Fluid Resuscitation and Standard Drug Treatment Strategies in Heatstroke Chinese Patients

Abstract

The objective of the present study was to evaluate different stage fluid and standard drug treatment strategies in 47 heatstroke patients. 47 adults with Heatstroke received fluid resuscitation treatment guided by transpulmonary thermodilution (PiCCO) in our intensive care unit. Systemic hemodynamics, microvascular indices and measures of acidosis, renal function, and pulmonary edema were followed prospectively. The speed of recovery and the component change was compared during the 6 h, 48 h and 96 h after the 3 stage fluid therapy. All patients were hyperpyrexia (core temperature>41°C), and on ventilation when enrolled in the ICU. Patients received a 6.17 (±1.8) ml/kg/h of crystal fluid and 3.31 (±0.5) ml/kg/h of colloidal fluid in the first 6 h; (3.41±1.2) ml/kg/h crystal fluid along with 2.27 (±0.3) ml/kg/h colloidal fluid in the first 48 h; 2.27 (±0.6) ml/kg/h crystal fluid along with 2.06 (±0.3) ml/kg/h colloidal fluid in the next 48 h. With resuscitation, acid-base status deteriorated in 25 of 47 patients (53.1%), extravascular lung water increased in 36 of 47 resuscitated patients (77%); 21 of these patients developed pulmonary edema though guided by transpulmonary thermodilution, 30 (63.8%) patients survived. All patients with pulmonary edema during the study were hypovolemic or euvolemic at the time pulmonary edema developed. Plasma lactate was lower in hypovolemic patients before (p<0.05) and after (p<0.05) resuscitation. Acute kidney injury was evident in 21 of 47 patients (47%) 48 h after enrollment. In conclusion, our study revealed that fluid resuscitation post heatstroke should be adjusted according to different stages.