas of the world, with a significant effect on respiratory health both independently and synergistically with weather conditions; climate scenarios show Europe as one of the most vulnerable regions. European studies on heatwave episodes have consistently shown a synergistic effect of air pollution and high temperatures, while the potential weather-air pollution interaction during wildfires and dust storms is unknown. Allergen patterns are also changing in response to climate change, and air pollution can modify the allergenic potential of pollens, especially in the presence of specific weather conditions. The underlying mechanisms of all these interactions are not well known; the health consequences vary from decreases in lung function to allergic diseases, new onset of diseases, exacerbation of chronic respiratory diseases, and premature death. These multidimensional climate-pollution-allergen effects need to be taken into account in estimating both climate and air pollution-related respiratory effects, in order to set up adequate policy and public health actions to face both the current and future climate and pollution challenges. @ERSpublications Climate change, extreme weather events and air pollution affect respiratory health: the evidence reviewed

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“…However, despite these advances in supportive care, mortality remains at approximately 40% in such patients (4). Fever is common in critically ill patients (5,6), especially in those with ALI/ARDS (7), and ARDS is a common complication of heat stroke (8). Fever is associated with increased length of stay in the intensive care unit, prolonged mechanical ventilation, and increased mortality (5,6,9).…”

mentioning

confidence: 99%

Febrile-Range Hyperthermia Modifies Endothelial and Neutrophilic Functions to Promote Extravasation

Tulapurkar

Almutairy

Shah

et al. 2012

Am J Respir Cell Mol Biol

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Acute respiratory distress syndrome (ARDS) is a neutrophil (polymorphonuclear leukocyte; PMN)-driven lung injury that is associated with fever and heat-stroke, and involves approximately 40% mortality. In murine models of acute lung injury (ALI), febrile-range hyperthermia (FRH) enhanced PMN accumulation, vascular permeability, and epithelial injury, in part by augmenting pulmonary cysteine-x-cysteine (CXC) chemokine expression. To determine whether FRH increases chemokine responsiveness within the lung, we used in vivo and in vitro models that bypass the endogenous generation of chemokines. We measured PMN transalveolar migration (TAM) in mice after intratracheal instillations of the human CXC chemokine IL-8 in vivo, and of IL-8-directed PMN transendothelial migration (TEM) through human lung microvascular endothelial cell (HMVEC-L) monolayers in vitro. Pre-exposure to FRH increased in vivo IL-8-directed PMN TAM by 23.5-fold and in vitro TEM by 7-fold. Adoptive PMN transfer demonstrated that enhanced PMN TAM required both PMN donors and recipients to be exposed to FRH, suggesting interdependent effects on PMNs and endothelium. FRH exposure caused the activation of extracellular signal-regulated kinase (ERK) and p38 mitogen-activated protein kinase in lung homogenates and circulating PMNs, with an associated increase in HSP27 phosphorylation and stress-fiber formation. The inhibition of these signaling pathways with U0126 and SB203580 blocked the effects of FRH on PMN extravasation in vivo and in vitro. Collectively, these results (1) demonstrate that FRH augments chemokine-directed PMN extravasation through direct effects on endothelium and PMNs, (2) identify ERK and p38 signaling pathways in the effect, and (3) underscore the complex effects of physiologic temperature change on innate immune function and its potential consequences for lung injury.Keywords: ARDS; neutrophil; endothelium; febrile-range hyperthermia; p38 MAP kinase Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) pose frequent complications in critically ill patients, and are responsible for significant morbidity, mortality, and related healthcare costs (1). To date, only two interventions, low-volume mechanical ventilation (2) and aggressive fluid management (3), have been shown to confer benefit in patients with ARDS. However, despite these advances in supportive care, mortality remains at approximately 40% in such patients (4). Fever is common in critically ill patients (5, 6), especially in those with ALI/ARDS (7), and ARDS is a common complication of heat stroke (8). Fever is associated with increased length of stay in the intensive care unit, prolonged mechanical ventilation, and increased mortality (5, 6, 9).Murine studies in which hyperthermia is induced by raising ambient temperature demonstrated that febrile-range hyperthermia (FRH; an z 2 8 C increase in core temperature) profoundly increases ALI/ARDS (10, 11). In murine models of ALI caused by exposure to hyperoxia (10) or an intratracheal instillation of LPS (11...

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Adult Respiratory Distress Syndrome and Disseminated Intravascular Coagulation Complicating Heat Stroke

Cited by 71 publications

References 19 publications

Respiratory Effects of Indoor Heat and the Interaction with Air Pollution in Chronic Obstructive Pulmonary Disease

Respiratory Effects of Indoor Heat and the Interaction with Air Pollution in Chronic Obstructive Pulmonary Disease

Climate change, extreme weather events, air pollution and respiratory health in Europe

Febrile-Range Hyperthermia Modifies Endothelial and Neutrophilic Functions to Promote Extravasation

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