Severe heat stroke with multiple organ dysfunction.

Authors' response

Gregor Broessner, Ronny Beer, Gerhard Franz, Peter Lackner, Klaus Engelhardt, Christian Brenneis, Bettina Pfausler and Erich Schmutzhard

We read with interest the letter by Drs Heled and Deuster regarding our case report of a novel intravascular treatment approach in heat stroke.

Immediate cooling and support of organ system functioning are the two main therapeutic objectives in patients with heat stroke [4]. As a consequence of that, we intended to lower the patient's highly elevated body core temperature by using conventional temperature control measures during the acute phase of the disease. Antipyretics are widely used to combat hyperthermia, although the use of pharmacologic agents in heat stroke is controversially discussed in the literature [4,5]. In our opinion, the role of antipyretic agents in heat stroke is still unclear, despite the fact that pyrogenic cytokines have been implicated in its development and may be influenced by such drugs.

Despite the aggressive use of conventional temperature control methods, including antipyretics and surface cooling techniques, for the first 20 hours of treatment (the red line in Figure 1 of our report [1]), we could not control the patient's body core temperature. Physical means to lower temperature, including surface cooling, have been shown to be ineffective in many studies because these methods can have limited efficacy as a result of skin vasoconstriction and shivering [5,6].

While using the novel intravascular treatment device, we did not add or continue any conventional treatment except for opioids for analgesia, because control of body core temperature was achieved by endovascular treatment alone. This system has been shown to be more effective in preventing fever than conventional methods, such as antipyretic medications and surface cooling techniques [7].

We concede that the aspiration pneumonia and the sinusitis maxillaris might have had an additional effect on the severity of heat stroke in this particular case, although adequate antimicrobial treatment was started immediately and should have controlled these infections.

In our reported case conventional temperature control methods were ineffective in combating hyperthermia, but endovascular treatment was effective, feasible and instrumental in achieving a favourable outcome. Thus, further prospective randomized and controlled studies are warranted to evaluate the various treatment possibilities in heat stroke.

Competing interests

The author(s) declare that they have no competing interests.