Physical characteristics cannot be used to predict cooling time using cold-water immersion as a treatment for exertional hyperthermia

Poirier, Martin P.; Notley, Sean R.; Flouris, Andreas D.; Kenny, Glen P.

doi:10.1139/apnm-2017-0619

Cited by 7 publications

(12 citation statements)

References 12 publications

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“…12 Similarly, BSA:LBM ratio has been reported to have one of the highest correlates with cooling rates (r = −0.345) in men and women with hyperthermia cooled using CWI (temperature = 2°C). 13 In contrast, Tikuisis et al 15 reported that women with euthermia cooled half as quickly as did men with euthermia when in 18°C water over 90 minutes, which O n l i n e F i r s t was attributed primarily to differences in physical characteristics (eg, body fat, surface area) rather than to shivering thermogenesis or fat oxidation.…”

Section: O N L I N E F I R S Tmentioning

confidence: 98%

“…Previous researchers have suggested physical characteristics, such as adipose tissue thickness, lean body mass (LBM), body surface area (BSA), and BSA:LBM ratio, affect and are correlated with Trec cooling rates. [10][11][12][13] In general, women have more adipose tissue, 13,14 as well as a greater BSA:LBM ratio, than do men, further suggesting that the sexes may cool differently. 10 In a recent study, men with higher BSA:LBM ratios cooled faster than did men with lower BSA:LBM ratios.…”

Section: O N L I N E F I R S Tmentioning

confidence: 99%

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Body Anthropometric Characteristics and Rectal Temperature Cooling Rates in Women With Hyperthermia

Koenig

Miller

O’Connor

et al. 2022

Journal of Athletic Training

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Context: Cold-water immersion (CWI) is the best treatment for exertional heat stroke (EHS), and rectal temperature (Trec) cooling rates may differ between sexes. Previous authors have suggested body surface area (BSA) to lean body mass (LBM) ratio is the largest factor affecting CWI Trec cooling rates in men with hyperthermia; this has never been confirmed in women with hyperthermia. Objective: To examine whether the BSA:LBM ratio and other anthropometrics affect Trec cooling rates in women with hyperthermia. Design: Cross-sectional study. Setting: Laboratory. Patients or Other Participants: Sixteen women were placed in either a low BSA:LBM ratio (LOW; n = 8; age = 22 ± 1 years, height = 166.8 ± 6.0 cm, mass = 64.1 ± 4.5 kg, BSA:LBM ratio = 3.759 ± 0.214 m2/kg·102) or high BSA:LBM ratio group (HIGH; n = 8; age = 22 ± 2 years, height = 162.7 ± 8.9 cm, mass = 65.8 ± 12.7 kg, BSA:LBM ratio = 4.161 ± 0.232 m2/kg·102). Intervention(s): On day 1, we measured physical characteristics using dual-energy x-ray absorptiometry, and participants completed a maximal oxygen consumption test. On day 2, participants walked at 4.8 km/h for 3 minutes and then ran at 80% of their predetermined maximal oxygen consumption for 2 minutes in the heat (temperature = ~40°C, relative humidity = 40%). This sequence was repeated until Trec reached 39.5°C. Then, they completed CWI (temperature = ~10°C) until Trec was 38°C. Main Outcome Measure(s): Rectal temperature and CWI cooling rates. Results: Groups had different BSA:LBM ratios (P = .001), body fat percentages (LOW: 25.7% ± 5.0%; HIGH: 33.7% ± 6.3%; P = .007), and LBM (LOW: 45.8 ± 3.0 kg; HIGH: 41.0 ± 5.1 kg; P = .02) but not different BSA (LOW: 1.72 ± 0.08 m2; HIGH: 1.70 ± 0.16 m2; P = .40) or BMI (LOW: 23.1 ± 2.1; HIGH: 24.9 ± 4.7; P = .17). Despite differences in several physical characteristics, Trec cooling rates were excellent but comparable (LOW: 0.26°C/min ± 0.09°C/min; HIGH: 0.27°C/min ± 0.07°C/min; P = .39). The BSA:LBM ratio (r = 0.14, P = .59), body fat percentage (r = 0.29, P = .28), LBM (r = −0.10, P = .70), BSA (r = −0.01, P = .97), and BMI (r = 0.37, P = .16) were not correlated with Trec cooling rates. Conclusions: Body anthropometrics did not affect CWI Trec cooling rates in women with hyperthermia. Clinicians need not worry about anthropometric characteristics slowing the treatment of severe hyperthermia in women using CWI.

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Section: O N L I N E F I R S Tmentioning

confidence: 98%

Section: O N L I N E F I R S Tmentioning

confidence: 99%

Body Anthropometric Characteristics and Rectal Temperature Cooling Rates in Women With Hyperthermia

Koenig

Miller

O’Connor

et al. 2022

Journal of Athletic Training

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“…The rate of cooling cannot be estimated from the initial body temperature result or from the body composition of the athlete. 18 Therefore, the rectal temperature must be monitored continuously throughout the duration of the treatment, and continue until the body temperature has stabilised post cooling for at least 15 min. Although many publications report a cooling rate in a linear manner to the ease of calculation and data presentation, it is common for the rectal temperature to plateau or even slightly increase during the first few minutes of the whole-body Figure 3 Algorithm (B) for the management of an athlete with exertional heat stroke (continued from figure 2).…”

Section: Prehospital Treatment At the Cold Water Immersion Areamentioning

confidence: 99%

Prehospital management of exertional heat stroke at sports competitions: International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020

et al. 2021

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ObjectivesThis document aimed to summarise the key components of exertional heat stroke (EHS) prehospital management.MethodsMembers of the International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 summarised the current best practice regarding the EHS prehospital management.ResultsSports competitions that are scheduled under high environmental heat stress or those that include events with high metabolic demands should implement and adopt policy and procedures for EHS prehospital management. The basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. In order to achieve these principles, medical organisers must establish an area called the heat deck within or adjacent to the main medical tent that is optimised for EHS diagnosis, treatment and monitoring. Once admitted to the heat deck, the rectal temperature of the athlete with suspected EHS is assessed to confirm an elevated core body temperature. After EHS is diagnosed, the athlete must be cooled on-site until the rectal temperature is below 39°C. While cooling the athlete, medical providers are recommended to conduct a blood analysis to rule out exercise-associated hyponatraemia or hypoglycaemia, provided that this can be safely performed without interrupting cooling. The athlete is transported to advanced care for a full medical evaluation only after the treatment has been provided on-site.ConclusionsA coordination of care among all medical stakeholders at the sports venue, during transport, and at the hospital is warranted to ensure effective management is provided to the EHS athlete.

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“…Clinicians should use Trec rather than predetermined CWI immersion times because cooling rates are influenced by numerous factors, including sex, anthropomorphic values (eg, lean body mass:body surface area ratio), water-bath temperature, Trec at the start of treatment, amount of clothing worn during CWI, and the degree of convective cooling that occurs during treatment. 46,51,52 Thus, standardized treatment times are likely to either overcool or undercool patients.…”

Section: Misconception #13mentioning

confidence: 99%

Roundtable on Preseason Heat Safety in Secondary School Athletics: Prehospital Care of Patients With Exertional Heat Stroke

Miller

Casa

Adams

et al. 2020

Journal of Athletic Training

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Objective First, we will update recommendations for the prehospital management and care of patients with exertional heat stroke (EHS) in the secondary school setting. Second, we provide action items to aid clinicians in developing best-practice documents and policies for EHS. Third, we provide practical strategies clinicians can use to implement best practice for EHS in the secondary school setting. Data Sources An interdisciplinary work group of scientists, physicians, and athletic trainers evaluated the current literature regarding the prehospital care of EHS patients in secondary schools and developed this narrative review. When published research was nonexistent, expert opinion and experience guided the development of recommendations for implementing life-saving strategies. The workgroup evaluated and further refined the action-oriented recommendations using the Delphi method. Conclusions Exertional heat stroke continues to be a leading cause of sudden death in young athletes and the physically active. This may be partly due to the numerous barriers and misconceptions about the best practice for diagnosing and treating patients with EHS. Exertional heat stroke is survivable if it is recognized early and appropriate measures are taken before patients are transported to hospitals for advanced medical care. Specifically, best practice for EHS evaluation and treatment includes early recognition of athletes with potential EHS, a rectal temperature measurement to confirm EHS, and cold-water immersion before transport to a hospital. With planning, communication, and persistence, clinicians can adopt these best-practice recommendations to aid in the recognition and treatment of patients with EHS in the secondary school setting.

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Physical characteristics cannot be used to predict cooling time using cold-water immersion as a treatment for exertional hyperthermia

Cited by 7 publications

References 12 publications

Body Anthropometric Characteristics and Rectal Temperature Cooling Rates in Women With Hyperthermia

Body Anthropometric Characteristics and Rectal Temperature Cooling Rates in Women With Hyperthermia

Prehospital management of exertional heat stroke at sports competitions: International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020

Roundtable on Preseason Heat Safety in Secondary School Athletics: Prehospital Care of Patients With Exertional Heat Stroke

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