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Keywords

cooling devices, esophageal cooling, exertional heat stroke, targeted temperature management, therapeutic hypothermia

 

Authors

  1. Martin, Katherine Riley
  2. Naiman, Melissa
  3. Espinoza, Maurice

Abstract

ABSTRACT: BACKGROUND: Exertional heat stroke (EHS) is defined by a core body temperature that exceeds 40[degrees]C with associated central nervous system dysfunction, skeletal muscle injury, and multiple organ damage. The most important initial focus of treatment involves reduction of patient temperature. First approaches to achieve temperature reduction often include ice packs, water blankets, and cold intravenous fluid administration. When these measures fail, more advanced temperature management methods may be deployed but often require surgical expertise. Esophageal temperature management (ETM) has recently emerged as a new temperature management modality in which an esophageal heat transfer device replaces the standard orogastric tube routinely placed after endotracheal intubation and adds a temperature modulation capability. The objective of this case study is to report the first known use of ETM driven by bedside nursing staff in the treatment of EHS. METHOD: An ETM device was placed after endotracheal intubation in a 28-year-old man experiencing EHS over a 5-day course of treatment. RESULTS: Because the ETM device was left in place, when the patient experienced episodes of increasing temperature as high as 39.1[degrees]C, which required active cooling, nursing staff were able to immediately adjust the external heat exchange unit settings to achieve aggressive cooling at bedside. CONCLUSION: This nurse-driven technology offers a new means to rapidly deploy cooling to critically ill patients without needing to implement advanced surgical approaches or obstruct access to the patient, freeing the provider to continue optimal care in high-morbidity conditions.