今日の臨床サポート

熱中症、熱射病

著者: 千葉拓世 国際医療福祉大学 救急医学講座

監修: 志賀隆 国際医療福祉大学 医学部救急医学/国際医療福祉大学病院 救急医療部

著者校正/監修レビュー済:2021/02/03
参考ガイドライン:
  1. American College of Sports Medicine position stand. Exertional heat illness during training and competition. 2007
  1. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2019 Update
  1. 日本救急医学会:熱中症診療ガイドライン2015
患者向け説明資料

概要・推奨   

  1. 体温測定は直腸温か食道温で行う。
  1. 体温を下げるには、運動誘発性熱射病では水風呂に漬かるのが一番早く、有効である。体温を何度まで下げるかについての目標ははっきりしないが、一般的には38~39程度まで下げる(推奨度2)
  1. ダントロレンは熱射病には使用を推奨しない(推奨度3)
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧には
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要とな
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となり
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧に
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
千葉拓世 : 未申告[2021年]
監修:志賀隆 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 定期レビューを行った(変更なし)。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 熱中症とは、暑熱環境下にて身体適応の障害によって起こる状態の総称である。熱中症(heat-related illness)には、熱射病(heatstroke)、熱疲労(heat exhaustion)、熱けいれん、熱失神、熱テタニーなど多くの分類がある。
  1. また、高体温の原因により古典的熱射病と運動性熱射病に分類される。古典的熱射病は、高齢者が数日かけて熱波などにやられてじわじわと高体温になる病態であり、運動性熱射病は若年者が運動時に短時間で熱射病になる病態である。
  1. 熱中症の分類:<図表>
  1. 熱中症の診断基準(日本救急医学会):<図表>
  1. 意識障害の有無と体温が40度以上であるかどうかが熱射病診断の鍵となるが、体温は来院時には低下していることもあり、腋窩温や口腔温は正確な深部体温を反映しないため注意が必要である。
問診・診察のポイント  
熱中症の分類:
  1. 熱中症(heat-related illness)には、熱射病(heatstroke)、熱疲労(heat exhaustion)、熱けいれん、熱失神、熱テタニーなど多くの分類があるが、一番大切なのは、その最重症である熱射病かどうかを適切に判断して、すぐに治療に移ることである。日本救急医学会のガイドラインでは熱中症を軽度のI度から重症のIII度にまで分類している。

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文献 

著者: American College of Sports Medicine, Lawrence E Armstrong, Douglas J Casa, Mindy Millard-Stafford, Daniel S Moran, Scott W Pyne, William O Roberts
雑誌名: Med Sci Sports Exerc. 2007 Mar;39(3):556-72. doi: 10.1249/MSS.0b013e31802fa199.
Abstract/Text Exertional heat illness can affect athletes during high-intensity or long-duration exercise and result in withdrawal from activity or collapse during or soon after activity. These maladies include exercise associated muscle cramping, heat exhaustion, or exertional heatstroke. While certain individuals are more prone to collapse from exhaustion in the heat (i.e., not acclimatized, using certain medications, dehydrated, or recently ill), exertional heatstroke (EHS) can affect seemingly healthy athletes even when the environment is relatively cool. EHS is defined as a rectal temperature greater than 40 degrees C accompanied by symptoms or signs of organ system failure, most frequently central nervous system dysfunction. Early recognition and rapid cooling can reduce both the morbidity and mortality associated with EHS. The clinical changes associated with EHS can be subtle and easy to miss if coaches, medical personnel, and athletes do not maintain a high level of awareness and monitor at-risk athletes closely. Fatigue and exhaustion during exercise occur more rapidly as heat stress increases and are the most common causes of withdrawal from activity in hot conditions. When athletes collapse from exhaustion in hot conditions, the term heat exhaustion is often applied. In some cases, rectal temperature is the only discernable difference between severe heat exhaustion and EHS in on-site evaluations. Heat exhaustion will generally resolve with symptomatic care and oral fluid support. Exercise associated muscle cramping can occur with exhaustive work in any temperature range, but appears to be more prevalent in hot and humid conditions. Muscle cramping usually responds to rest and replacement of fluid and salt (sodium). Prevention strategies are essential to reducing the incidence of EHS, heat exhaustion, and exercise associated muscle cramping.

PMID 17473783  Med Sci Sports Exerc. 2007 Mar;39(3):556-72. doi: 10.12・・・
著者: Grant S Lipman, Flavio G Gaudio, Kurt P Eifling, Mark A Ellis, Edward M Otten, Colin K Grissom
雑誌名: Wilderness Environ Med. 2019 Dec;30(4S):S33-S46. doi: 10.1016/j.wem.2018.10.004. Epub 2019 Jun 17.
Abstract/Text The Wilderness Medical Society convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures, as well as best practice recommendations for both field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks or burdens for each modality. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Treatment and Prevention of Heat-Related Illness published in 2013.

Copyright © 2018 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.
PMID 31221601  Wilderness Environ Med. 2019 Dec;30(4S):S33-S46. doi: 1・・・
著者: Abderrezak Bouchama, Mohammed Dehbi, Enrique Chaves-Carballo
雑誌名: Crit Care. 2007;11(3):R54. doi: 10.1186/cc5910.
Abstract/Text INTRODUCTION: Although rapid cooling and management of circulatory failure are crucial to the prevention of irreversible tissue damage and death in heatstroke, the evidence supporting the optimal cooling method and hemodynamic management has yet to be established.
METHODS: A systematic review of all clinical studies published in Medline (1966 to 2006), CINAHL (Cumulative Index to Nursing & Allied Health Literature) (1982 to 2006), and Cochrane Database was performed using the OVID interface without language restriction. Search terms included heatstroke, sunstroke, and heat stress disorders.
RESULTS: Fourteen articles reported populations subjected to cooling treatment for classic or exertional heatstroke and included data on cooling time, neurologic morbidity, or mortality. Five additional articles described invasive monitoring with central venous or pulmonary artery catheters. The four clinical trials and 15 observational studies covered a total of 556 patients. A careful analysis of the results obtained indicated that the cooling method based on conduction, namely immersion in iced water, was effective among young people, military personnel, and athletes with exertional heatstroke. There was no evidence to support the superiority of any one cooling technique in classic heatstroke. The effects of non-invasive, evaporative, or conductive-based cooling techniques, singly or combined, appeared to be comparable. No evidence of a specific endpoint temperature for safe cessation of cooling was found. The circulatory alterations in heatstroke were due mostly to a form of distributive shock associated with relative or absolute hypovolemia. Myocardial failure was found to be rare.
CONCLUSION: A systematic review of the literature failed to identify reliable clinical data on the optimum treatment of heatstroke. Nonetheless, the findings of this study could serve as a framework for preliminary recommendations in cooling and hemodynamic management of heatstroke until more evidence-based data are generated.

PMID 17498312  Crit Care. 2007;11(3):R54. doi: 10.1186/cc5910.
著者: Flavio G Gaudio, Colin K Grissom
雑誌名: J Emerg Med. 2016 Apr;50(4):607-16. doi: 10.1016/j.jemermed.2015.09.014. Epub 2015 Oct 31.
Abstract/Text BACKGROUND: Heat stroke is an illness with a high risk of mortality or morbidity, which can occur in the young and fit (exertional heat stroke) as well as the elderly and infirm (nonexertional heat stroke). In the United States, from 2006 to 2010, there were at least 3332 deaths attributed to heat stroke.
OBJECTIVE: To summarize the available evidence on the principal cooling methods used in the treatment of heat stroke.
DISCUSSION: Although it is generally agreed that rapid, effective cooling increases survival in heat stroke, there continues to be debate on the optimal cooling method. Large, controlled clinical trials on heat stroke are lacking. Cooling techniques applied to healthy volunteers in experimental models of heat stroke have not worked as rapidly in actual patients with heat stroke. The best available evidence has come from large case series using ice-water immersion or evaporation plus convection to cool heat-stroke patients.
CONCLUSIONS: Ice-water immersion has been shown to be highly effective in exertional heat stroke, with a zero fatality rate in large case series of younger, fit patients. In older patients with nonexertional heat stroke, studies have more often promoted evaporative plus convective cooling. Evaporative plus convective cooling may be augmented by crushed ice or ice packs applied diffusely to the body. Chilled intravenous fluids may also supplement primary cooling. Based on current evidence, ice packs applied strategically to the neck, axilla, and groin; cooling blankets; and intravascular or external cooling devices are not recommended as primary cooling methods in heat stroke.

Copyright © 2016 Elsevier Inc. All rights reserved.
PMID 26525947  J Emerg Med. 2016 Apr;50(4):607-16. doi: 10.1016/j.jeme・・・
著者: Yuri Hosokawa, William M Adams, Luke N Belval, Lesley W Vandermark, Douglas J Casa
雑誌名: Ann Emerg Med. 2017 Mar;69(3):347-352. doi: 10.1016/j.annemergmed.2016.08.428. Epub 2016 Nov 16.
Abstract/Text STUDY OBJECTIVE: We investigated the efficacy of tarp-assisted cooling as a body cooling modality.
METHODS: Participants exercised on a motorized treadmill in hot conditions (ambient temperature 39.5°C [103.1°F], SD 3.1°C [5.58°F]; relative humidity 38.1% [SD 6.7%]) until they reached exercise-induced hyperthermia. After exercise, participants were cooled with either partial immersion using a tarp-assisted cooling method (water temperature 9.20°C [48.56°F], SD 2.81°C [5.06°F]) or passive cooling in a climatic chamber.
RESULTS: There were no differences in exercise duration (mean difference=0.10 minutes; 95% CI -5.98 to 6.17 minutes or end exercise rectal temperature (mean difference=0.10°C [0.18°F]; 95% CI -0.05°C to 0.25°C [-0.09°F to 0.45°F] between tarp-assisted cooling (48.47 minutes [SD 8.27 minutes]; rectal temperature 39.73°C [103.51°F], SD 0.27°C [0.49°F]) and passive cooling (48.37 minutes [SD 7.10 minutes]; 39.63°C [103.33°F], SD 0.40°C [0.72°F]). Cooling time to rectal temperature 38.25°C (100.85°F) was significantly faster in tarp-assisted cooling (10.30 minutes [SD 1.33 minutes]) than passive cooling (42.78 [SD 5.87 minutes]). Cooling rates for tarp-assisted cooling and passive cooling were 0.17°C/min (0.31°F/min), SD 0.07°C/min (0.13°F/min) and 0.04°C/min (0.07°F/min), SD 0.01°C/min (0.02°F/min), respectively (mean difference=0.13°C [0.23°F]; 95% CI 0.09°C to 0.17°C [0.16°F to 0.31°F]. No sex differences were observed in tarp-assisted cooling rates (men 0.17°C/min [0.31°F/min], SD 0.07°C/min [0.13°F/min]; women 0.16°C/min [0.29°F/min], SD 0.07°C/min [0.13°F/min]; mean difference=0.02°C/min [0.04°F/min]; 95% CI -0.06°C/min to 0.10°C/min [-0.11°F/min to 0.18°F/min]). Women (0.04°C/min [0.07°F/min], SD 0.01°C/min [0.02°F/min]) had greater cooling rates than men (0.03°C/min [0.05°F/min], SD 0.01°C/min [0.02°F/min]) in passive cooling, with negligible clinical effect (mean difference=0.01°C/min [0.02°F/min]; 95% CI 0.001°C/min to 0.024°C/min [0.002°F/min to 0.04°F/min]). Body mass was moderately negatively correlated with the cooling rate in passive cooling (r=-0.580) but not in tarp-assisted cooling (r=-0.206).
CONCLUSION: In the absence of a stationary cooling method such as cold-water immersion, tarp-assisted cooling can serve as an alternative, field-expedient method to provide on-site cooling with a satisfactory cooling rate.

Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
PMID 27865532  Ann Emerg Med. 2017 Mar;69(3):347-352. doi: 10.1016/j.a・・・
著者: Rosa McNamara, Damien Ryan, Gerard McCarthy
雑誌名: Emerg Med J. 2008 Jul;25(7):441-2. doi: 10.1136/emj.2008.061705.
Abstract/Text
PMID 18573966  Emerg Med J. 2008 Jul;25(7):441-2. doi: 10.1136/emj.200・・・
著者: A Bouchama, A Cafege, E B Devol, O Labdi, K el-Assil, M Seraj
雑誌名: Crit Care Med. 1991 Feb;19(2):176-80.
Abstract/Text STUDY OBJECTIVE: To determine the efficacy of dantrolene sodium in the treatment of heatstroke.
DESIGN: Randomized, double-blind, placebo-controlled trial.
SETTING: Heatstroke center in Makkah, Saudi Arabia.
PATIENTS: Fifty-two adult patients with heatstroke.
INTERVENTIONS: Patients were assigned to receive either dantrolene sodium (2 mg/kg body weight iv) or placebo. Conventional cooling therapy was initiated in all.
MEASUREMENTS AND MAIN RESULTS: There was no significant difference in the mean cooling times for the treatment and control groups (67.9 vs. 69 min). There was only one death in the control group. Complications were seen in six (23%) patients receiving dantrolene sodium and seven (27%) patients receiving placebo; the difference was not statistically significant. There was no significant difference in the mean number of hospital days (4.7 +/- 2.0 vs. 2.9 +/- 0.9 days).
CONCLUSION: Treatment with dantrolene sodium at the dose used, did not prove beneficial to patients with heatstroke.

PMID 1989755  Crit Care Med. 1991 Feb;19(2):176-80.
著者: A B Channa, M A Seraj, A A Saddique, G H Kadiwal, M H Shaikh, A H Samarkandi
雑誌名: Crit Care Med. 1990 Mar;18(3):290-2.
Abstract/Text Dantrolene (2.45 mg/kg body weight, range 2 to 4) was administered iv in eight heat stroke (HS) patients and compared with a control group of 12 patients of similar age, weight, and temperature range (41.9 degrees to 44 degrees C). Body surface cooling was conducted in air conditioned rooms at temperatures of 18 degrees to 23 degrees C. Mean cooling time in the dantrolene group was 49.7 +/- 4.4 (SEM) min, whereas cooling time in the control group was 69.2 +/- 4.8 min. The decrease in temperature was significantly greater in the dantrolene group, for whom the cooling time was decreased by about 19.5 min (p less than .01). Although cooling time was significantly shorter in the dantrolene group, there was no difference in the recovery of both groups. Dantrolene is an expensive drug and justification for its routine use in HS remains to be evaluated.

PMID 2302955  Crit Care Med. 1990 Mar;18(3):290-2.
著者: M A Seraj, A B Channa, S S al Harthi, F M Khan, A Zafrullah, A H Samarkandi
雑誌名: Resuscitation. 1991 Feb;21(1):33-9.
Abstract/Text During pilgrimage season (Hajj) in Saudi Arabia 34 patients with heat stroke (HS) were centrally cannulated to assess their state of hydration and fluid requirement during cooling period. Central venous pressure (C.V.P.) measurements indicated that most victims of heat stroke had normal C.V.P. on arrival at heat stroke centres and may not be fluid depleted. Twenty-two patients (64.7%) had normal or above normal C.V.P. Twelve patients (35.3%) had zero or below zero C.V.P. Six patients (17.6%) had above 10 cmH2O (range 10-26 cmH2O) and could have developed acute congestive heat failure and pulmonary edema if they had been transfused at the standard recommended rate of 3-4 litres of fluid during an average cooling time of 1 h as has been practiced in the heat stroke centres to date. This study also showed that heat stroke patients should not be briskly transfused because the heart may be affected by heat stroke per se and an unmonitored challenge by brisk i.v. therapy during cooling (which on its own increases preload on the heart due to peripheral vasoconstriction) can lead to acute overload problems. An average of 1 litre of normal saline or Ringer's lactate (crystalloids) was sufficient to normalize C.V.P. during the cooling period and to restore an optimal state of hydration without predisposing to congestive cardiac failure and pulmonary edema--the potential to develop disastrous adult respiratory distress syndrome and disseminated intravascular coagulopathy.

PMID 1852063  Resuscitation. 1991 Feb;21(1):33-9.
著者: Young Soon Cho, Hoon Lim, Seung Ho Kim
雑誌名: Emerg Med J. 2007 Apr;24(4):276-80. doi: 10.1136/emj.2006.043265.
Abstract/Text OBJECTIVE: To compare the effectiveness and side effects of lactated Ringer's solution (LR) and 0.9% saline (NS) in the treatment of rhabdomyolysis induced by doxylamine intoxication.
METHODS: In this 15-month-long prospective randomised single-blind study, after excluding 8 patients among 97 doxylamine-intoxicated patients, 28 (31%) patients were found to have developed rhabdomyolysis and were randomly allocated to NS group (n = 15) or LR group (n = 13).
RESULTS: After 12 h of aggressive hydration (400 ml/h), urine/serum pH was found to be significantly higher in the LR group, and serum Na+/Cl- levels to be significantly higher in the NS group. There were no significant differences in serum K+ level and in the time taken for creatine kinase normalisation. The amount of sodium bicarbonate administered and the frequency administration of diuretics was significantly higher in the NS group. Unlike the NS group, the LR group needed little supplemental sodium bicarbonate and did not develop metabolic acidosis.
CONCLUSION: LR is more useful than NS in the treatment of rhabdomyolysis induced by doxylamine intoxication.

PMID 17384382  Emerg Med J. 2007 Apr;24(4):276-80. doi: 10.1136/emj.20・・・
著者: Christopher S D Almond, Andrew Y Shin, Elizabeth B Fortescue, Rebekah C Mannix, David Wypij, Bryce A Binstadt, Christine N Duncan, David P Olson, Ann E Salerno, Jane W Newburger, David S Greenes
雑誌名: N Engl J Med. 2005 Apr 14;352(15):1550-6. doi: 10.1056/NEJMoa043901.
Abstract/Text BACKGROUND: Hyponatremia has emerged as an important cause of race-related death and life-threatening illness among marathon runners. We studied a cohort of marathon runners to estimate the incidence of hyponatremia and to identify the principal risk factors.
METHODS: Participants in the 2002 Boston Marathon were recruited one or two days before the race. Subjects completed a survey describing demographic information and training history. After the race, runners provided a blood sample and completed a questionnaire detailing their fluid consumption and urine output during the race. Prerace and postrace weights were recorded. Multivariate regression analyses were performed to identify risk factors associated with hyponatremia.
RESULTS: Of 766 runners enrolled, 488 runners (64 percent) provided a usable blood sample at the finish line. Thirteen percent had hyponatremia (a serum sodium concentration of 135 mmol per liter or less); 0.6 percent had critical hyponatremia (120 mmol per liter or less). On univariate analyses, hyponatremia was associated with substantial weight gain, consumption of more than 3 liters of fluids during the race, consumption of fluids every mile, a racing time of >4:00 hours, female sex, and low body-mass index. On multivariate analysis, hyponatremia was associated with weight gain (odds ratio, 4.2; 95 percent confidence interval, 2.2 to 8.2), a racing time of >4:00 hours (odds ratio for the comparison with a time of <3:30 hours, 7.4; 95 percent confidence interval, 2.9 to 23.1), and body-mass-index extremes.
CONCLUSIONS: Hyponatremia occurs in a substantial fraction of nonelite marathon runners and can be severe. Considerable weight gain while running, a long racing time, and body-mass-index extremes were associated with hyponatremia, whereas female sex, composition of fluids ingested, and use of nonsteroidal antiinflammatory drugs were not.

Copyright 2005 Massachusetts Medical Society.
PMID 15829535  N Engl J Med. 2005 Apr 14;352(15):1550-6. doi: 10.1056/・・・
著者: Carlos V R Brown, Peter Rhee, Linda Chan, Kelly Evans, Demetrios Demetriades, George C Velmahos
雑誌名: J Trauma. 2004 Jun;56(6):1191-6.
Abstract/Text BACKGROUND: The combination of bicarbonate and mannitol (BIC/MAN) is commonly used to prevent renal failure (RF) in patients with rhabdomyolysis despite the absence of sufficient evidence validating its use. The purpose of this study was to determine whether BIC/ MAN is effective in preventing RF in patients with rhabdomyolysis caused by trauma.
METHODS: This study was a review of all adult trauma intensive care unit (ICU) admissions over 5 years (January 1997-September 2002). Creatine kinase (CK) levels were checked daily (abnormal,>520 U/L). RF was defined as a creatinine greater than 2.0 mg/dL. Patients received BIC/MAN on the basis of the surgeon's discretion.
RESULTS: Among 2,083 trauma ICU admissions, 85% had abnormal CK levels. Overall, RF occurred in 10% of trauma ICU patients. A CK level of 5,000 U/L was the lowest abnormal level associated with RF; 74 of 382 (19%) patients with CK greater than 5,000 U/L developed RF as compared with 143 of 1,701 (8%) patients with CK less than 5,000 U/L (p < 0.0001). Among patients with CK greater than 5,000 U/L, there was no difference in the rates of RF, dialysis, or mortality between those who received BIC/MAN and those who did not. Subanalysis of groups with various levels of CK still failed to show any benefit of BIC/MAN.
CONCLUSION: Abnormal CK levels are common among critically injured patients, and a CK level greater than 5,000 U/L is associated with RF. BIC/MAN does not prevent RF, dialysis, or mortality in patients with creatine kinase levels greater than 5,000 U/L. The standard of administering BIC/MAN to patients with post-traumatic rhabdomyolysis should be reevaluated.

PMID 15211124  J Trauma. 2004 Jun;56(6):1191-6.
著者: Abderrezak Bouchama, Mohammed Dehbi, Gamal Mohamed, Franziska Matthies, Mohamed Shoukri, Bettina Menne
雑誌名: Arch Intern Med. 2007 Nov 12;167(20):2170-6. doi: 10.1001/archinte.167.20.ira70009. Epub 2007 Aug 13.
Abstract/Text BACKGROUND: Although identifying individuals who are at increased risk of dying during heat waves and instituting protective measures represent an established strategy, the evidence supporting the components of this strategy and their strengths has yet to be evaluated. We conducted a meta-analysis of observational studies on risk and protective factors in heat wave-related deaths.
METHODS: Using the OVID interface, we searched Medline (1966-2006) and CINHAL (1982-2006) databases. The Web sites of the World Health Organization, Institut National de Veille Sanitaire, and Centers for Disease Control and Prevention were also visited. The search terms included heat wave, heat stroke, heatstroke, sunstroke, and heat stress disorders. Eligible studies were case-control or cohort studies. Odds ratios (ORs) and information on study quality were abstracted by 2 investigators independently. Six case-control studies involving 1065 heat wave-related deaths were identified.
RESULTS: Being confined to bed (OR, 6.44; 95% confidence interval [CI], 4.5-9.2), not leaving home daily (OR, 3.35; 95% CI, 1.6-6.9), and being unable to care for oneself (OR, 2.97; 95% CI, 1.8-4.8) were associated with the highest risk of death during heat waves. Preexisting psychiatric illness (OR, 3.61; 95% CI, 1.3-9.8) tripled the risk of death, followed by cardiovascular (OR, 2.48; 95% CI, 1.3-4.8) and pulmonary (OR, 1.61; 95% CI, 1.2-2.1) illness. Working home air-conditioning (OR, 0.23; 95% CI, 0.1-0.6), visiting cool environments (OR, 0.34; 95% CI, 0.2-0.5), and increasing social contact (OR, 0.40; 95% CI, 0.2-0.8) were strongly associated with better outcomes. Taking extra showers or baths (OR, 0.32; 95% CI, 0.1-1.1) and using fans (OR, 0.60; 95% CI, 0.4-1.1) were associated with a trend toward lower risk of death.
CONCLUSION: The present study identified several prognostic factors that could help to detect those individuals who are at highest risk during heat waves and to provide a basis for potential risk-reducing interventions in the setting of heat waves.

PMID 17698676  Arch Intern Med. 2007 Nov 12;167(20):2170-6. doi: 10.10・・・

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