Original Article

Heat Wave in Italy and Hyperthermia Syndrome

Authors: Alberto Barbieri, MD, Cristina Pinna, MD, Luca Fruggeri, MD, Emanuela Biagioni, MD, Anselmo Campagna, MD

Abstract

In the city of Modena, Italy, daily temperatures registered during the year 2003 showed a higher mean increase of 3° C compared with the previous three years, with average temperature of 26.1° C, compared with 22.8° C. The reported ambient temperature was higher than 32.3° C in 84% of the recorded days, and daily values exceeded 35.1° C in 62% of the days. During the summer, four heat waves occurred (June 11–15, July 21–23, August 3–15 and August 17–24).


Nine patients affected by hyperthermia syndrome with a mean body temperature of 41.4 ± 1.3° C were admitted to the Intensive Care Unit (ICU) of the Modena Teaching Hospital. Another patient with similar clinical features was not admitted to ICU, but to a general ward, and eventually died a few hours later. Mortality reached 80% and the mean survival time was 4.2 days with median values of one day. All patients except for one were admitted during one of the four above-mentioned heat waves, and in particular, 7 patients were admitted during the period from August 3rd to 15th. A common feature among 8 of the 10 patients was the chronic consumption of psychoactive drugs.


According to these observations, it is important to identify a population at risk in case of bioclimatological alarm, to find prevention strategies. It is extremely important in patients with hyperthermia to lower body temperature levels in the early hours to influence the malignant evolution of this severe pathologic process.


Key Points


* At least 8 of the 10 patients in our study were taking psychoactive medications.


* Patients presented with hyperthermia and multiple organ failure.


* A high mortality rate was noted.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Semenza JC, Rubin HC, Falter KH, et al. Heat related deaths during the July 1995 heat wave in Chicago. N Engl J Med 1996;11:84–90.
 
2. Whitman S, Good G, Donoghue ER, et al. Mortality in Chicago attributed to the July 1995 heat wave.Am J Public Health 1997;87:1515–1518.
 
3. Pascal M, Laaidi K, Ledrans M, et al. France’s heat health watch warning system. Int J Biometereol2006;50:144–153.
 
4. Rooney C, McMichael AJ, Kovats RS, et al. Excess mortality in England and Wales, and in Greater London, during the 1995 heatwave. J Epidemiol Community Health 1998;52:482–486.
 
5. Braga AL, Zanobetti A, Schwartz J. The time course of weather-related deaths. Epidemiology2001;12:662–667.
 
6. Smoyer K, Rainham D, Hewko J. Heat-stress-related mortality in five cities in Southern Ontario: 1980–1996. Int J Biometereol 2000;44:190–197.
 
7. Weisskopf MG, Anderson HA, Foldy S, et al. Heat wave morbidity and mortality, Milwaukee, Wisconsin, 1999 vs 1995: an improved response? Am J Public Health 2002;92:830–833.
 
8. Naughton MP, Henderson A, Mirabelli MC, et al. Heat-related mortality during a 1999 heat wave in Chicago. Am J Prev Med 2002;22:221–227.
 
9. Davis RE, Knappenberger PC, Michaels PJ, et al. Changing heat-related mortality in the United States. Environ Health Perspect 2003;111:1712–1718.
 
10. Koutsavlis AT, Kosatsky T. Environmental-temperature injury in a Canadian metropolis. J Environ Health 2003;66:40–45.
 
11. Megarbane B, Resiere D, Shabafrouz K, et al. Descriptive study of the patients admitted to an intensive care unit during the heat wave of August 2003 in France. Presse Med 2003;32:1690–1698.
 
12. Dhainaut JF, Claessens YE, Ginsburg C, et al. Unprecedented heat-related deaths during the 2003 heat wave in Paris: consequences on emergency departments. Crit Care 2004;8:1–2.
 
13. Caspani ML, Savioli M, Crotti S, et al. Heat stress: characteristics, pathophysiology and avoidable mistakes. Minerva Anestesiol 2004;70:617–624.
 
14. Bar-Or O, Lundegren HM, Buskirk ER. Heat tolerance of exercising obese and lean women. J Appl Physiol 1969;26:403–409.
 
15. Hall RC, Appleby B, Hall RC. Atypical neuroleptic malignant syndrome presenting as fever of unknown origin in the elderly. South Med J 2005;98:114–117.
 
16. Martinez M, Devenport L, Saussy J, et al. Drug-associated heat stroke. South Med J 2002;95:799–803.