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This pilot randomized controlled trial examined targeted temperature management (TTM) at 35°C compared to controlled normothermia (36.5°C–37.5°C) in intubated adult heatstroke patients admitted to intensive care units (ICUs). The study demonstrated operational feasibility for a larger trial but revealed no differences in survival or neurological outcomes. However, therapeutic hypothermia was associated with significantly higher rates of severe gastrointestinal injury and cardiac arrhythmias. Additionally, universal and intensified pharmacologic treatment was required to control shivering in the hypothermia group, raising safety concerns. These findings suggest therapeutic hypothermia should not be routinely applied in ICU heatstroke management until further data confirm benefit and safety.
