Incidence of climate change among critically ill patients

Rising temperatures associated with climate change are worsening the condition of patients suffering from certain respiratory and infectious diseases. For this reason, the Spanish Society of Critical Intensive Care and Coronary Care Units (SEMICYUC) notes that intensive care services must adapt to these new circumstances.

The most severe heat strokes, requiring admission to the intensive care unit, are accompanied by neurological changes and multiple organ failure, which contribute to their high mortality. EPA/Alessandro Di Marco

He temperature increase In Spain, summer has lengthened by almost five weeks, resulting in an increasingly semi-arid climate and increased heat waves that are becoming more frequent, longer and more intense due to climate change, the effects of which SEMICYUC has observed in seriously ill patients.

During the National Congress of the Spanish Society of Critical Intensive Care and Coronary Care, recently held in Barcelona, increased incidence of heatstroke and infections.

For this reason, SEMICUYC requires adaptation of intensive care services to new needs.

“Intensive care is an important activity for maintaining population health, as has been highlighted during the COVID-19 pandemic. Intensive care providers are aware of how changes in the environment alter clinical practice; and also that our own activities, although necessary, must be carried out within the framework of optimal environmental standards,” says Ricard Ferrer, head of intensive care medicine at the Vall d’Hebron Hospital in Barcelona.

New infection profile

Infections associated with elevated temperatures were identified at the said congress, where Dr. Antoni Trilla, epidemiologist and professor of preventive medicine at the University of Barcelona, ​​noted that Diseases transmitted by small organisms and water spread more easily..

Such pathologies include malaria, West Nile fever, dengue fever, chikungunya or cryptosporidiosis.

“They are all known and present in other latitudes. Currently, most of the cases we treat in Europe are imported by travellers; But if climatic conditions are met, we may begin to observe autochthonous cases and even epidemics, which will be localized and limited. We were able to see this in Italy with chikungunya,” the epidemiologist added.

“The most important thing is to know these entities, treat them not as imported cases but as possible local cases, and quickly establish a presumptive diagnosis and appropriate preventative measures in each case,” Dr. Trilla said.

heatstroke

In addition to infections, heat strokes have been identified in the National Congress, which may require hospitalization in the intensive care unit.

To care for this type of patient, intensivists focus on obtaining lower body temperature by immersion in cold water and evaporation of the cold water.

“This is a medical emergency with a high mortality rate that can range from 5 to 50%. It is characterized by body temperature above 40.5 °C, neurological changes and multiple organ failure. The diagnosis may include severe neurological changes and multi-organ involvement. This degree of severity requires admission to the intensive care unit for treatment,” says Dr. Edouard Argudo, intensivist at the Val d’Hebron hospital.

It is also important to give organ support who fail due to intubation, invasive mechanical ventilation, vasoactive drugs and renal replacement therapy, explains Dr. Argudo.

Changing of the climate This also impacts the transport of critical patients.. Extreme temperatures can have an impact by changing the temperature of your body and some equipment or appliances.

“For example, patients who require extracorporeal membrane oxygenation (ECMO) tend to be at greater risk of exposure to external temperatures, so their body temperature can easily change if we don’t have monitoring devices. To minimize this risk we must have air conditioned vehicles, this is usually easy to do overland (by ambulance) but more than that.
difficult by air, since not all planes have air conditioning. In addition, extreme heat also limits helicopter performance,” explains Dr. Argudo.

Minimize your carbon footprint

Climate change is a concern for critical care services at the healthcare and organizational levels. Resuscitation specialists from all over Europe are leading the movement for the so-called “green intensive care unit“who stands for adjusting the carbon footprint of services.

Ricard Ferrer insists that work needs to be done waste reductionespecially disposable materials, we are looking for suppliers who use recycled materials and minimize packaging of its products.

Intensivists have proposed measures such as regulate the temperature in the intensive care unit and effectively use equipment for reduce energy consumption. They also suggest reducing water consumption to the required level.

“Surgical hand washing, patient hygiene and other interventions can be carried out perfectly with less consumption,” added the head of intensive care medicine at the Val d’Hebron hospital.

“It is logical that these interventions should be consistent and coordinated with those implemented by other countries.
hospital services and require the involvement of general services to carry out certain
changes, such as installing faucets and lamps with motion sensors, thermostats…”,
– Dr. Ferrer points out.

When it comes to transportation, Dr. Argudo believes there is room for improvement to reduce carbon emissions. An example of progress in infrastructure is the use of more efficient and less consuming vehicles and the right choice of vehicles for each transfer. The critical care specialist also suggests investing in technologies such as telemedicine, which can avoid unnecessary transfers and therefore reduce carbon emissions.