Case report: severe heat stroke with multiple organ dysfunction - a novel intravascular treatment approach.
BACKGROUND
We report the case of a patient who developed a severe post-exertional heat stroke with consecutive multiple organ dysfunction resistant to conventional antipyretic treatment, necessitating the use of a novel endovascular device to combat hyperthermia and maintain normothermia.


METHODS
A 38-year-old male suffering from severe heat stroke with predominant signs and symptoms of encephalopathy requiring acute admission to an intensive care unit, was admitted to a ten-bed neurological intensive care unit of a tertiary care hospital. The patient developed consecutive multiple organ dysfunction with rhabdomyolysis, and hepatic and respiratory failure. Temperature elevation was resistant to conventional treatment measures. Aggressive intensive care treatment included forced diuresis and endovascular cooling to combat hyperthermia and maintain normothermia.


RESULTS
Analyses of serum revealed elevation of proinflammatory cytokines (TNF alpha, IL-6), cytokines (IL-2R), anti-inflammatory cytokines (IL-4) and chemokines (IL-8) as well as signs of rhabdomyolysis and hepatic failure. Aggressive intensive care treatment as forced diuresis and endovascular cooling (CoolGard and CoolLine) to combat hyperthermia and maintain normothermia were used successfully to treat this severe heat stroke.


CONCLUSIONS
In this case of severe heat stroke, presenting with multiple organ dysfunction and elevation of cytokines and chemokines, which was resistant to conventional cooling therapies, endovascular cooling may have contributed significantly to the reduction of body temperature and, possibly, avoided a fatal result.
Broessner
Gregor
G
Department of Neurology, Neurological Intensive Care Unit, Medical University, Innsbruck, Austria. gregor.broessner@uibk.ac.at
Beer
Ronny
R
Franz
Gerhard
G
Lackner
Peter
P
Engelhardt
Klaus
K
Brenneis
Christian
C
Pfausler
Bettina
B
Schmutzhard
Erich
E
D000328:Adult; D001831:Body Temperature; D016207:Cytokines / Q000097:blood; D004231:Diuresis; D018883:Heat Stroke / Q000150:complications* / Q000628:therapy; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000628:therapy; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology* / Q000628:therapy; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012206:Rhabdomyolysis / Q000209:etiology / Q000628:therapy
D016207:Cytokines