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Vural A, Dolanbay T. Early and late adverse clinical outcomes of severe carbon monoxide intoxication: A cross-sectional retrospective study. PLoS One 2024; 19:e0301399. [PMID: 39213322 PMCID: PMC11364238 DOI: 10.1371/journal.pone.0301399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Carbon monoxide (CO) results from incomplete combustion of carbon-based materials, causing symptoms such as headaches, dizziness, nausea, chest pain, confusion, and, in severe cases, unconsciousness. Normobaric oxygen therapy (NBOT) is the standard therapy, whereas hyperbaric oxygen therapy (HBOT) is recommended in severe cases of organ damage. This study examined the early and late adverse outcomes in patients with severe CO poisoning. MATERIALS AND METHODS This study analyzed severe cases of CO poisoning among patients admitted to the emergency department between January 2020 and May 2022. The demographic, clinical, and laboratory data of symptomatic individuals and those requiring HBOT were examined. The study recorded early outcomes, such as intubation and in-hospital mortality, and late outcomes, such as delayed neurological sequelae and 1-year mortality. Chi-square tests, Spearman's rho correlation tests, and logistic regression analyses were performed to identify factors affecting these outcomes. RESULTS Patients who received HBOT showed a significant difference in delayed neurological sequelae (DNS) compared to those who received NBOT (p = 0.037). Significant differences were observed in the need for intubation, in-hospital mortality, and 1-year mortality between patients based on COHb levels, but no significant differences were found in DNS. The 1-year mortality probability was significantly influenced by COHb level (odds ratio = 1.159, 95% CI [1.056-1.273]). Patients receiving NBOT had a higher odds ratio for DNS risk than those receiving HBOT (odds ratio = 8.464, 95% [1.755-40.817], p = 0.008). CONCLUSION The study showed no differences in intubation, in-hospital mortality, and 1-year mortality rates between the HBOT and NBOT groups. However, significant differences in DNS suggest that treatment modalities have different effects on neurological outcomes. High COHb levels are associated with an increased risk of intubation, and mortality underscores the significance of monitoring COHb levels in clinical evaluations.
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Affiliation(s)
- Abdussamed Vural
- Department of Emergency Medicine, Nigde Omer Halisdemir University School of Medicine, Nigde, Turkey
| | - Turgut Dolanbay
- Department of Emergency Medicine, Nigde Omer Halisdemir University School of Medicine, Nigde, Turkey
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Zeng S, Li Y, Yao Z, Li Y, Cao Y, Wen L, Li M, Zheng J, Wang H. Edaravone combined with hyperbaric oxygen therapy in delayed encephalopathy after acute carbon monoxide poisoning: A meta-analysis. J Clin Neurosci 2024; 126:270-283. [PMID: 38986338 DOI: 10.1016/j.jocn.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/21/2024] [Accepted: 06/19/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND The use of both edaravone (EDA) and hyperbaric oxygen therapy (HBOT) is increasingly prevalent in the treatment of delayed encephalopathy after carbon monoxide poisoning (DEACMP). This meta-analysis aims to evaluate the efficacy of using EDA and HBOT in combination with HBOT alone in the treatment of DEACMP. METHODS We searched and included all randomized controlled trials (RCTs) published before November 6, 2023, from 12 Chinese and English databases and clinical trial centers in China and the United States. The main outcome indicator was the total effective rate. The secondary outcome indicators included the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Hasegawa Dementia Scale (HDS), Fugl-Meyer Assessment (FMA), Superoxide Dismutase (SOD), and Malondialdehyde (MDA). Statistical measures utilized include risk ratios (RR), weighted mean difference (WMD), and 95 % confidence intervals (95 % CI). RESULTS Thirty studies involving a combined total of 2075 participants were ultimately incorporated. It was observed that the combination of EDA with HBOT for the treatment of DEACMP demonstrated an improvement in the total effective rate (RR: 1.25; 95 % CI: 1.20-1.31; P < 0.01), MMSE (WMD: 3.67; 95 % CI: 2.59-4.76; P < 0.01), MoCA (WMD: 4.38; 95 % CI: 4.00-4.76; P < 0.01), BI (WMD: 10.94; 95 % CI: 5.23-16.66; P < 0.01), HDS (WMD: 6.80; 95 % CI: 4.05-9.55; P < 0.01), FMA (WMD: 8.91; 95 % CI: 7.22-10.60; P < 0.01), SOD (WMD: 18.45; 95 % CI: 16.93-19.98; P < 0.01); and a reduction in NIHSS (WMD: -4.12; 95 % CI: -4.93 to -3.30; P < 0.01) and MDA (WMD: -3.05; 95 % CI: -3.43 to -2.68; P < 0.01). CONCLUSION Low-quality evidence suggests that for DEACMP, compared to using HBOT alone, the combined use of EDA and HBOT may be associated with better cognition and activity of daily living. In the future, conducting more meticulously designed multicenter and large-sample RCTs to substantiate our conclusions is essential.
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Affiliation(s)
- Siyao Zeng
- Harbin Medical University Graduate School, Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Yue Li
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Zhipeng Yao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Yunlong Li
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Yang Cao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Lianghe Wen
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Ming Li
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Junbo Zheng
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China.
| | - Hongliang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China.
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El-Sarnagawy GN, Elgazzar FM, Ghonem MM. Development of a risk prediction nomogram for delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning. Inhal Toxicol 2024; 36:406-419. [PMID: 38984500 DOI: 10.1080/08958378.2024.2374394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES Delayed neuropsychiatric sequelae (DNS) are critical complications following acute carbon monoxide (CO) poisoning that can substantially affect the patient's life. Identifying high-risk patients for developing DNS may improve the quality of follow-up care. To date, the predictive DNS determinants are still controversial. Consequently, this study aimed to construct a practical nomogram for predicting DNS in acute CO-poisoned patients. METHODS This retrospective study was conducted on patients with acute CO poisoning admitted to the Tanta University Poison Control Center (TUPCC) from December 2018 to December 2022. Demographic, toxicological, and initial clinical characteristics data, as well as laboratory investigation results, were recorded for the included patients. After acute recovery, patients were followed up for six months and categorized into patients with and without DNS. RESULTS Out of 174 enrolled patients, 38 (21.8%) developed DNS. The initial Glasgow Coma Scale (GCS), carboxyhemoglobin (COHb) level, CO exposure duration, oxygen saturation, PaCO2, and pulse rate were significantly associated with DNS development by univariate analysis. However, the constructed nomogram based on the multivariable regression analysis included three parameters: duration of CO exposure, COHb level, and GCS with adjusted odd ratios of 1.453 (95% CI: 1.116-1.892), 1.262 (95% CI: 1.126-1.415), and 0.619 (95% CI: 0.486-0.787), respectively. The internal validation of the nomogram exhibited excellent discrimination (area under the curve [AUC] = 0.962), good calibration, and satisfactory decision curve analysis for predicting the DNS probability. CONCLUSIONS The proposed nomogram could be considered a simple, precise, and applicable tool to predict DNS development in acute CO-poisoned patients.
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Affiliation(s)
- Ghada N El-Sarnagawy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Fatma M Elgazzar
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mona M Ghonem
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Hagiwara K, Matsubara T, Nakagawa S. Delayed neuropsychiatric sequelae with improvement of decreased cerebral bold flow by single-photon emission computed tomography during hyperbaric oxygen therapy: A case report with a 10-year follow-up. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e139. [PMID: 38867825 PMCID: PMC11114380 DOI: 10.1002/pcn5.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/06/2023] [Accepted: 08/21/2023] [Indexed: 06/14/2024]
Abstract
Background Delayed neuropsychiatric sequelae (DNS) occurs in 10%-30% of acute carbon monoxide poisoning cases. Patients with this condition present higher brain dysfunction. Hyperbaric oxygen (HBO) therapy was reportedly an effective treatment for DNS in the acute phase. Favorable predictive factors affecting the prognosis of patients with DNS after HBO therapy include younger age and longer interictal periods. However, the relationship between these factors and neuroimaging findings remains unclear. Case Presentation The patient was a 59-year-old man with DNS, who developed major depressive disorder and attempted suicide with charcoal briquettes. He was diagnosed with carbon monoxide poisoning and underwent acute HBO therapy. After a 1-month lucid period, the patient developed intermittent carbon monoxide poisoning with cognitive dysfunction, following which HBO therapy was re-initiated. Following treatment, the patient returned to work for 10 years. Frontal lobe hypoperfusion, measured by single-photon emission computed tomography and cognitive impairment, improved with HBO therapy. However, magnetic resonance imaging revealed brain volume atrophy over time. Conclusion This study reported a case of DNS that completely resolved within a 10-year follow-up period. Cerebral blood flow reduction, mainly in the frontal lobe, improved along with cognitive recovery during HBO therapy. Despite gradually progressive brain atrophy over the past decade, no noted deficits in cerebral blood flow were observed in the frontal lobes. These findings suggest that improvement in cerebral blood flow during HBO therapy and its retention may be factors associated with a favorable prognosis in patients with DNS.
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Affiliation(s)
- Kosuke Hagiwara
- Division of Neuropsychiatry, Department of NeuroscienceYamaguchi University Graduate School of MedicineUbeJapan
| | - Toshio Matsubara
- Division of Neuropsychiatry, Department of NeuroscienceYamaguchi University Graduate School of MedicineUbeJapan
| | - Shin Nakagawa
- Division of Neuropsychiatry, Department of NeuroscienceYamaguchi University Graduate School of MedicineUbeJapan
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Jung MH, Lee J, Oh J, Ko BS, Lim TH, Kang H, Cho Y, Yoo KH, Lee SH, Sohn CH, Kim WY. Effectiveness of Initial Troponin I and Brain Natriuretic Peptide Levels as Biomarkers for Predicting Delayed Neuropsychiatric Sequelae in Patients with CO Poisoning: A Retrospective Multicenter Observational Study. J Pers Med 2023; 13:921. [PMID: 37373910 DOI: 10.3390/jpm13060921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/27/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Delayed neuropsychiatric sequelae (DNS) are a severe complication of carbon monoxide (CO) poisoning, and predicting DNS is difficult. This study aimed to investigate whether cardiac markers can be used as biomarkers to predict DNS occurrence following acute CO poisoning. METHODS This was a retrospective observational study that included patients with acute CO poisoning who visited two emergency medical centers in Korea from January 2008 to December 2020. The primary outcome was whether the occurrence of DNS was associated with laboratory results. RESULTS Of the 1327 patients with CO poisoning, 967 patients were included. Troponin I and BNP were significantly higher in the DNS group. As a result of multivariate logistic regression analysis, it was found that troponin I, mentality, creatine kinase, brain natriuretic peptide, and lactate levels independently influenced DNS occurrence in CO poisoning patients. The adjusted odds ratios for DNS occurrence were 2.12 (95% CI 1.31-3.47, p = 0.002) for troponin I and 2.80 (95% CI 1.81-3.47, p < 0.001) for BNP. CONCLUSION Troponin I and BNP might be useful biomarkers for predicting the occurrence of DNS in patients with acute CO poisoning. This finding can help to identify high-risk patients who require close monitoring and early intervention to prevent DNS.
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Affiliation(s)
- Myung Hyun Jung
- Department of Emergency Medicine, Hanyang University Medical Center, Seoul 04763, Republic of Korea
| | - Juncheol Lee
- Department of Emergency Medicine, Hanyang University Medical Center, Seoul 04763, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, Hanyang University Medical Center, Seoul 04763, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Byuk Sung Ko
- Department of Emergency Medicine, Hanyang University Medical Center, Seoul 04763, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University Medical Center, Seoul 04763, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University Medical Center, Seoul 04763, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Yongil Cho
- Department of Emergency Medicine, Hanyang University Medical Center, Seoul 04763, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Kyung Hun Yoo
- Department of Emergency Medicine, Hanyang University Medical Center, Seoul 04763, Republic of Korea
| | - Sang Hwan Lee
- Department of Emergency Medicine, Hanyang University Medical Center, Seoul 04763, Republic of Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, University of Ulsan College of Medicine Asan Medical Center, Seoul 05505, Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine Asan Medical Center, Seoul 05505, Republic of Korea
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Multi-Modal Synergistic 99mTc-TRODAT-1 SPECT and MRI for Evaluation of the Efficacy of Hyperbaric Oxygen Therapy in CO-Induced Delayed Parkinsonian and Non-Parkinsonian Syndromes. Antioxidants (Basel) 2022; 11:antiox11112289. [PMID: 36421475 PMCID: PMC9687447 DOI: 10.3390/antiox11112289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Delayed neuropsychiatric syndrome (DNS) is characterized by motor dysfunction after acute carbon monoxide (CO) poisoning. We examined the relationship between dopamine transporter (DAT) loss using kit-based Tc-99m-TRODAT-1 (DAT single-photon emission-computed tomography (SPECT) radioligand) and globus pallidus necrosis on MRI, DAT availability before and after hyperbaric oxygen therapy (HBOT), and feasibility of Tc-99m-TRODAT-1 as an index for parkinsonian syndrome in CO poisoning. Methods: Twenty-one CO-intoxicated patients (mean ± SD age, 38.6 ± 11.4; range, 20−68 years) with DNS underwent Tc-99m-TRODAT-1 SPECT and MRI before HBOT and follow-up Tc-99m-TRODAT-1 SPECT to assess DAT recovery. Neurological examinations for Parkinsonism were performed after development of DNS. Results: Over 70% (15/21) of DNS patients showed globus pallidus necrosis on MRI. Significantly lower bilateral striatal DAT availability was associated with globus pallidus necrosis (p < 0.005). Moreover, 68.4% (13/19) of DNS subjects with Parkinsonian syndrome had lower bilateral striatal DAT availability vs. non-parkinsonian subjects pre- or post-HBOT. The SURs for both striata increased by ~11% post-HBOT in the Parkinsonian group; however, the left striatum presented a significantly higher DAT recovery rate than the right (*** p < 0.005). Conclusions: Coupled Tc-99m TRODAT-1 SPECT and MRI could assist evaluation of Parkinsonism risk and indicate DAT availability after HBOT in CO-poisoned patients with DNS.
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Fichtner A, Eichhorn L. [Carbon monoxide intoxication-New aspects and current guideline-based recommendations]. DIE ANAESTHESIOLOGIE 2022; 71:801-810. [PMID: 35925170 DOI: 10.1007/s00101-022-01149-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
Carbon monoxide poisoning is a common and potentially life-threatening intoxication, showing an interindividual variety of unspecific symptoms as well as late neurological and other sequelae. Two new German guidelines (S2k guidelines diagnosis and treatment of carbon monoxide poisoning as well as S3 guidelines oxygen therapy in the acute care of adult patients) focus on current evidence-based information on diagnostics as well as therapeutic options with considerable uncertainty remaining. This review summarizes current information and presents a flow scheme for daily practical use.
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Affiliation(s)
- A Fichtner
- Notfall- und OP-Management, Kreiskrankenhaus Freiberg, Donatsring 20, 09599, Freiberg, Deutschland.
| | - L Eichhorn
- Anästhesie, Intensivmedizin und Schmerztherapie, Helios Klinikum Bonn/Rhein-Sieg, Bonn, Deutschland
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