title: Can Temperate-Water Immersion Effectively Reduce Rectal Temperature in Exertional Heat Stroke? A Critically Appraised Topic.
abstract: Clinical Scenario: Exertional heat stroke (EHS) is a medical emergency which, if left untreated, can result in death. The standard of care for EHS patients includes confirmation of hyperthermia via rectal temperature (Trec) and then immediate cold-water immersion (CWI). While CWI is the fastest way to reduce Trec, it may be difficult to lower and maintain water bath temperature in the recommended ranges (1.7°C-15°C [35°F-59°F]) because of limited access to ice and/or the bath being exposed to high ambient temperatures for long periods of time. Determining if Treccooling rates are acceptable (ie, >0.08°C/min) when significantly hyperthermic humans are immersed in temperate water (ie, ≥20°C [68°F]) has applications for how EHS patients are treated in the field.
  
  
  OBJECTIVE
  Are Treccooling rates acceptable (≥0.08°C/min) when significantly hyperthermic humans are immersed in temperate water?
  
  
  RESULTS
  Treccooling rates of hyperthermic humans immersed in temperate water (≥20°C [68°F]) ranged from 0.06°C/min to 0.19°C/min. The average Treccooling rate for all examined studies was 0.11±0.06°C/min. Clinical Bottom Line: Temperature water immersion (TWI) provides acceptable (ie, >0.08°C/min) Treccooling rates for hyperthermic humans post-exercise. However, CWI cooling rates are higher and should be used if feasible (eg, access to ice, shaded treatment areas). Strength of Recommendation: The majority of evidence (eg, Level 2 studies with PEDro scores ≥5) suggests TWI provides acceptable, though not ideal, Treccooling. If possible, CWI should be used instead of TWI in EHS scenarios.
authors.forename: Tyler T
authors.initials: TT
authors.lastname: Truxton
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Miller
mesh_terms: D015444:Exercise; D018883:Heat Stroke / Q000628:therapy*; D006801:Humans; D007101:Immersion; D013696:Temperature; D014867:Water
chemical_list: D014867:Water
keywords: heat stroke; hyperthermia; treatment