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Targeted Temperature Management at 35°C vs. 37°C for Heatstroke in ICU: A Pilot Randomized Controlled Trial
Yu-Cong Wang1, Jian-Wen Wang1, Xu Li2
1Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
Critical Care Medicine
|August 6, 2026
Summary
Targeted temperature management (TTM) at 35°C-37°C in heatstroke patients is feasible but not beneficial. Therapeutic hypothermia increased severe gastrointestinal injury and arrhythmias without improving outcomes.
Area of Science:
- Critical Care Medicine
- Environmental Health
- Clinical Trials
Background:
- Heatstroke is a life-threatening condition requiring effective management.
- Targeted temperature management (TTM) is a potential therapeutic strategy for heatstroke.
- Feasibility and safety of TTM in heatstroke patients require further investigation.
Purpose of the Study:
- To assess the feasibility of a randomized clinical trial comparing TTM at 35°C-37°C versus controlled normothermia in heatstroke patients.
- To gather preliminary data on the safety and clinical outcomes of these TTM strategies.
Main Methods:
- Pilot multicenter randomized clinical trial involving 35 intubated heatstroke patients.
- Patients were assigned to either therapeutic hypothermia (35°C for 48 hours) or controlled normothermia (36.5°C-37.5°C).
- Shivering was managed with a stepwise protocol, including a lytic cocktail for refractory cases.
Main Results:
- High recruitment (83.7%) and retention (97.2%) rates demonstrated trial feasibility.
- No significant differences in 28-day functional outcome or survival were observed between groups.
- Therapeutic hypothermia was linked to significantly higher rates of severe gastrointestinal injury (52.9% vs. 0%) and arrhythmias (41.2% vs. 11.1%).
Conclusions:
- The pilot study confirmed the operational feasibility of a large-scale heatstroke TTM trial.
- Therapeutic hypothermia showed no benefit but increased risks of gastrointestinal injury and arrhythmias.
- Routine adoption of therapeutic hypothermia for ICU heatstroke management is not recommended based on these findings.
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