Heat stroke: Role of the systemic inflammatory response

Leon, Lisa R.; Helwig, Bryan G.

doi:10.1152/japplphysiol.00301.2010

Cited by 382 publications

(343 citation statements)

References 87 publications

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“…Thermoregulation helps humans maintain safe body temperatures in heat but is associated with systemic inflammation, increases in cardiac output, increases in skin blood flow, and increases in pulmonary ventilation (32,33). Additionally, although humans primarily lose body heat through surface sweating, hyperthermia can increase ventilation and cause thermal hyperpnea (second-phase panting, during which tidal volume and respiratory rate both increase) (32).…”

Section: Discussionmentioning

confidence: 99%

Heat-related Emergency Hospitalizations for Respiratory Diseases in the Medicare Population

Anderson¹,

Dominici

Wang

et al. 2013

Am J Respir Crit Care Med

202

168

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Rationale: The heat-related risk of hospitalization for respiratory diseases among the elderly has not been quantified in the United States on a national scale. With climate change predictions of more frequent and more intense heat waves, it is of paramount importance to quantify the health risks related to heat, especially for the most vulnerable. Objectives: To estimate the risk of hospitalization for respiratory diseases associated with outdoor heat in the U.S. elderly. Methods: An observational study of approximately 12.5 million Medicare beneficiaries in 213 United States counties, January 1, 1999 to December 31, 2008. We estimate a national average relative risk of hospitalization for each 10 8 F (5.6 8 C) increase in daily outdoor temperature using Bayesian hierarchical models. Measurements and Main Results: We obtained daily county-level rates of Medicare emergency respiratory hospitalizations (International Classification of Diseases, Ninth Revision,(464)(465)(466)(480)(481)(482)(483)(484)(485)(486)(487)(490)(491)(492) in 213 U.S. counties from 1999 through 2008. Overall, each 10 8 F increase in daily temperature was associated with a 4.3% increase in same-day emergency hospitalizations for respiratory diseases (95% posterior interval, 3.8, 4.8%). Counties' relative risks were significantly higher in counties with cooler average summer temperatures. Conclusions: We found strong evidence of an association between outdoor heat and respiratory hospitalizations in the largest population of elderly studied to date. Given projections of increasing temperatures from climate change and the increasing global prevalence of chronic pulmonary disease, the relationship between heat and respiratory morbidity is a growing concern.Keywords: chronic obstructive pulmonary disease; hospitalization; hot temperature; respiratory tract infections; weatherOutdoor heat can cause spikes in respiratory deaths (1, 2), but considerably less is known about heat's impacts on respiratory morbidity. Given that: (1) climate change will increase exposure to extreme heat (3), (2) the prevalence of chronic respiratory diseases is increasing (4), and (3) the elderly will likely be most affected by heat-related problems (5), there is a pressing need to improve our understanding of respiratory heat effects among the elderly for both fatal and nonfatal outcomes.There are two major limitations to current research on the relationship between heat and respiratory hospitalizations. First, this relationship has not been adequately studied worldwide to confidently identify a consistent link between respiratory hospitalizations and heat. The few studies that have investigated heat and respiratory hospitalizations have found somewhat conflicting results (6). For example, studies of Brisbane, Australia (7,8) and Athens, Greece (9) found hospitalization rates decreased slightly during hot weather, whereas studies of California (10, 11), New York (12, 13), and 12 European cities (14) found respiratory hospitalizations increased with heat. Although a me...

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Section: Discussionmentioning

confidence: 99%

Heat-related Emergency Hospitalizations for Respiratory Diseases in the Medicare Population

Anderson¹,

Dominici

Wang

et al. 2013

Am J Respir Crit Care Med

202

168

View full text Add to dashboard Cite

show abstract

“…38 At extreme core temperatures, thermoregulatory mechanisms are overwhelmed, cellular proteins begin denaturing, and apoptosis (programmed cellular death) can occur within 5 minutes. 39,40 Failure to promptly recognize and treat hyperthermia can lead to EHS within minutes, a life-threatening medical emergency. The integrated effects of hyperthermia leading to derangement of the central nervous system and multiorgan dysfunction are typical of EHS (Figure 1).…”

Section: Hyperthermiamentioning

confidence: 99%

Exertional Heat Stroke in Navy and Marine Personnel: A Hot Topic

Goforth

Kazman

2015

Critical Care Nurse

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Although exertional heat stroke is considered a preventable condition, this life-threatening emergency affects hundreds of military personnel annually. Because heat stroke is preventable, it is important that Navy critical care nurses rapidly recognize and treat heat stroke casualties. Combined intrinsic and extrinsic risk factors can quickly lead to heat stroke if not recognized by deployed critical care nurses and other first responders. In addition to initial critical care nursing interventions, such as establishing intravenous access, determining body core temperature, and assessing hemodynamic status, aggressive cooling measures should be initiated immediately. The most important determinant in heat stroke outcome is the amount of time that patients sustain hyperthermia. Heat stroke survival approaches 100% when evidence-based cooling guidelines are followed, but mortality from heat stroke is a significant risk when care is delayed. Navy critical care and other military nurses should be aware of targeted assessments and cooling interventions when heat stroke is suspected during military operations. (Critical Care Nurse. 2015;35[1]:52–59)

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“…Widespread endothelial damage may also result in tissue thromboplastin and factor XII release, with consequent activation of the coagulation and complement cascades, which may culminate in systemic inflammatory response syndrome (SIRS) and widespread microthrombosis and hemorrhagic diathesis as a result of disseminated intravascular coagulation (DIC). 1,6,50,66,71 Thrombocytopenia, which is a common finding in canine heatstroke, may be due to direct heat damage to megakaryocytes or platelets, or may be associated with DIC. Hepatic damage due to thermal injury and prolonged splanchnic hypoperfusion may also further exacerbate hemostatic abnormalities.…”

Section: Pathophysiology Of Heatstrokementioning

confidence: 99%

Pathophysiology and pathological findings of heatstroke in dogs

Romanucci¹,

Salda²

2013

VMRR

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Canine heatstroke is a life-threatening condition resulting from an imbalance between heat dissipation and production, and characterized by a nonpyrogenic elevation in core body temperature above 41°C (105.8°F). Several exogenous and endogenous factors may predispose dogs to the development of heatstroke; on the other hand, adaptive mechanisms also exists which allow organisms to combat the deleterious effects of heat stress, which are represented by the cellular heat-shock response and heat acclimatization. The pathophysiology and consequences of heatstroke share many similarities to those observable in sepsis and are related to the interaction between the direct cytotoxicity of heat, the acute physiological alterations associated with hyperthermia, such as increased metabolic demand, hypoxia, and circulatory failure, and the inflammatory and coagulation responses of the host to the widespread endothelial and tissue injuries, which may culminate in disseminated intravascular coagulation, systemic inflammatory response syndrome, and multiple organ dysfunction.

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Heat stroke: Role of the systemic inflammatory response

Abstract: Leon LR, Helwig BG. Heat stroke: Role of the systemic inflammatory response.

Cited by 382 publications

References 87 publications

Heat-related Emergency Hospitalizations for Respiratory Diseases in the Medicare Population

Heat-related Emergency Hospitalizations for Respiratory Diseases in the Medicare Population

Exertional Heat Stroke in Navy and Marine Personnel: A Hot Topic

Pathophysiology and pathological findings of heatstroke in dogs

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