Decreasing Work of Breathing in Heat Stroke Patients

Vapotherm does not practice medicine or provide medical services or advice. These guidelines are based on an assessment of physician interviews, and physiological modeling. Providers should refer to the full indications for use and operating instructions of any products referenced before use.

With record heatwaves showing no sign of slowing down, your hospital may be seeing an increase of hyperthermic patients. While there aren’t many high-quality studies on management of classic heat stroke in adults[1], the current understanding is that successful treatment requires early recognition, rapid cooling to normal body temperature, and supportive care.[1,2,3]

The Need for Cooling is Well-Known

A standard-equipped emergency department can use several tools to cool a patient down via evaporative and conductive methods, including[3]:

  • Cooling blanket
  • Cold saline
  • Ice packs (if several are placed on the patient, it may grow to resemble an ice water bath)
  • Cool water bath (though logistics may be difficult depending on the emergency department)
  • Foley catheter
  • Sheets/towels (to cover ice packs and mitigate potential skin damage upon exposure to ice)
  • Spray bottle & fan (for evaporative cooling, provided relative ambient humidity is below 75%[1])

Decreasing the Work of Breathing Could Help, Too

One less obvious adjunctive approach is to help support the patients’ breathing. Increased work of breathing during heat stroke is one of the body’s methods to cool itself off as heat is exhaled with each breath[4,5].

Using respiratory modalities that are proven to help reduce work of breathing—such as high velocity therapy—could help support the function of breathing to cool the patient  (evaporative cooling via the respiratory tract). Provided the patient is able to protect their airway and not in need of emergent intubation, Vapotherm high velocity therapy can offer support to patients experiencing heat stroke. The therapy rapidly flushes the upper airway dead space and replaces it with conditioned gas. That gas may be administered below the hyperthermic patient’s temperature.

In general, supporting the patient’s work of breathing could prevent the deterioration of respiratory function and potentially prevent intubation.

High velocity therapy has been shown to be effective in managing respiratory distress, and is commonly applied as Mask-Free NIV® for respiratory symptoms of COPD exacerbations, CHF crises, COVID-19, and other conditions that often require respiratory support modalities.

 Learn More About High Velocity Therapy for Respiratory Support

Crawford Mechem, C MD, FACEP S. “Severe nonexertional hyperthermia (classic heat stroke) in adults.” UpToDate Jun 20, 2022.
2. Rublee C, Dresser C, Giudice C, Lemery J, Sorensen C. Evidence-Based Heatstroke Management in the Emergency Department. West J Emerg Med. 2021 Feb 26;22(2):186-195. doi: 10.5811/westjem.2020.11.49007. PMID: 33856299; PMCID: PMC7972371.
3. Wasserman DD, Creech JA, Healy M. Cooling Techniques For Hyperthermia. [Updated 2021 Oct 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
4. Mariak Z, White MD, Lewko J, Lyson T, Piekarski P. Direct cooling of the human brain by heat loss from the upper respiratory tract. Journal of applied physiology. 1999;87(5):1609-1613.
5. Nybo L, Secher NH, Bielsen B. Inadequate heat release from the human brain during prolonged exercise. J Physiol. 2002;545(2):697-704.