Critical Care and Early Management of Occupational Heat Stroke in Tropical and Low-Resource Settings: A Narrative Review

Abstract

Background: Occupational heat stroke is a life-threatening emergency that is increasingly prevalent in tropical regions with sustained heat and humidity. Outdoor and industrial workers face high risk due to environmental heat exposure and metabolic workload, leading to organ dysfunction and systemic inflammation. Methods: A narrative review of literature published between 2020 and 2025 was conducted using PubMed/MEDLINE, Scopus, and Web of Science focusing on occupational heat stroke, tropical climate, core temperature, and cooling strategies. Results: Occupational heat stroke remains under-recognized due to limited surveillance, diagnostic variability, and vulnerability among migrant and low-income workers. Pathophysiology involves elevated core body temperature and central nervous system dysfunction, triggering systemic inflammation and multi-organ failure. Rectal thermometry is the practical gold standard, while esophageal probes are preferred in intubated patients. Peripheral measurements frequently underestimate core temperature in humid tropical settings. When reliable thermometry is unavailable, diagnosis should be based on clinical features and immediate cooling. Prevention requires integrated strategies including workrest cycles, hydration, heat acclimatization, environmental heat mitigation, and personal cooling systems. Conclusion: Rising global temperatures will increase occupational heat stroke in tropical regions. Improving access to accurate thermometry and implementing comprehensive workplace prevention strategies are essential to reduce morbidity.