1
|
Vigh Z, Johnson P, Thomovsky EJ, Brooks AC. Smoke Inhalation in Veterinary Patients: Pathophysiology, Diagnosis, and Management. J Am Anim Hosp Assoc 2024; 60:169-178. [PMID: 39235782 DOI: 10.5326/jaaha-ms-7431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 09/06/2024]
Abstract
Smoke contains a mixture of harmful gases, chemicals, and superheated particles. Inhalation of smoke causes generalized hypoxia and airway inflammation due to impaired oxygen transport and utilization, as well as thermal and chemical injury in the airways. Generally, treatment is supportive with oxygen therapy and airway management, including chest physiotherapy, bronchodilators, and nebulization. Immediate oxygen therapy is mandatory for all suspected smoke inhalation patients and should not be delayed pending diagnostic test results or due to "normal" oxygen saturation readings that can be falsely elevated in carbon monoxide intoxication. Smoke inhalation patients with mild clinical signs who respond well to initial stabilization generally have a favorable prognosis. However, patients with severe signs or progression despite initial stabilization may require more advanced or intensive care.
Collapse
Affiliation(s)
- Zsofia Vigh
- From the Department of Veterinary Clinical Sciences, Small Animal Emergency and Critical Care, School of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Paula Johnson
- From the Department of Veterinary Clinical Sciences, Small Animal Emergency and Critical Care, School of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Elizabeth J Thomovsky
- From the Department of Veterinary Clinical Sciences, Small Animal Emergency and Critical Care, School of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Aimee C Brooks
- From the Department of Veterinary Clinical Sciences, Small Animal Emergency and Critical Care, School of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| |
Collapse
|
2
|
Goodman D, Davidson C. Veinous Staining and Chromaturia associated with Hydroxocobalamin Infusion. BMJ Case Rep 2024; 17:e259749. [PMID: 38649239 PMCID: PMC11043731 DOI: 10.1136/bcr-2024-259749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Affiliation(s)
- Dáire Goodman
- Plastic & Reconstructive Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
- Plastic & Reconstructive Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Claire Davidson
- Plastic & Reconstructive Surgery, St Vincent's University Hospital, Dublin, Ireland
| |
Collapse
|
3
|
Velamuri SR, Ali Y, Lanfranco J, Gupta P, Hill DM. Inhalation Injury, Respiratory Failure, and Ventilator Support in Acute Burn Care. Clin Plast Surg 2024; 51:221-232. [PMID: 38429045 DOI: 10.1016/j.cps.2023.11.001] [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] [Indexed: 03/03/2024]
Abstract
Sustaining an inhalation injury increases the risk of severe complications and mortality. Current evidential support to guide treatment of the injury or subsequent complications is lacking, as studies either exclude inhalation injury or design limit inferences that can be made. Conventional ventilator modes are most commonly used, but there is no consensus on optimal strategies. Settings should be customized to patient tolerance and response. Data for pharmacotherapy adjunctive treatments are limited.
Collapse
Affiliation(s)
- Sai R Velamuri
- Department of Surgery, College of Medicine, University of Tennessee, Health Science Center, Memphis, TN 38103, USA.
| | - Yasmin Ali
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, 2nd floor Suite 217, Memphis, TN 38103, USA
| | - Julio Lanfranco
- Division of Pulmonary and Critical Care, University of Tennessee Health Science Center, 965 Court Avenue Room H316B, Memphis, TN 38103, USA
| | - Pooja Gupta
- Pulmonary and Critical Care, University of Tennessee Health Science Center, 965 court avenue, Room H316B, Memphis, TN 38103, USA
| | - David M Hill
- Department of Pharmacy, Regional One Health, University of Tennessee, 80 madison avenue, Memphis TN 38103, USA
| |
Collapse
|
4
|
Lim JWL, Kwa C, Loh S, Yew WS. Delayed presentation of transdermal cyanide poisoning. Anaesth Rep 2023; 11:e12254. [PMID: 37937282 PMCID: PMC10626002 DOI: 10.1002/anr3.12254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
A 45-year-old man attended to a warehouse fire involving burning plastic, without wearing full protective equipment. He subsequently presented to hospital with shortness of breath and his trachea was intubated for airway protection due to initial concerns of inhalational injury. However, a post-intubation bronchoscopy was normal. The patient's serum lactate level was normal on admission but was increased when measured 14 h after the initial event and accompanied by a metabolic acidosis. Transdermal cyanide poisoning was suspected given this delayed biochemical presentation and the absence of another apparent cause. A handheld chemical detector detected a high level of toxins on the patient's skin. Clinical improvement was not observed after the first dose of intravenous hydroxocobalamin, which was administered before full body decontamination. After decontamination and the administration of a second dose of hydroxocobalamin, the patient's acid-base status rapidly improved and serum lactate level returned to normal. Clinicians should have a high index of suspicion for transdermal cyanide poisoning in patients presenting after exposure to a fire.
Collapse
Affiliation(s)
- J. W. L. Lim
- Department of AnaesthesiologySingapore General HospitalSingapore
| | - C. Kwa
- Department of AnaesthesiologySingapore General HospitalSingapore
| | - S. Loh
- Department of AnaesthesiologySingapore General HospitalSingapore
| | - W. S. Yew
- Department of AnaesthesiologySingapore General HospitalSingapore
| |
Collapse
|
5
|
Williams JM, Ingle CL, Schauer SG, Maddry JK. Prehospital and Emergency Management. Surg Clin North Am 2023; 103:389-401. [PMID: 37149376 DOI: 10.1016/j.suc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Burn care in the prehospital and emergency settings requires rapid assessment of airway, breathing, and circulation. Intubation (if indicated) and fluid resuscitation are most important in emergency burn care. Total body surface area burned and depth of burn are important early assessments that help guide resuscitation and disposition. Burn care in the emergency department further includes carbon monoxide and cyanide toxicity evaluation and management.
Collapse
Affiliation(s)
| | | | - Steven G Schauer
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA; US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joseph K Maddry
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA; US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 59th Medical Wing, JBSA Lackland, TX, USA
| |
Collapse
|
6
|
Behymer M, Mo H, Fujii N, Suresh V, Chan A, Lee J, Nath AK, Saha K, Mahon SB, Brenner M, MacRae CA, Peterson R, Boss GR, Knipp GT, Davisson VJ. Identification of Platinum(II) Sulfide Complexes Suitable as Intramuscular Cyanide Countermeasures. Chem Res Toxicol 2022; 35:1983-1996. [PMID: 36201358 PMCID: PMC9682522 DOI: 10.1021/acs.chemrestox.2c00157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The development of rapidly acting cyanide countermeasures using intramuscular injection (IM) represents an unmet medical need to mitigate toxicant exposures in mass casualty settings. Previous work established that cisplatin and other platinum(II) or platinum(IV)-based agents effectively mitigate cyanide toxicity in zebrafish. Cyanide's in vivo reaction with platinum-containing materials was proposed to reduce the risk of acute toxicities. However, cyanide antidote activity depended on a formulation of platinum-chloride salts with dimethyl sulfoxide (DMSO) followed by dilution in phosphate-buffered saline (PBS). A working hypothesis to explain the DMSO requirement is that the formation of platinum-sulfoxide complexes activates the cyanide scavenging properties of platinum. Preparations of isolated NaPtCl5-DMSO and Na (NH3)2PtCl-DMSO complexes in the absence of excess DMSO provided agents with enhanced reactivity toward cyanide in vitro and fully recapitulated in vivo cyanide rescue in zebrafish and mouse models. The enhancement of the cyanide scavenging effects of the DMSO ligand could be attributed to the activation of platinum(IV) and (II) with a sulfur ligand. Unfortunately, the efficacy of DMSO complexes was not robust when administered IM. Alternative Pt(II) materials containing sulfide and amine ligands in bidentate complexes show enhanced reactivity toward cyanide addition. The cyanide addition products yielded tetracyanoplatinate(II), translating to a stoichiometry of 1:4 Pt to each cyanide scavenger. These new agents demonstrate a robust and enhanced potency over the DMSO-containing complexes using IM administration in mouse and rabbit models of cyanide toxicity. Using the zebrafish model with these Pt(II) complexes, no acute cardiotoxicity was detected, and dose levels required to reach lethality exceeded 100 times the effective dose. Data are presented to support a general chemical design approach that can expand a new lead candidate series for developing next-generation cyanide countermeasures.
Collapse
Affiliation(s)
- Matthew
M. Behymer
- Department
of Industrial and Physical Pharmacy, Purdue
University, 575 Stadium Mall Drive, West Lafayette, Indiana47907, United States
| | - Huaping Mo
- Department
of Medicinal Chemistry and Molecular Pharmacology, Purdue University, 575
Stadium Mall Drive, West Lafayette, Indiana47907, United
States
| | - Naoaki Fujii
- Department
of Medicinal Chemistry and Molecular Pharmacology, Purdue University, 575
Stadium Mall Drive, West Lafayette, Indiana47907, United
States
| | - Vallabh Suresh
- Department
of Medicinal Chemistry and Molecular Pharmacology, Purdue University, 575
Stadium Mall Drive, West Lafayette, Indiana47907, United
States
| | - Adriano Chan
- Department
of Medicine, University of California, San Diego, California92093, United States
| | - Jangweon Lee
- Beckman
Laser Institute and Medical Clinic, Department of Medicine, University of California, Irvine, California92697, United States
| | - Anjali K. Nath
- Department
of Cardiology, Beth Israel Deaconess Medical
Center, Boston, Massachusetts02115, United States
| | - Kusumika Saha
- Division
of Cardiovascular Medicine, Brigham and
Women’s Hospital, Boston, Massachusetts02115, United States
| | - Sari B. Mahon
- Beckman
Laser Institute and Medical Clinic, Department of Medicine, University of California, Irvine, California92697, United States
| | - Matthew Brenner
- Beckman
Laser Institute and Medical Clinic, Department of Medicine, University of California, Irvine, California92697, United States
| | - Calum A. MacRae
- Division
of Cardiovascular Medicine, Brigham and
Women’s Hospital, Boston, Massachusetts02115, United States
| | - Randall Peterson
- Department
of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake
City, Utah84112, United States
| | - Gerry R. Boss
- Department
of Medicine, University of California, San Diego, California92093, United States
| | - Gregory T. Knipp
- Department
of Industrial and Physical Pharmacy, Purdue
University, 575 Stadium Mall Drive, West Lafayette, Indiana47907, United States
| | - Vincent Jo Davisson
- Department
of Medicinal Chemistry and Molecular Pharmacology, Purdue University, 575
Stadium Mall Drive, West Lafayette, Indiana47907, United
States,
| |
Collapse
|
7
|
Datta PK, Roy Chowdhury S, Aravindan A, Saha S, Rapaka S. Medical and Surgical Care of Critical Burn Patients: A Comprehensive Review of Current Evidence and Practice. Cureus 2022; 14:e31550. [PMID: 36540501 PMCID: PMC9754771 DOI: 10.7759/cureus.31550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/16/2022] Open
Abstract
Critically ill burn patients pose several unique challenges to care providers. The concepts of fluid resuscitation, nutritional management, organ support and wound care are rapidly evolving. There is a pressing need to review emerging evidence and incorporate these into practice for the effective management of burn patients. We have searched the PubMed and Google Scholar databases to review the current evidence on the acute care management of adult as well as paediatric burn patients. The rationales for current practices have been integrated into the review. The management of critically ill burn patients requires an in-depth knowledge of the pathophysiology of burn injury, a tailored approach for timely resuscitation, timely diagnosis of organ specific problems, and comprehensive wound care. This review will help the doctors and healthcare providers involved in the management of critical burn patients in their day-to-day practice.
Collapse
Affiliation(s)
- Priyankar K Datta
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Sumit Roy Chowdhury
- Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Ajisha Aravindan
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Shivangi Saha
- Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Sriharsha Rapaka
- Critical Care Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| |
Collapse
|
8
|
Gretarsdottir J, Lambert IH, Sturup S, Suman SG. In Vitro Characterization of a Threonine-Ligated Molybdenyl-Sulfide Cluster as a Putative Cyanide Poisoning Antidote; Intracellular Distribution, Effects on Organic Osmolyte Homeostasis, and Induction of Cell Death. ACS Pharmacol Transl Sci 2022; 5:907-918. [PMID: 36268119 PMCID: PMC9578141 DOI: 10.1021/acsptsci.2c00093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Indexed: 11/28/2022]
Abstract
Binuclear molybdenum sulfur complexes are effective for the catalytic conversion of cyanide into thiocyanate. The complexes themselves exhibit low toxicity and high aqueous solubility, which render them suitable as antidotes for cyanide poisoning. The binuclear molybdenum sulfur complex [(thr)Mo2O2(μ-S)2(S2)]- (thr - threonine) was subjected to biological studies to evaluate its cellular accumulation and mechanism of action. The cellular uptake and intracellular distribution in human alveolar (A549) cells, quantified by inductively coupled plasma mass spectrometry (ICP-MS) and cell fractionation methods, revealed the presence of the compound in cytosol, nucleus, and mitochondria. The complex exhibited limited binding to DNA, and using the expression of specific protein markers for cell fate indicated no effect on the expression of stress-sensitive channel components involved in cell volume regulation, weak inhibition of cell proliferation, no increase in apoptosis, and even a reduction in autophagy. The complex is anionic, and the sodium complex had higher solubility compared to the potassium. As the molybdenum complex possibly enters the mitochondria, it is considered as a promising remedy to limit mitochondrial cyanide poisoning following, e.g., smoke inhalation injuries.
Collapse
Affiliation(s)
| | - Ian H. Lambert
- Department
of Biology, University of Copenhagen, Universitetsparken 13, 2100 Copenhagen Ø, Denmark
| | - Stefan Sturup
- Department
of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark
| | - Sigridur G. Suman
- Science
Institute, University of Iceland, Dunhaga 3, 107 Reykjavik, Iceland
| |
Collapse
|
9
|
Sheckter CC, Mandell S. Say no to cyanokit. Pause at the 10, 10 threshold. Burns 2022; 48:1516-1518. [PMID: 35850879 PMCID: PMC9935086 DOI: 10.1016/j.burns.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Clifford C Sheckter
- Department of Surgery, Stanford University, United States; Regional Burn Center, Santa Clara Valley Medical Center, United States.
| | - Samuel Mandell
- Department of Surgery, University of Texas Southwestern, United States; Parkland Burn Center, United States
| |
Collapse
|
10
|
Indications for Emergent Hyperbaric Oxygen Therapy. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40138-022-00251-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
11
|
Cyanide Anion Determination Based on Nucleophilic Addition to 6-[(E)-(4-Nitrophenyl)diazenyl]-1′,3,3′,4-tetrahydrospiro[chromene-2,2′-indole] Derivatives. CHEMOSENSORS 2022. [DOI: 10.3390/chemosensors10050185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
This work provides a novel approach for the instant detection of CN− anions based on chromogenic 6-[(E)-(4-nitrophenyl)diazenyl]-1′,3,3′,4-tetrahydrospiro[chromene-2,2′-indole] derivatives. New colorimetric detectors were synthesized and characterized. These compounds exhibited a substantial color change from orange to magenta and blue when treated with cyanide ions in a CH3CN solution buffered with sodium phosphate and demonstrated high selectivity to CN− anions. Common anions were tested, and they did not interfere with cyanide detection, except for carbonates and hydrosulfites. The simple preparation of a molecular sensor and the easily noticeable color change makes this a practical system for the monitoring of CN− ions. This color change is explained by nucleophilic substitution of the pyrane ring oxygen atom at the indoline C-2 atom by the cyanide anion. This generates the appearance of intensively colored 4-(4-nitrophenylazo)phenolate chromophore and allows for determining very low levels of CN− anion.
Collapse
|
12
|
Evaluation of Hydrogen Cyanide in the Blood of Fire Victims Based on the Kinetics of the Reaction with Ninhydrin. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An original kinetic spectrophotometric procedure was developed for the determination of hydrogen cyanide (HCN) in the whole blood of fire victims. Cyanide poisoning by smoke inhalation is common in forensic medicine, but the blood HCN of fire victims has not been studied in detail so far. In this research project, we developed a simple, fast, sensitive, and selective quantification method for both free and metabolized HCN based on the kinetics of cyanide reaction with ninhydrin. The method was linear in range, from 0.26 to 2.6 μg mL−1, with a coefficient of determination of r = 0.994. A high molar absorptivity of 4.95 × 105 L mol−1 cm−1 was calculated under the reaction conditions. The limit of quantification was 0.052 μg mL−1; the detection limit was 0.012 μg mL−1 and the standard error was ±2.7%. This micro method proved to be accurate, sensitive, and selective and has been successfully applied to the analysis of blood samples, allowing rapid monitoring of blood cyanide in several fire victims.
Collapse
|
13
|
Sanders KN, Aggarwal J, Stephens JM, Michalopoulos SN, Dalton D, Lewis DE, Kahn SA. Cost impact of hydroxocobalamin in the treatment of patients with known or suspected cyanide poisoning due to smoke inhalation from closed-space fires. Burns 2021; 48:1325-1330. [PMID: 34903402 DOI: 10.1016/j.burns.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND & OBJECTIVES Cyanide poisoning can occur due to exposure to smoke in closed-space fires. With no point of care cyanide test at the scene of a fire, first responders and clinicians base decisions to treat with cyanide antidote on patient history, clinical signs, and other indirect data points that have not been proven to correspond with actual systemic levels of cyanide. The aim of this exploratory study was to determine the economic implications of treating patients with known or suspected cyanide poisoning due to smoke inhalation with hydroxocobalamin. METHODS A decision analysis model was developed from the US hospital perspective. Healthcare resource utilization was estimated from a retrospective evaluation of clinical outcomes in hydroxocobalamin-treated patients and in historical controls without hydroxocobalamin use (Nguyen, et al. 2017). Epidemiologic parameters and costs were estimated from the published literature, and publicly-available hospital charges were identified. Outcomes reported in the analysis included expected healthcare resource utilization in the US population and per-patient costs with and without the use of hydroxocobalamin. A cost-to-charge ratio was applied so that all costs would reflect hospital costs rather than hospital charges. Deterministic sensitivity analysis was performed to identify the most influential model parameters. All costs were reported in 2017 US dollars. RESULTS Use of hydroxocobalamin reduces healthcare resource utilization and contributes to decreased per-patient hospital costs ($15,381 with hydroxocobalamin treatment versus $22,607 with no cyanide antidote). The most substantive cost-savings resulted from decreased hospital length of stay (i.e., intensive care unit [ICU] and non-ICU). Costs attributed to mechanical ventilation also decreased with use of hydroxocobalamin. A univariate sensitivity analysis demonstrated that the most impactful variables in the cost analysis were related to hospital length of stay (ICU followed by non-ICU stay), followed by the daily cost of ICU stay. CONCLUSIONS Use of hydroxocobalamin in patients with known or suspected cyanide poisoning from closed-space fire smoke inhalation may decrease hospital costs and contribute to more efficient healthcare resource utilization.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Steven A Kahn
- Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
14
|
Engwall A, Blache A, Lintner A, Bright A, Kahn S. Hydroxocobalamin Administration After Inhalation Injury Is Not Associated With Mesenteric Ischemia. ANNALS OF BURNS AND FIRE DISASTERS 2021; 34:240-244. [PMID: 34744539 PMCID: PMC8534304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/27/2021] [Indexed: 06/13/2023]
Abstract
Hydroxocobalamin has been administered in the United States since 2006 by first responders and burn centers as a safe antidote for cyanide toxicity, a serious complication of smoke inhalation. There are no current contraindications to the use of this rescue measure. A recent retrospective French publication reported a potential correlation between hydroxcobalamin administration and acute mesenteric ischemia (AMI) in critically ill burn and inhalation injury patients. The purpose of this study is to characterize the risk of AMI related to hydroxocobalamin. A retrospective review of hydroxocobalamin administration among adult burn patients was conducted at a regional burn center over a 2-year period. Injury characteristics, demographics, and outcomes including presence of mesenteric ischemia (defined as presence of pneumatosis or perforation on CT scan or necrotic bowel on laparotomy) were recorded. Of 17 confirmed inhalation injuries, patients had a median (interquartile range) age, total body surface area (TBSA), and abbreviated burn severity (ABSI) index as follows: 60 (45, 65 IQR), 8.5 (1.8, 39 IQR), and 6 (5,7 IQR). Inhalation injury was diagnosed with bronchoscopy, carboxyhemoglobin, or clinical suspicion. Eighty-two percent of those with bronchoscopy had an inhalation grade of 2 or greater. None (0%) of the patients showed signs of mesenteric ischemia, tube feeding intolerance, pneumatosis/perforation on CT, or necrotic bowel on laparotomy. Aware of the study limitations, we conclude that hydroxocobalamin does not increase risk for AMI.
Collapse
Affiliation(s)
- A.J. Engwall
- Michigan State University, Lansing, Michigan, USA
| | - A. Blache
- University of South Alabama, Mobile, Alabama, USA
| | - A. Lintner
- University of South Alabama, Mobile, Alabama, USA
| | - A. Bright
- University of South Alabama, Mobile, Alabama, USA
| | - S. Kahn
- Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
15
|
Hon KL, Hui WF, Leung AK. Antidotes for childhood toxidromes. Drugs Context 2021; 10:dic-2020-11-4. [PMID: 34122588 PMCID: PMC8177957 DOI: 10.7573/dic.2020-11-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background Poisoning causes significant morbidity and sometimes mortality in children worldwide. The clinical skill of toxidrome recognition followed by the timely administration of an antidote specific for the poison is essential for the management of children with suspected poisoning. This is a narrative review on antidotes for toxidromes in paediatric practice. Methods A literature search was conducted on PubMed with the keywords “antidote”, “poisoning”, “intoxication”, “children” and “pediatric”. The search was customized by applying the appropriate filters (species: humans; age: birth to 18 years) to obtain the most relevant articles for this review article. Results Toxidrome recognition may offer a rapid guide to possible toxicology diagnosis such that the specific antidote can be administered in a timely manner. This article summarizes toxidromes and their respective antidotes in paediatric poisoning, with an emphasis on the symptomatology and source of exposure. The antidote and specific management for each toxidrome are discussed. Antidotes are only available for a limited number of poisons responsible for intoxication. Antidotes for common poisonings include N-acetyl cysteine for paracetamol and sodium thiosulphate for poisoning by cyanide. Conclusion Poisoning is a common cause of paediatric injury. Physicians should be familiar with the recognition of common toxidromes and promptly use specific antidotes for the management of childhood toxidromes.
Collapse
Affiliation(s)
- Kam Lun Hon
- Department of a Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
| | - Wun Fung Hui
- Department of a Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
| | - Alexander Kc Leung
- Department of Pediatrics, The University of Calgary and The Alberta Children's Hospital, Calgary, Alberta, Canada
| |
Collapse
|
16
|
Gretarsdottir JM, Jonsdottir S, Lewis W, Hambley TW, Suman SG. Water-Soluble α-Amino Acid Complexes of Molybdenum as Potential Antidotes for Cyanide Poisoning: Synthesis and Catalytic Studies of Threonine, Methionine, Serine, and Leucine Complexes. Inorg Chem 2020; 59:18190-18204. [PMID: 33249838 DOI: 10.1021/acs.inorgchem.0c02672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Water-soluble complexes are desirable for the aqueous detoxification of cyanide. Molybdenum complexes with α-amino acid and disulfide ligands with the formula K[(L)Mo2O2(μ-S)2(S2)] (L = leu (1), met (2), thr (3), and ser (4)) were synthesized in a reaction of [(DMF)3MoO(μ-S)2(S2)] with deprotonated α-amino acids; leu, met, thr, and ser are the carboxylate anions of l-leucine, l-methionine, l-threonine, and l-serine, respectively. Potassium salts of α-amino acids (leu (1a), met (2a), thr (3a), and ser (4a)) were prepared as precursors for complexes 1-4, respectively, by employing a nonaqueous synthesis route. The ligand exchange reaction of [Mo2O2(μ-S)2(DMF)6](I)2 with deprotonated α-amino acids afforded bis-α-amino acid complexes, [(L)2Mo2O2(μ-S)2] (6-8). A tris-α-amino acid complex, [(leu)2Mo2O2(μ-S)2(μ-leu + H)] (5; leu + H is the carboxylate anion of l-leucine with the amine protonated), formed in the reaction with leucine. 5 crystallized from methanol with a third weakly bonded leucine as a bridging bidentate carboxylate. An adduct of 8 with SCN- coordinated, 9, crystallized and was structurally characterized. Complexes 1-4 are air stable and highly water-soluble chiral molecules. Cytotoxicity studies in the A549 cell line gave IC50 values that range from 80 to 400 μM. Cyclic voltammetry traces of 1-8 show solvent-dependent irreversible electrochemical behavior. Complexes 1-4 demonstrated the ability to catalyze the reaction of thiosulfate and cyanide in vitro to exhaustively transform cyanide to thiocyanate in less than 1 h.
Collapse
Affiliation(s)
| | | | - William Lewis
- School of Chemistry, The University of Sydney, Sydney, NSW 2006, Australia
| | - Trevor W Hambley
- School of Chemistry, The University of Sydney, Sydney, NSW 2006, Australia
| | - Sigridur G Suman
- Science Institute, University of Iceland, Dunhagi 3, 107 Reykjavik, Iceland
| |
Collapse
|
17
|
Kranioti EF, Nathena D, Spanakis K, Karantanas A, Bouhaidar R, McLaughlin S, Thali MJ, Ampanozi G. Unenhanced PMCT in the diagnosis of fatal traumatic brain injury in a charred body. J Forensic Leg Med 2020; 77:102093. [PMID: 33316735 DOI: 10.1016/j.jflm.2020.102093] [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: 06/16/2020] [Revised: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
Traffic incidents are one of the most frequent causes of death in young adults worldwide. Depending on the location of the incident, the velocity of the vehicle(s), the weather condition, traffic incidents are often complicated making the investigation of the circumstances difficult. Here we report a case of an incinerated body involved in a vehicle incident. Differential diagnosis included natural cause of death during driving, fatal traumatic injuries, death due to fire and positional asphyxia. The body was submitted to PMCT prior to autopsy as part of a research protocol (N. 1388/2016) at the Department of Medical Imaging of the University Hospital of Heraklion in Crete, Greece. Unenhanced PMCT revealed craniofacial fractures, a thin film of subdural haemorrhage and an epidural fluid collection. The findings were interpreted as consistent with an impact to the face, causing craniofacial fractures mainly on the right side, and an acute subdural hematoma. Autopsy findings corroborated the diagnosis. The epidural hematoma was deemed to be post-mortem heat-induced. This case is an excellent example of the diagnostic value of PMCT in the medicolegal investigation of death.
Collapse
Affiliation(s)
- Elena F Kranioti
- Forensic Medicine Unit, Department of Forensic Sciences, Medical School, University of Crete, Heraklion, Greece; Edinburgh Forensic Radiology and Anthropology Imaging Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
| | - Despoina Nathena
- Forensic Medicine Unit, Department of Forensic Sciences, Medical School, University of Crete, Heraklion, Greece.
| | | | - Apostolos Karantanas
- Department of Medical Imaging, Heraklion University Hospital, Heraklion, Greece.
| | - Ralph Bouhaidar
- Division of Forensic Pathology, Medical School, University of Edinburgh, UK; Edinburgh Forensic Radiology and Anthropology Imaging Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
| | - Siobhan McLaughlin
- Edinburgh Forensic Radiology and Anthropology Imaging Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
| | - Michael J Thali
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
| | - Garyfalia Ampanozi
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
| |
Collapse
|
18
|
Chao KY, Lin YW, Chiang CE, Tseng CW. Respiratory Management in Smoke Inhalation Injury. J Burn Care Res 2020; 40:507-512. [PMID: 30893426 DOI: 10.1093/jbcr/irz043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Smoke inhalation injury (SII) is a major morbidity and cause of mortality in patients with burns. Damage caused by inhalation of thermal or chemical irritants, including toxic fumes and chemicals, leads to respiratory cilia and epithelial cell injuries, which turn to severe bronchospasm and alveolar damage and results in acute respiratory distress syndrome. Respiratory management plays a vital role in the treatment of SII. In this review, we provide an overview of SII with emphasis on respiratory management, including aerosol therapy, bronchial hygiene therapy, advanced ventilation modes, and heated humidified high-flow nasal cannula. In summary, the information may be helpful for further improvements in outcomes.
Collapse
Affiliation(s)
- Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Taoyuan, Taiwan
| | - Yu-Wen Lin
- Department of Nursing, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chen-En Chiang
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chi-Wei Tseng
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| |
Collapse
|
19
|
One-Step Assembly of Fluorescence-Based Cyanide Sensors from Inexpensive, Off-The-Shelf Materials. SENSORS 2020; 20:s20164488. [PMID: 32796627 PMCID: PMC7472291 DOI: 10.3390/s20164488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 11/16/2022]
Abstract
We report a simple and versatile approach to assemble sensitive and selective fluorescence “turn-on” sensors for cyanide by combining three off-the-shelf materials; namely fluorescent dye, 1-vinyl imidazole polymer, and cupric chloride. The cyanide-sensing species is a non-fluorescent fluorophore-polymer-Cu2+ complex; which forms as a result of the imidazole polymer’s ability to bind both fluorophore and fluorescence quencher (Cu2+). Cyanide removes Cu2+ from these complexes; thereby “turning-on” sensor fluorescence. These sensors are water-soluble and have a detection limit of ~2.5 μM (CN−) in water. Our ternary complex-based sensing approach also enables facile emission tuning; we demonstrate the convenient, synthesis-free preparation of blue and green-emitting sensors using distyrylbiphenyl and fluorescein fluorophores, respectively. Furthermore; these ternary complexes are easily immobilized using agarose to create cyanide-sensing hydrogels; which are then used in a simple; novel microdiffusion apparatus to achieve interference-free cyanide analysis of aqueous media. The present study provides an inexpensive approach for portable; interference-free cyanide detection.
Collapse
|
20
|
Suman SG, Gretarsdottir JM, Penwell PE, Gunnarsson JP, Frostason S, Jonsdottir S, Damodaran KK, Hirschon A. Reaction Chemistry of the syn-[Mo 2O 2(μ-S) 2(S 2)(DMF) 3] Complex with Cyanide and Catalytic Thiocyanate Formation. Inorg Chem 2020; 59:7644-7656. [PMID: 32401019 DOI: 10.1021/acs.inorgchem.0c00608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Removal of cyanide as nontoxic thiocyanate under physiological conditions may serve as a catalytic detoxification route in vivo. Aqueous catalytic reaction conditions were explored where at the conditions employed the reaction proceeded to exhaustion in 1 h. The complex, syn-[Mo2O2(μ-S)2(S2)(DMF)3] 1, participates in a ligand exchange reaction of the dimethylformamide ligands and cyanide. Simultaneous sulfur abstraction reaction from the terminal disulfide group forms thiocyanate and terminal sulfido ligand. Respective reaction rates for the two reactions appear competitive where different products were isolated solely based on change of reaction temperature. The approach to determine the number of cyanide ligands participating in the ligand exchange reaction by varying the stoichiometry and reaction temperature led to identification and isolation of tetranuclear complexes 2 and 5 and dinuclear complexes 3, 4, and 6. A synthesized and fully characterized thiocyanate analog of 6 (7) supports spectroscopic characterization of 6. The tetranuclear anion, [Mo4O4(μ-S)6(CN)4]4-, 2, was crystallized from a reaction at ambient temperature. The dinuclear anion, [Mo2O2(μ-S)2(S)(CN)3]3-, 3, was crystallized from similar reaction conditions at lower temperature. The reaction yield of thiocyanate obtained at pH of 7.4 and at 9.2 as a function of time, for several ratios of cyanide, favors the sulfur abstraction reaction at elevated pH. The sulfur abstraction reaction is the first step in a proposed mechanism of the reaction of cyanide and thiosulfate to form thiocyanate and sulfite by 1.
Collapse
Affiliation(s)
- Sigridur G Suman
- Science Institute, University of Iceland, Dunhagi 3, 107 Reykjavik, Iceland.,Chemical Science and Technology Laboratory, Physical Sciences Division, SRI International, 333 Ravenswood Avenue, Menlo Park, California 94025, United States
| | | | - Paul E Penwell
- Chemical Science and Technology Laboratory, Physical Sciences Division, SRI International, 333 Ravenswood Avenue, Menlo Park, California 94025, United States
| | - Jon P Gunnarsson
- Science Institute, University of Iceland, Dunhagi 3, 107 Reykjavik, Iceland
| | - Sindri Frostason
- Science Institute, University of Iceland, Dunhagi 3, 107 Reykjavik, Iceland
| | | | | | - Albert Hirschon
- Chemical Science and Technology Laboratory, Physical Sciences Division, SRI International, 333 Ravenswood Avenue, Menlo Park, California 94025, United States
| |
Collapse
|
21
|
Geslain G, Tilea B, Heraut F, Rubinsztajn R. Smoke inhalation injury in a 2-year-old domestic fire victim. Arch Pediatr 2020; 27:223-226. [PMID: 32192813 DOI: 10.1016/j.arcped.2020.01.008] [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: 12/20/2018] [Revised: 11/06/2019] [Accepted: 01/25/2020] [Indexed: 11/15/2022]
Abstract
Smoke inhalation injury is common in victims of domestic fires, among whom children are the most vulnerable. Cyanide poisoning may occur in addition to carbon monoxide poisoning and is challenging to diagnose. In France, the recommended antidotes are hydroxocobalamin for cyanide and hyperbaric oxygen for carbon monoxide. We managed a 26-month-old girl who sustained smoke inhalation injury with both carbon monoxide and cyanide poisoning during a house fire. Despite hydroxocobalamin and sodium thiosulfate therapy combined with hyperbaric oxygen, she had residual neurological impairments 3 months after the injury. The treatment challenges and detailed neurological follow-up data are described.
Collapse
Affiliation(s)
- G Geslain
- Pediatric Intensive Care Unit, Raymond-Poincaré Hospital, AP-HP, 92380 Garches, France.
| | - B Tilea
- Radiology, Robert-Debré Hospital, AP-HP, 75019 Paris, France
| | - F Heraut
- Physiological Explorations, Raymond-Poincaré Hospital, AP-HP, 92380 Garches, France
| | - R Rubinsztajn
- Pediatric Intensive Care Unit, Raymond-Poincaré Hospital, AP-HP, 92380 Garches, France
| |
Collapse
|
22
|
Abstract
A middle-aged patient presented with toxic inhalational injury, and was resuscitated prehospitally and treated in the emergency department for smoke inhalation, carbon monoxide (CO) exposure and cyanide poisoning with the use of antidotes. Due to the CO effects on spectrophotometry, an anaemia initially identified on blood gas analysis was thought to be artefactual, but was later confirmed by laboratory testing to be accurate. In addition, cyanide can confound haemoglobin testing due to its use in the analytical process and non-cyanide analysis is required when there is suspected exposure. Although no consensus exists on a first-line cyanide antidote choice, hydroxocobalamin is the only antidote without a serious side effect profile and/or deleterious cardiovascular effects. We propose prehospital enhanced care teams consider carrying hydroxocobalamin for early administration in toxic inhalational injury.
Collapse
Affiliation(s)
| | - Jake Turner
- Department of Anaesthesia, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Michael Greenway
- Department of Anaesthesia, Royal Stoke University Hospital, Stoke-on-Trent, UK
| |
Collapse
|
23
|
Dépret F, Hoffmann C, Daoud L, Thieffry C, Monplaisir L, Creveaux J, Annane D, Parmentier E, Mathieu D, Wiramus S, Demeure DIt Latte D, Kpodji A, Textoris J, Robin F, Klouche K, Pontis E, Schnell G, Barbier F, Constantin JM, Clavier T, du Cheyron D, Terzi N, Sauneuf B, Guerot E, Lafon T, Herbland A, Megarbane B, Leclerc T, Mallet V, Pirracchio R, Legrand M. Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:421. [PMID: 31870461 PMCID: PMC6929494 DOI: 10.1186/s13054-019-2706-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/16/2019] [Indexed: 11/10/2022]
Abstract
Background The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored. Methods We conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models. Results Among 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively. Conclusion Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation. Trial registration ClinicalTrials.gov, NCT03558646
Collapse
Affiliation(s)
- François Dépret
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, GH Saint Louis-Lariboisière, Paris, France.,UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,F-CRIN, INICRCT network, Paris, France.,Paris Diderot University, F-75475, Paris, France
| | - Clément Hoffmann
- Burn Center, Percy Military Teaching Hospital, BP 406, 101, avenue Henri-Barbusse, 92141, Clamart CEDEX, France
| | - Laura Daoud
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, GH Saint Louis-Lariboisière, Paris, France
| | - Camille Thieffry
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, F-59037, Lille CEDEX, France
| | - Laure Monplaisir
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, GH Saint Louis-Lariboisière, Paris, France
| | - Jules Creveaux
- Burn Center, Percy Military Teaching Hospital, BP 406, 101, avenue Henri-Barbusse, 92141, Clamart CEDEX, France
| | - Djillali Annane
- General ICU, Service de Réanimation, Hôpital Raymond Poincaré, Laboratory of Infection and Inflammation, U1173, AP-HP, University of Versailles SQY and INSERM, 104 Boulevard Raymond Poincaré, 92380, Garches, France
| | - Erika Parmentier
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, F-59037, Lille CEDEX, France
| | - Daniel Mathieu
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, F-59037, Lille CEDEX, France
| | - Sandrine Wiramus
- Centre de traitement des grands brûlés Hopital de la Conception APHM, 147 boulevard Baille, 13005, Marseille, France
| | | | - Aubin Kpodji
- Centre de traitement des grands brûlés Hopital de Mercy,1 Allée du Château, 57245 Ars-Laquenexy-C.H.R Metz-, Thionville, France
| | - Julien Textoris
- Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon-Université Claude Bernard Lyon 1, Lyon, France
| | - Florian Robin
- Anesthesiology and Critical Care Medicine, CHU Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Kada Klouche
- Intensive Care Medicine Department, University of Montpellier Lapeyronie Hospital, 371, Av Doyen Gaston Giraud, 34295, Montpellier, France
| | - Emmanuel Pontis
- Intensive Care Medicine Department, CHU de Rennes, 2 rue Henri Le Guilloux, 35033, Rennes CEDEX 9, France
| | - Guillaume Schnell
- Service de réanimation médico-chirurgicale, Groupe Hospitalier du Havre-Hôpital Jacques Monod, Montivilliers, France
| | - François Barbier
- Medical Intensive Care Unit, La Source Hospital, CHR Orléans, Orléans, France
| | - Jean-Michel Constantin
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Thomas Clavier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France.,Normandie Univ, UNIROUEN, INSERM U1096, Rouen, France
| | - Damien du Cheyron
- Medical Intensive Care Unit, Caen University Hospital, Avenue côte de Nacre, 14033, Caen CEDEX, France
| | - Nicolas Terzi
- Service de Réanimation Médicale, Centres Hospitaliers Universitaires Grenoble Alpes, Grenoble, France
| | - Bertrand Sauneuf
- Service de Réanimation Médicale Polyvalente, Centre Hospitalier Public du Cotentin, BP 208, 50102, Cherbourg-Octeville, France
| | - Emmanuel Guerot
- Service de Réanimation Médicale, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Thomas Lafon
- Département des urgences, service des urgences, SAMU, CHU de Limoges, 87042, Limoges CEDEX, France.,Inserm CIC 1435, 87042, Limoges, France
| | | | - Bruno Megarbane
- Service de réanimation médicale et toxicologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Vincent Mallet
- Service d'hépato gastro entérologie Hôpital Cochin, hépato Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Pirracchio
- Department of Anesthesia and perioperative care, University of California San Francisco, San Francisco, USA
| | - Matthieu Legrand
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, GH Saint Louis-Lariboisière, Paris, France. .,UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France. .,F-CRIN, INICRCT network, Paris, France. .,Burn Center, Percy Military Teaching Hospital, BP 406, 101, avenue Henri-Barbusse, 92141, Clamart CEDEX, France. .,Department of Anesthesiology and Perioperative care Parnassus hospital, UCSF, San Francisco, USA.
| |
Collapse
|
24
|
Weitgasser L, Ihra G, Schäfer B, Markstaller K, Radtke C. Update on hyperbaric oxygen therapy in burn treatment. Wien Klin Wochenschr 2019; 133:137-143. [PMID: 31701218 DOI: 10.1007/s00508-019-01569-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 06/26/2019] [Accepted: 10/14/2019] [Indexed: 12/21/2022]
Abstract
Hyperbaric oxygen therapy (HBOT) has been shown to improve tissue hypoxia, neovascularization and ischemia reperfusion injury and reduce pathologic inflammation in various clinical settings and was proposed to be a game changer in treatment of burns. Improved and faster wound healing as well as a reduction of morbidity and mortality after thermal and concomitant carbon monoxide poisoning are expected. In defiance of the observed benefits for burn wounds and carbon monoxide poisoning in animal models and few randomized controlled trials there is an ongoing controversy regarding its use, indications and cost effectiveness. Furthermore, the use of HBOT, its indications and the evidence behind its efficiency are still widely unknown to most physicians involved in the treatment of burn patients. Therefore, a review of the up to date evidence-based literature was performed with a focus on available data of HBOT in burn care, to elaborate its use in acute thermal injury and carbon monoxide intoxication. Although beneficial effects of HBOT seem very likely insufficient evidence to support or disprove the routine use of HBOT in the treatment of burn care was found. Although difficult to carry out because of the high interindividual variability of burns and chronic wounds, the need for larger high-quality prospective randomized double-blinded controlled multicenter trials are necessary to be able to evaluate useful applications, expense and cost-efficiency of HBOT for burn care.
Collapse
Affiliation(s)
- Laurenz Weitgasser
- Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Gerald Ihra
- Department of Anesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Bruno Schäfer
- Department of Anesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Klaus Markstaller
- Department of Anesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christine Radtke
- Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| |
Collapse
|
25
|
Htike TT, Moriya F, Miyaishi S. Cyanide concentrations in blood and tissues of fire victims. Leg Med (Tokyo) 2019; 41:101628. [DOI: 10.1016/j.legalmed.2019.101628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/29/2019] [Accepted: 10/10/2019] [Indexed: 01/16/2023]
|
26
|
Gorgun MF, Zhuo M, Dineley KT, Englander EW. Elevated Neuroglobin Lessens Neuroinflammation and Alleviates Neurobehavioral Deficits Induced by Acute Inhalation of Combustion Smoke in the Mouse. Neurochem Res 2019; 44:2170-2181. [PMID: 31420834 DOI: 10.1007/s11064-019-02856-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/03/2019] [Accepted: 08/05/2019] [Indexed: 12/11/2022]
Abstract
Acute inhalation of combustion smoke produces long-term neurologic deficits in survivors. To study the mechanisms that contribute to the development of neurologic deficits and identify targets for prevention, we developed a mouse model of acute inhalation of combustion smoke, which supports longitudinal investigation of mechanisms that underlie the smoke induced inimical sequelae in the brain. Using a transgenic mouse engineered to overexpress neuroglobin, a neuroprotective oxygen-binding globin protein, we previously demonstrated that elevated neuroglobin preserves mitochondrial respiration and attenuates formation of oxidative DNA damage in the mouse brain after smoke exposure. In the current study, we show that elevated neuronal neuroglobin attenuates the persistent inflammatory changes induced by smoke exposure in the mouse brain and mitigates concordant smoke-induced long-term neurobehavioral deficits. Specifically, we found that increases in hippocampal density of GFAP and Iba-1 positive cells that are detected post-smoke in wild-type mice are absent in the neuroglobin overexpressing transgenic (Ngb-tg) mice. Similarly, the smoke induced hippocampal myelin depletion is not observed in the Ngb-tg mice. Importantly, elevated neuroglobin alleviates behavioral and memory deficits that develop after acute smoke inhalation in the wild-type mice. Taken together, our findings suggest that the protective effects exerted by neuroglobin in the brains of smoke exposed mice afford protection from long-term neurologic sequelae of acute inhalation of combustion smoke. Our transgenic mouse provides a tool for assessing the potential of elevated neuroglobin as possible strategy for management of smoke inhalation injury.
Collapse
Affiliation(s)
- Murat F Gorgun
- Department of Surgery, Medical Branch, University of Texas, 301 University Boulevard, Galveston, TX, 77555, USA
| | - Ming Zhuo
- Department of Surgery, Medical Branch, University of Texas, 301 University Boulevard, Galveston, TX, 77555, USA
| | - Kelly T Dineley
- Department of Neurology, University of Texas Medical Branch, Galveston, TX, USA
- Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch, Galveston, TX, USA
- Center for Addiction Research, University of Texas Medical Branch, Galveston, TX, USA
| | - Ella W Englander
- Department of Surgery, Medical Branch, University of Texas, 301 University Boulevard, Galveston, TX, 77555, USA.
- Shriners Hospitals for Children, Galveston, TX, USA.
| |
Collapse
|
27
|
Yan TT, Lin GA, Wang MJ, Lamkowski A, Port M, Rump A. Pharmacological treatment of inhalation injury after nuclear or radiological incidents: The Chinese and German approach. Mil Med Res 2019; 6:10. [PMID: 30961671 PMCID: PMC6454727 DOI: 10.1186/s40779-019-0200-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/25/2019] [Indexed: 12/20/2022] Open
Abstract
Inhalation injury is often associated with burns and significantly increases morbidity and mortality. The main toxic components of fire smoke are carbon monoxide, hydrogen cyanide, and irritants. In the case of an incident at a nuclear power plant or recycling facility associated with fire, smoke may also contain radioactive material. Medical treatments may vary in different countries, and in this paper, we discuss the similarities and differences in the treatments between China and Germany. Carbon monoxide poisoning is treated by 100% oxygen administration and, if available, hyperbaric oxygenation in China as well as in Germany. In addition, antidotes binding the cyanide ions and relieving the respiratory chain are important. Methemoglobin-forming agents (e.g., nitrites, dimethylaminophenol) or hydroxocobalamin (Vitamin B12) are options. The metabolic elimination of cyanide may be enhanced by sodium thiosulfate. In China, sodium nitrite with sodium thiosulfate is the most common combination. The use of dimethylaminophenol instead of sodium nitrite is typical for Germany, and hydroxocobalamin is considered the antidote of choice if available in cases of cyanide intoxications by fire smoke inhalation as it does not further reduce oxygen transport capacity. Systematic prophylactic use of corticosteroids to prevent toxic pulmonary edema is not recommended in China or Germany. Stable iodine is indicated in the case of radioiodine exposure and must be administered within several hours to be effective. The decorporation of metal radionuclides is possible with Ca (DTPA) or Prussian blue that should be given as soon as possible. These medications are used in both countries, but it seems that Ca (DTPA) is administered at lower dosages in China. Although the details of the treatment of inhalation injury and radionuclide(s) decorporation may vary, the general therapeutic strategy is very similar in China and Germany.
Collapse
Affiliation(s)
- Tian-Tian Yan
- Military Burn Center, the 990th Hospital of the Joint Logistics Support Forces of Chinese PLA (the 159th Hospital of Chinese PLA), Zhumadian, 463000, Henan, China.
| | - Guo-An Lin
- Military Burn Center, the 990th Hospital of the Joint Logistics Support Forces of Chinese PLA (the 159th Hospital of Chinese PLA), Zhumadian, 463000, Henan, China
| | - Min-Jie Wang
- Military Burn Center, the 990th Hospital of the Joint Logistics Support Forces of Chinese PLA (the 159th Hospital of Chinese PLA), Zhumadian, 463000, Henan, China
| | | | - Matthias Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Alexis Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany
| |
Collapse
|
28
|
Tambasco N, Romoli M, Calabresi P. Selective basal ganglia vulnerability to energy deprivation: Experimental and clinical evidences. Prog Neurobiol 2018; 169:55-75. [DOI: 10.1016/j.pneurobio.2018.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/24/2018] [Accepted: 07/27/2018] [Indexed: 02/07/2023]
|
29
|
Gupta K, Mehrotra M, Kumar P, Gogia AR, Prasad A, Fisher JA. Smoke Inhalation Injury: Etiopathogenesis, Diagnosis, and Management. Indian J Crit Care Med 2018; 22:180-188. [PMID: 29657376 PMCID: PMC5879861 DOI: 10.4103/ijccm.ijccm_460_17] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Smoke inhalation injury is a major determinant of morbidity and mortality in fire victims. It is a complex multifaceted injury affecting initially the airway; however, in short time, it can become a complex life-threatening systemic disease affecting every organ in the body. In this review, we provide a summary of the underlying pathophysiology of organ dysfunction and provide an up-to-date survey of the various critical care modalities that have been found beneficial in caring for these patients. Major pathophysiological change is development of edema in the respiratory tract. The tracheobronchial tree is injured by steam and toxic chemicals, leading to bronchoconstriction. Lung parenchyma is damaged by the release of proteolytic elastases, leading to release of inflammatory mediators, increase in transvascular flux of fluids, and development of pulmonary edema and atelectasis. Decreased levels of surfactant and immunomodulators such as interleukins and tumor-necrosis-factor-α accentuate the injury. A primary survey is conducted at the site of fire, to ensure adequate airway, breathing, and circulation. A good intravenous access is obtained for the administration of resuscitation fluids. Early intubation, preferably with fiberoptic bronchoscope, is prudent before development of airway edema. Bronchial hygiene is maintained, which involves therapeutic coughing, chest physiotherapy, deep breathing exercises, and early ambulation. Pharmacological agents such as beta-2 agonists, racemic epinephrine, N-acetyl cysteine, and aerosolized heparin are used for improving oxygenation of lungs. Newer agents being tested are perfluorohexane, porcine pulmonary surfactant, and ClearMate. Early diagnosis and treatment of smoke inhalation injury are the keys for better outcome.
Collapse
Affiliation(s)
- Kapil Gupta
- Department of Anaesthesia, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Mayank Mehrotra
- Department of Anesthesia, Integral Institute of Medical Sciences, Lucknow, India
| | - Parul Kumar
- Department of Emergency Medicine, Sinai Health Systems, Chicago, USA
| | - Anoop Raj Gogia
- Department of Anaesthesia, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Arun Prasad
- Department of Anaesthesia, University Health Network, and University of Toronto, Toronto, Canada
| | - Joseph Arnold Fisher
- Department of Anaesthesia, University Health Network, and University of Toronto, Toronto, Canada
| |
Collapse
|
30
|
Abstract
Smoke inhalation injury can cause severe physiologic perturbations. In pediatric patients, these perturbations cause profound changes in cardiac and pulmonary physiology. In this review, we examine the pathology, early management options, ventilator strategy, and long-term outcomes in pediatric patients who have suffered a smoke inhalation injury.
Collapse
Affiliation(s)
- Soman Sen
- Division of Burn Surgery, Department of Surgery, University of California Davis, Shriners Hospital for Children Northern California, Sacramento, USA
| |
Collapse
|
31
|
Purvis M, Rooks H, Young Lee J, Longerich S, Kahn S. Prehospital hydroxocobalamin for inhalation injury and cyanide toxicity in the United States - analysis of a database and survey of ems providers. ANNALS OF BURNS AND FIRE DISASTERS 2017; 30:126-128. [PMID: 29021725 PMCID: PMC5627550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 04/29/2017] [Indexed: 06/07/2023]
Abstract
Prehospital use of hydroxocobalamin as an antidote for cyanide toxicity, a serious complication of smoke inhalation, has yet to be universally adopted in the United States though its efficacy and safety have been demonstrated since 2006. The purpose of this study was to characterize practices of prehospital hydroxocobalamin administration via a survey of emergency medical services (EMS) and to report a case series from an EMS database to track use of hydroxocobalamin. The Fire Smoke Coalition Newsletter emailed a voluntary survey to EMS subscribers regarding hydroxocobalamin use. Survey responses were analyzed in addition to survival data from the Smoke Inhalation Treatment Database (SITD), a publically available, self-reported, online database for EMS regarding smoke inhalation patient outcomes. Analysis was compared to current published data from PubMed. The survey had a 14% response rate (284/2000). Only 38% reported prehospital utilization of a hydrogen cyanide antidote with 46% using hydroxocobalamin. 20% of responders reported a formal ALS protocol was in place for hydroxocobalamin use. For the SITD, 12 of 13 (92%) patients who received hydroxocobalamin for suspected inhalation survived. Other studies found a survival rate of 72% and 42% after administration of hydroxocobalamin for smoke inhalation. Prehospital administration of hydroxocobalamin for cyanide toxicity is uncommon in the United States, as evidenced by this analysis, despite well-documented safety and efficacy. Although a small sample, patients who received prehospital hydroxocobalamin had improved survival. This survival rate is significantly greater than those reported previously.
Collapse
Affiliation(s)
- M.V. Purvis
- Department of Surgery, The University of South Alabama Medical Center, Mobile, USA
| | - H. Rooks
- Department of Surgery, The University of Tennessee Health Science Center, Chattanooga, USA
| | | | - S. Longerich
- Fire Smoke Coalition, Inc., Division of Cyanide Poisoning Treatment Coalition, Indianapolis, USA
| | - S.A. Kahn
- Department of Surgery, The University of South Alabama Medical Center, Mobile, USA
| |
Collapse
|
32
|
O'Driscoll BR, Howard LS, Earis J, Mak V. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax 2017; 72:ii1-ii90. [DOI: 10.1136/thoraxjnl-2016-209729] [Citation(s) in RCA: 316] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/03/2017] [Accepted: 02/12/2017] [Indexed: 12/15/2022]
|
33
|
Trehan K, Rotta S, Gregg SC, Glasgow K, Crombie RE, Cholewczynski WM, Atweh N, Savetamal A. Is Pre-Hospital CPR a Risk Factor for Early Death in Patients Transferred to an Adult Burn Center? J Am Coll Surg 2017; 225:210-215. [PMID: 28522168 DOI: 10.1016/j.jamcollsurg.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 04/21/2017] [Accepted: 05/01/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Burn patients who require CPR before admission to a burn center are anecdotally known to suffer higher mortality than those who do not require pre-hospital CPR. STUDY DESIGN A retrospective chart review identified adult patients admitted to our burn center between 2013 and 2015. Included patients met 1 or both of the following criteria: 20% or more total body surface area burned and need for intubation before admission to our facility. We sought to identify predictors of early death, late death, and survival among burn patients who underwent CPR before admission. RESULTS Of the 80 patients meeting inclusion criteria, 17.5% underwent CPR before arrival at our facility. Seventy-nine percent of these died, compared with 29% of the patients who did not require CPR (p = 0.0005). Seventy-one percent of CPR patients died within 48 hours of admission, compared with 8% of non-CPR patients (p < 0.0001). The major predictor of death vs survival after CPR was lower initial arterial pH. CONCLUSIONS Patients who undergo CPR before transfer to a burn center are at high risk for early death. Predictors of death and early death after CPR may include elevated initial lactate and lower initial arterial pH.
Collapse
Affiliation(s)
- Kanika Trehan
- Connecticut Burn Center, Bridgeport Hospital, Bridgeport, CT; Yale New Haven Hospital, Department of Surgery, Yale School of Medicine, New Haven, CT.
| | - Stacey Rotta
- Connecticut Burn Center, Bridgeport Hospital, Bridgeport, CT; Yale New Haven Hospital, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Shea C Gregg
- Connecticut Burn Center, Bridgeport Hospital, Bridgeport, CT
| | - Kristen Glasgow
- Connecticut Burn Center, Bridgeport Hospital, Bridgeport, CT
| | | | | | - Nabil Atweh
- Connecticut Burn Center, Bridgeport Hospital, Bridgeport, CT
| | - Alisa Savetamal
- Connecticut Burn Center, Bridgeport Hospital, Bridgeport, CT
| |
Collapse
|
34
|
Jackson R, Logue BA. A review of rapid and field-portable analytical techniques for the diagnosis of cyanide exposure. Anal Chim Acta 2017; 960:18-39. [DOI: 10.1016/j.aca.2016.12.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 12/22/2022]
|
35
|
da Silva IRF, Frontera JA. Neurologic complications of acute environmental injuries. HANDBOOK OF CLINICAL NEUROLOGY 2017; 141:685-704. [PMID: 28190442 DOI: 10.1016/b978-0-444-63599-0.00037-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Environmental injuries can result in serious neurologic morbidity. This chapter reviews neurologic complications of thermal burns, smoke inhalation, lightning strikes, electric injury, near drowning, decompression illness, as well as heat stroke and accidental hypothermia. Knowing the pathophysiology and clinical presentation of such injuries is essential to proper management of primary and secondary medical complications. This chapter highlights the most frequently encountered neurologic injuries secondary to common environmental hazards, divided into the topics: injuries related to fire, electricity, water, and the extremes of temperature.
Collapse
Affiliation(s)
- I R F da Silva
- Neurocritical Care Unit, Americas Medical City, Rio de Janeiro, Brazil
| | - J A Frontera
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
36
|
Singh VK, Garcia M, Wise SY, Seed TM. Medical countermeasures for unwanted CBRN exposures: Part I chemical and biological threats with review of recent countermeasure patents. Expert Opin Ther Pat 2016; 26:1431-1447. [DOI: 10.1080/13543776.2017.1233178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Vijay K. Singh
- Department of Pharmacology and Molecular Therapeutics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Melissa Garcia
- Department of Pharmacology and Molecular Therapeutics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Stephen Y. Wise
- Department of Pharmacology and Molecular Therapeutics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | |
Collapse
|
37
|
|
38
|
Leung AMR, Lu JLDP. Environmental Health and Safety Hazards of Indigenous Small-Scale Gold Mining Using Cyanidation in the Philippines. ENVIRONMENTAL HEALTH INSIGHTS 2016; 10:125-31. [PMID: 27547035 PMCID: PMC4978203 DOI: 10.4137/ehi.s38459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 05/23/2023]
Abstract
OBJECTIVES This cross-sectional study aimed at the environmental health hazards at work and cyanide exposure of small-scale gold miners engaged in gold extraction from ores in a mining area in the Philippines. METHODS Methods consisted of structured questionnaire-guided interviews, work process observation tools, physical health assessment by medical doctors, and laboratory examination and blood cyanide determination in the blood samples of 34 indigenous small-scale gold miners from Benguet, Philippines. RESULTS The small-scale gold miners worked for a mean of 10.3 years, had a mean age of 36 years, with mean lifetime mining work hours of 18,564. All were involved in tunneling work (100%) while a considerable number were involved in mixing cyanide with the ore (44%). A considerable number were injured (35%) during the mining activity, and an alarming number (35%) had elevated blood cyanide level. The most prevalent hazard was exposure to chemicals, particularly to cyanide and nitric acid, which were usually handled with bare hands. CONCLUSION The small-scale gold miners were exposed to occupational and environmental hazards at work.
Collapse
Affiliation(s)
- Ana Marie R. Leung
- Medical Doctor and Community Health Practitioner, Cordillera Administrative Region, Philippines
| | - Jinky Leilanie DP. Lu
- Research Professor, Institute of Health Policy and Development Studies, National Institutes of Health, University of the Philippines Manila, Philippines; and Affiliate Faculty, Department of Social Sciences, College of Arts and Sciences, University of the Philippines Manila
| |
Collapse
|
39
|
|
40
|
Rech TH, Boniatti MM, Franke CA, Lisboa T, Wawrzeniak IC, Teixeira C, Maccari JG, Schaich F, Sauthier A, Schifelbain LM, Riveiro DFM, da Fonseca DLO, Berto PP, Marques L, Dos Santos MC, de Oliveira VM, Dornelles CFD, Vieira SRR. Inhalation injury after exposure to indoor fire and smoke: The Brazilian disaster experience. Burns 2016; 42:884-90. [PMID: 26975698 DOI: 10.1016/j.burns.2016.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 01/14/2016] [Accepted: 02/18/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the pre-hospital, emergency department, and intensive care unit (ICU) care and prognosis of patients with inhalation injury after exposure to indoor fire and smoke. MATERIALS AND METHODS This is a prospective observational cohort study that includes patients admitted to seven ICUs after a fire disaster. The following data were collected: demographic characteristics; use of fiberoptic bronchoscopy; degree of inhalation injury; percentage of burned body surface area; mechanical ventilation parameters; and subsequent events during ICU stay. Patients were followed to determine the ICU and hospital mortality rates. RESULTS Within 24h of the incident, 68 patients were admitted to seven ICUs. The patients were young and had no comorbidities. Most patients (n=35; 51.5%) only had an inhalation injury. The mean ventilator-free days for patients with an inhalation injury degree of 0 or I was 12.5±8.1 days. For patients with an inhalation injury degree of II or III, the mean ventilator-free days was 9.4±5.8 days (p=0.12). In terms of the length of ICU stay for patients with degrees 0 or I, and patients with degrees II or III, the median was 7.0 days (5.0-8.0 days) and 12.0 days (8.0-23.0 days) (p<0.001), respectively. In addition, patients with a larger percentage of burned surface areas also had a longer ICU stay; however, no association with ventilator-free days was found. The patients with <10% of burned body surface area showed a mean of 9.2±5.4 ventilator-free days. The mean ventilator-free days for patients who had >10% burned body surface area was 11.9±9.5 (p=0.26). The length of ICU stay for the <10% and >10% burned body surface area patients was 7.0 days (5.0-10.0 days) and 23.0 days (11.5-25.5 days) (p<0.001), respectively. CONCLUSIONS We conclude that burn patients with inhalation injuries have different courses of disease, which are mainly determined by the percentage of burned body surface area.
Collapse
Affiliation(s)
- Tatiana Helena Rech
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Márcio Manozzo Boniatti
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil.
| | - Cristiano Augusto Franke
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Thiago Lisboa
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Iuri Christmann Wawrzeniak
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Cassiano Teixeira
- Department of Intensive Care Medicine, Hospital Moinhos de Vento, Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Juçara Gasparetto Maccari
- Department of Intensive Care Medicine, Hospital Moinhos de Vento, Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Felipe Schaich
- Department of Intensive Care Medicine, Hospital Moinhos de Vento, Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Angelica Sauthier
- Department of Intensive Care Medicine, Hospital de Pronto Socorro de Porto Alegre, Largo Teodoro Herzl, Porto Alegre, Brazil
| | - Luciele Medianeira Schifelbain
- Department of Intensive Care Medicine, Hospital de Caridade Dr. Astrogildo de Azevedo, Presidente Vargas, 2291, Santa Maria, Brazil
| | | | | | - Paula Pinheiro Berto
- Department of Intensive Care Medicine, Santa Casa de Misericórdia, Professor Annes Dias, 295, Porto Alegre, Brazil
| | - Leonardo Marques
- Department of Intensive Care Medicine, Santa Casa de Misericórdia, Professor Annes Dias, 295, Porto Alegre, Brazil
| | - Moreno Calcagnotto Dos Santos
- Department of Intensive Care Medicine, Hospital Nossa Senhora da Conceição, Francisco Trein, 596, Porto Alegre, Brazil
| | - Vanessa Martins de Oliveira
- Department of Intensive Care Medicine, Hospital Nossa Senhora da Conceição, Francisco Trein, 596, Porto Alegre, Brazil
| | | | - Sílvia Regina Rios Vieira
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
| |
Collapse
|
41
|
Gretarsdóttir JM, Bobersky S, Metzler-Nolte N, Suman SG. Cytotoxicity studies of water soluble coordination compounds with a [Mo2O2S2](2+) core. J Inorg Biochem 2016; 160:166-71. [PMID: 26920227 DOI: 10.1016/j.jinorgbio.2016.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/06/2016] [Accepted: 01/18/2016] [Indexed: 11/30/2022]
Abstract
Selected molybdenum sulfur compounds with the formulas (M)[Mo2O2S4L] where (Et4N)2(1), L=S4(2-), (Et4N)(2), L=Cp, (3), L=DMF, K(5), L=serine, M=Et4N(+), K(+), Na(+) and [Mo2O2S2L2] where Na2(4), L=cysteine, and (6), L=threonine, were prepared and subjected to cytotoxicity studies in vitro. The results were analyzed to rank the compounds according to their relative cytotoxicity and to correlate the observed toxicity to specific composition. The results guide future efforts to synthesize highly water soluble, non-toxic, compounds. Strong correlation was observed between toxicity and cation selection, as well as selection of biocompatible ligands combined with alkali metal salts. The most toxic compound analyzed showed about 50 times less cytotoxicity than the cisplatin reference compound in HT-29 cells. Preliminary results from in vivo data agree with the ranking obtained in vitro.
Collapse
Affiliation(s)
| | - Sandra Bobersky
- Ruhr Universität Bochum, Universitaetsstrasse 150, D-44780 Bochum, Germany
| | - Nils Metzler-Nolte
- Ruhr Universität Bochum, Universitaetsstrasse 150, D-44780 Bochum, Germany
| | - Sigridur G Suman
- Science Institute, University of Iceland, Dunhagi 3, 107 Reykjavik, Iceland.
| |
Collapse
|
42
|
Bassi E, Miranda LC, Tierno PFGMM, Ferreira CB, Cadamuro FM, Figueiredo VR, Damasceno MCDT, Malbouisson LMS. Assistance of inhalation injury victims caused by fire in confined spaces: what we learned from the tragedy at Santa Maria. Rev Bras Ter Intensiva 2016; 26:421-9. [PMID: 25607274 PMCID: PMC4304473 DOI: 10.5935/0103-507x.20140065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 10/28/2014] [Indexed: 11/30/2022] Open
Abstract
On January 2013, a disaster at Santa Maria (RS) due to a fire in a confined space
caused 242 deaths, most of them by inhalation injury. On November 2013, four
individuals required intensive care following smoke inhalation from a fire at the
Memorial da América Latina in São Paulo (SP). The
present article reports the clinical progression and management of disaster victims
presenting with inhalation injury. Patients ERL and OC exhibited early respiratory
failure, bronchial aspiration of carbonaceous material, and carbon monoxide
poisoning. Ventilation support was performed with 100% oxygen, the aspirated material
was removed by bronchoscopy, and cyanide poisoning was empirically treated with
sodium nitrite and sodium thiosulfate. Patient RP initially exhibited cough and
retrosternal burning and subsequently progressed to respiratory failure due to upper
airway swelling and early-onset pulmonary infection, which were treated with
protective ventilation and antimicrobial agents. This patient was extubated following
improvement of edema on bronchoscopy. Patient MA, an asthmatic, exhibited carbon
monoxide poisoning and bronchospasm and was treated with normobaric hyperoxia,
bronchodilators, and corticosteroids. The length of stay in the intensive care unit
varied from four to 10 days, and all four patients exhibited satisfactory functional
recovery. To conclude, inhalation injury has a preponderant role in fires in confined
spaces. Invasive ventilation should not be delayed in cases with significant airway
swelling. Hyperoxia should be induced early as a therapeutic means against carbon
monoxide poisoning, in addition to empiric pharmacological treatment in suspected
cases of cyanide poisoning.
Collapse
Affiliation(s)
- Estevão Bassi
- Unidade de Terapia Intensiva de Emergência Cirúrgica e Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Leandro Costa Miranda
- Unidade de Terapia Intensiva de Emergência Cirúrgica e Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - César Biselli Ferreira
- Unidade de Terapia Intensiva de Emergência Cirúrgica e Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Filipe Matheus Cadamuro
- Unidade de Terapia Intensiva de Emergência Cirúrgica e Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Viviane Rossi Figueiredo
- Departamento de Broncoscopia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Luiz Marcelo Sá Malbouisson
- Unidade de Terapia Intensiva de Emergência Cirúrgica e Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
43
|
Abstract
Respiratory tract injuries caused by inhalation of smoke or chemical products are related to significant morbidity and mortality. While many strategies have been built up to manage cutaneous burn injuries, few logical diagnostic strategies for patients with inhalation injuries exist and almost all treatment is supportive. The goals of initial management are to ensure that the airway allows adequate oxygenation and ventilation and to avoid ventilator-induced lung injury and substances that may complicate subsequent care. Intubation should be considered if any of the following signs exist: respiratory distress, stridor, hypoventilation, use of accessory respiratory muscles, blistering or edema of the oropharynx, or deep burns to the face or neck. Any patients suspected to have inhalation injuries should receive a high concentration of supplemental oxygen to quickly reverse hypoxia and to displace carbon monoxide from protein binding sites. Management of carbon monoxide and cyanide exposure in smoke inhalation patients remains controversial. Absolute indications for hyperbaric oxygen therapy do not exist because there is a low correlation between carboxyhemoglobin levels and the severity of the clinical state. A cyanide antidote should be administered when cyanide poisoning is clinically suspected. Although an ideal approach for respiratory support of patients with inhalation injuries do not exist, it is important that they are supported using techniques that do not further exacerbate respiratory failure. A well-organized strategy for patients with inhalation injury is critical to reduce morbidity and mortality.
Collapse
Affiliation(s)
- Shinsuke Tanizaki
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
| |
Collapse
|
44
|
MacLennan L, Moiemen N. Management of cyanide toxicity in patients with burns. Burns 2015; 41:18-24. [DOI: 10.1016/j.burns.2014.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/21/2014] [Accepted: 06/04/2014] [Indexed: 01/25/2023]
|
45
|
|
46
|
Physiologically based pharmacokinetic modeling of hydrogen cyanide levels in human breath. Arch Toxicol 2014; 89:1287-96. [DOI: 10.1007/s00204-014-1310-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 07/01/2014] [Indexed: 10/25/2022]
|
47
|
Antonio ACP, Castro PS, Freire LO. Smoke inhalation injury during enclosed-space fires: an update. J Bras Pneumol 2014; 39:373-81. [PMID: 23857686 PMCID: PMC4075838 DOI: 10.1590/s1806-37132013000300016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 04/25/2013] [Indexed: 11/22/2022] Open
Abstract
In view of the tragic fire at a nightclub in the city of Santa Maria, Brazil, which culminated in the sudden death of 232 young people, we decided to review the literature regarding smoke inhalation injury caused by enclosed-space fires, which can be divided into direct thermal damage, carbon monoxide poisoning, and cyanide poisoning. Such injuries often call for immediate orotracheal intubation, either due to acute airway obstruction or due to a reduced level of consciousness. The diagnosis and the severity of the thermal injury can be determined by fiberoptic bronchoscopy. The levels of gases and gas by-products in the bloodstream should be assessed as rapidly as possible, even while still at the scene of the incident. First responders can also treat carbon monoxide poisoning, with immediate administration of oxygen at 100%, as well as cyanide poisoning, with oxygen therapy and hydroxocobalamin injection.
Collapse
|
48
|
Sanaei-Zadeh H. First degree AV block due to carbon monoxide or cyanide poisoning. Which of them? J Saudi Heart Assoc 2014; 26:123-4. [DOI: 10.1016/j.jsha.2013.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022] Open
|
49
|
Reply to: First degree AV block due to carbon monoxide or cyanide poisoning. Which of them? J Saudi Heart Assoc 2014; 26:125. [DOI: 10.1016/j.jsha.2014.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
50
|
Huzar TF, George T, Cross JM. Carbon monoxide and cyanide toxicity: etiology, pathophysiology and treatment in inhalation injury. Expert Rev Respir Med 2014; 7:159-70. [DOI: 10.1586/ers.13.9] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|