Exertional Heat-related Illness Research Articles

Exertional Heat Illness-From Identifying Heat Rash to Treating Heat Stroke.

Heat-related illness commonly affects adolescent patients, especially as summer approaches and global temperature extremes worsen. Basic counseling on sunburn prevention can decrease the risk for future malignancies, and rapidly preventing, identifying, and treating heat stroke can prevent severe morbidity and mortality. This article will review the epidemiology of exertional heat-related illness and the variations in presentations and pathology, from heat rash and sunburn to heat exhaustion and heat stroke. By the end of this review clinicians should be able to identify and treat different heat-related illnesses in adolescents and potentially save a life. [Pediatr Ann. 2024;53(1):e17-e21.].

Greater thermoregulatory strain in the morning than late afternoon during judo training in the heat of summer

The time-of-day variations in environmental heat stress have been known to affect thermoregulatory responses and the risk of exertional heat-related illness during outdoor exercise in the heat. However, such effect and risk are still needed to be examined during indoor sports/exercises. The current study investigated the diurnal relationships between thermoregulatory strain and environmental heat stress during regular judo training in a judo training facility without air conditioning on a clear day in the heat of summer. Eight male high school judokas completed two 2.5-h indoor judo training sessions. The sessions were commenced at 09:00 h (AM) and 16:00 h (PM) on separate days. During the sessions, indoor and outdoor heat stress progressively increased in AM but decreased in PM, and indoor heat stress was less in AM than PM (mean ambient temperature: AM 32.7±0.4°C; PM 34.4±1.0°C, P<0.01). Mean skin temperature was higher in AM than PM (P<0.05), despite greater dry and evaporative heat losses in AM than PM (P<0.001). Infrared tympanic temperature, heart rate and thermal sensation demonstrated a trial by time interaction (P<0.001) with no differences at any time point between trials, showing relatively higher responses in these variables in PM compared to AM during the early stages of training and in AM compared to PM during the later stages of training. There were no differences between trials in body mass loss and rating of perceived exertion. This study indicates a greater thermoregulatory strain in the morning from 09:00 h than the late afternoon from 16:00 h during 2.5-h regular judo training in no air conditioning facility on a clear day in the heat of summer. This observation is associated with a progressive increase in indoor and outdoor heat stress in the morning, despite a less indoor heat stress in the morning than the afternoon.

Dogs Don't Die Just in Hot Cars-Exertional Heat-Related Illness (Heatstroke) Is a Greater Threat to UK Dogs.

Simple SummaryHeat-related illness (often called heatstroke) is a potentially fatal condition inflicted on dogs that will become more common as global temperatures rise. Understanding why dogs develop heatstroke can help to refine prevention strategies through owner education and societal changes. This study aimed to determine the most common triggers of heat-related illness in UK dogs, and which types of dogs were at most risk. We reviewed the veterinary records of over 900,000 dogs and identified that exercise was the most common trigger of heat-related illness in dogs. We also found that heatstroke caused by exercise was just as likely to kill as heatstroke from a hot car. Male dogs and younger dogs were more likely to develop heat-related illnesses triggered by exercise. Older dogs and flat-faced dogs were at greater risk of developing heat-related illness just by sitting outside in hot weather. Any dog can develop heatstroke if left in a hot car, but flat-faced breeds were particularly at risk. As the world gets hotter, we need to include our canine companions in our strategies to stay cool, as they can suffer fatal consequences when we fail to keep them safe.Heat-related illness will affect increasing numbers of dogs as global temperatures rise unless effective mitigation strategies are implemented. This study aimed to identify the key triggers of heat-related illness in dogs and investigate canine risk factors for the most common triggers in UK dogs. Using the VetCompassTM programme, de-identified electronic patient records of 905,543 dogs under primary veterinary care in 2016 were reviewed to identify 1259 heat-related illness events from 1222 dogs. Exertional heat-related illness was the predominant trigger (74.2% of events), followed by environmental (12.9%) and vehicular confinement (5.2%). Canine and human risk factors appear similar; young male dogs had greater odds of exertional heat-related illness, older dogs and dogs with respiratory compromise had the greatest odds of environmental heat-related illness. Brachycephalic dogs had greater odds of all three types of heat-related illness compared with mesocephalic dogs. The odds of death following vehicular heat-related illness (OR 1.47, p = 0.492) was similar to that of exertional heat-related illness. In the UK, exertional heat-related illness affects more dogs, and kills more dogs, than confinement in a hot vehicle. Campaigns to raise public awareness about heat-related illness in dogs need to highlight that dogs don’t die just in hot cars.

Risk Factors Associated with Exertional Heat Related Illness in Recruits of Nepal Army during Training Period: A Case Control Study

&#x0D; &#x0D; &#x0D; &#x0D; Introduction: Prevention is an important strategy to reduce the incidence of Exertional heat-related illnesses (EHRI) during training. It comprises a group of symptoms that occur in response to heat accumulation in the body caused by exercise or work in a hot and humid environment for a long period of time until the body is unable to regulate its temperature. The aim of the study is to find out associated risk factors and factors contributing EHRI especially in recruits of Nepal Army.&#x0D; Methods: A case-control study was conducted in recruit training center of Nepal army from June to September of 2017 using a Semi- structured questionnaire after taking ethical approval from IRB. All EHRI cases were included during data collection. The risk factors were analyzed with controls from the same center. 36 cases and 84 controls were taken. We computed the odd ratio (OR), corresponding 95% confidence interval (95% CI), Chi-Square test and Binary Logistic Regression test with SPSS version 20 software.&#x0D; Results: 85% were wearing army uniform with camouflage vest during the exertional phase of training which was identified as noticeable risk factor with odd ratio (OR) of 13.26 with 95% CI: 5.05 – 34.84 in comparisons to controls. Fear from instructors and seniors in following rules were the protective factors for EHRI (P&lt;0.05).&#x0D; Conclusions: Wearing camouflouge vests and previous history of EHRI were significant risk factors associated with EHRI during training period. Proper clothing protocol and identifying vulnerable groups by the commanders and trainees may prevent EHRI in future.&#x0D; &#x0D; &#x0D; &#x0D;

Progressive dry to humid hyperthermia alters exercise cerebral blood flow

Exercising in hot conditions may increase the risk for exertional heat-related illness due to reduction in cerebral blood flow (CBF); however, the acute effect of exercise-induced changes on CBF during compensable and uncompensable heat stress remain unclear. We tested the hypothesis that exercising in hot dry and humid conditions would have different CBF responses. Nine healthy active males completed a 30 min baseline rest then 60 min of low intensity self-paced exercise (12 rating of perceived exertion) in a 1) control compensable neutral dry (CN; 23.7 ± 0.7 °C; 10.7 ± 0.8%Rh) and 2) compensable hot dry (CH; 42.3 ± 0.3 °C; 10.7 ± 1.8%Rh) that progressively increased to an uncompensable hot humid (UCH; 42.3 ± 0.3 °C; 55.2 ± 7.7%Rh) environment in random order separated by at least 4 days. We observed that during CN environments from rest through 60 min of exercise, middle cerebral velocity (MCAvmean) and conductance (MCAvmean CVC) remained unchanged. In contrast, during CH, MCAvmean, MCAvmean CVC, and cardiac output (Q) increased and systemic vascular resistance (SVR) decreased. However, under UCH, MCAvmean, MCAvmean CVC, and Q was reduced. No difference in mean arterial pressure or ventilation was observed during any condition. Only during UCH, end-tidal PO2 increased and PCO2 decreased. The redistribution of blood to the skin for thermoregulation (heart rate, skin blood flow and sweat rate) remained higher during exercise in UCH environments. Collectively, exercise cerebral blood flow is altered by an integrative physiological manner that differs in CN, CH, and UCH environments. The control of CBF may be secondary to thermoregulatory control which may provide an explanation for the cause of exertional heat illness.

Outcome of Patients Admitted with Exertional Heat Related Illness in Intensive Care Unit of Tertiary Care Hospital

Introduction: Exertional heat related illness particularly heat stroke is very common life threatening condition that frequently occur in young military trainee due to high ambient temperature and humidity.&#x0D; Objective: The study was undertaken to identify its outcome in recruits admitted in intensive care units of military tertiary care hospital.&#x0D; Methods: An observational cross-sectional descriptive study was done among those recruits admitted in Intensive Care Unit of military tertiary care hospital with diagnosis of heat related illness from June 2016 to August 2017 A.D. Data based on hospital case records were collected and analyzed using SPSS version 22. Primary outcome studied was mortality. Secondary outcomes studied were length of stay in ICU, hospital and on ventilator.&#x0D; Results: Out of 17 recruits, 12 were diagnosed as heat exhaustion and 5 were diagnosed as heat stroke. SOFA score for heat stroke and heat exhaustion patients ranged from 2-16 and 0- 2 with respective mortality rate 7-95% and 0-7%. APACHE II score for heat stroke and heat exhaustion patients ranged from 5-33 and 0-5 with respective mortality rate 5.80-73% and 0-5.80%. There was no mortality among 12 heat exhaustion patients. Out of 5 heat stroke patients, 3 died with 60% mortality rate. Heat stroke patients had maximum stay of 4 days in ICU, hospital for 5 days and ventilator for 4 days.&#x0D; Conclusion: Exertional heat related illness is common in young military trainee with heat exhaustion and heat stroke being common causes for ICU admission. Heat stroke has higher mortality rate due to multiple organ dysfunction.

Heat-related illness in sports and exercise.

Exertional heat-related illness (EHRI) is comprised of several states that afflict physically active persons when exercising during conditions of high environmental heat stress. Certain forms of EHRI may become life threatening if not treated. Exertional heat stroke (EHS), characterized by a core body temperature of >40° C and mental status changes, is the most severe form of EHRI. EHS must be treated immediately with rapid body cooling to reduce morbidity and mortality. Many EHRI cases are preventable by following heat acclimatization guidelines, modifying sports and exercise sessions during conditions of high environmental heat stress, maintaining adequate hydration, avoiding exertion in the heat when ill, and by educating sports medicine personnel, coaches, parents, and athletes on the early recognition and prevention of EHRI. Heat exhaustion, exercise-associated collapse, exercise-associated muscle cramps, exercise-associated hyponatremia, and exertional rhabdomyolysis are also described.

Identification of risk factors for exertional heat-related illnesses in long-distance cyclists: experience from the California AIDS Ride

To identify risk factors for exertional heat-related illnesses and to determine if patients who are afflicted with the human immunodeficiency virus or have acquired immunodeficiency syndrome have an increased risk of exertional heat-related illness. Descriptive, retrospective, matched case-control study. Mobile community of 2,650 participants in the California AIDS Ride 3. Participants included 117 patients presenting for medical care with heat-related illnesses and 234 age-, gender-, and registration site-matched control subjects who did not develop a heat-related illness. Retrospective, matched case-control study utilizing univariate and multivariate conditional logistic regression to determine if human immunodeficiency virus seropositivity, the number of chronic medical illnesses, or the number of current medications known to affect heat dissipation increased the risk of exertional heat-related illnesses. The multivariate model revealed that patients with a greater number of chronic medical illnesses were at a significantly increased risk of a heat-related illness (odds ratio = 1.6, 95% CI = 1.2-2.1). The number of current medications (odds ratio = 1.1, 95% CI = 0.8-1.5) and human immunodeficiency virus seropositivity (odds ratio = 0.7, 95% CI = 0.2-3.1) were not significant predictors of risk for exertional heat-related illness. Those riders suffering from a greater number of chronic medical illnesses were at a greater risk for developing an exertional heat-related illness. Human immunodeficiency virus seropositivity alone was not associated with increased risk of exertional heat-related illness.