Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 569
Filtrar
1.
Medicine (Baltimore) ; 98(19): e15551, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083215

RESUMO

RATIONALE: Acute kidney injury (AKI), rhabdomyolysis, and delayed leukoencephalopathy after carbon monoxide (CO) poisoning are very rare. We report a case presenting with AKI, rhabdomyolysis, and delayed leukoencephalopathy after CO poisoning. PATIENT CONCERNS: The patient was admitted to our emergency department due to loss of consciousness after CO exposure during a suicide attempt. DIAGNOSES: Laboratory findings revealed elevated carboxyhemoglobin, serum creatinine, and serum muscle enzyme levels. Initially, this patient was diagnosed with AKI and rhabdomyolysis due to CO poisoning. A month after the CO poisoning, she showed neuropsychiatric symptoms. Brain magnetic resonance imaging showed white-matter hyperintensity on the T2 flair image. Therefore, she was diagnosed with delayed leukoencephalopathy after CO poisoning. INTERVENTIONS: At the same time as diagnosis of AKI and rhabdomyolysis, the normobaric oxygen and hydration therapies were performed. A month later, rehabilitation was started due to delayed leukoencephalopathy. OUTCOMES: Her renal function and muscle enzyme levels were completely restored with alert mental status. She could walk with the aid of a walker at last visit. LESSONS: This case shows that we should consider about rare acute and late complications such as AKI, rhabdomyolysis, and delayed leukoencephalopathy after CO poisoning.


Assuntos
Lesão Renal Aguda/etiologia , Intoxicação por Monóxido de Carbono/complicações , Leucoencefalopatias/etiologia , Rabdomiólise/etiologia , Lesão Renal Aguda/fisiopatologia , Lesão Renal Aguda/terapia , Adulto , Encéfalo/diagnóstico por imagem , Intoxicação por Monóxido de Carbono/diagnóstico por imagem , Intoxicação por Monóxido de Carbono/fisiopatologia , Intoxicação por Monóxido de Carbono/terapia , Feminino , Humanos , Leucoencefalopatias/diagnóstico por imagem , Leucoencefalopatias/fisiopatologia , Leucoencefalopatias/terapia , Rabdomiólise/fisiopatologia , Rabdomiólise/terapia , Tentativa de Suicídio
3.
Hum Exp Toxicol ; 38(1): 148-154, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29998771

RESUMO

Carbon monoxide (CO) poisoning is a significant cause of death especially in developing countries. The current study investigated cardioprotective effects of insulin in CO-poisoned rats. Male rats were exposed to 3000 ppm CO for 1 h. Insulin (100 and 120 U/kg intraperitoneally) was immediately administered after CO exposure and on the next 4 days, on a daily basis (a total of 5 doses). On day 5, animals were euthanized, and the hearts were harvested for Western blotting and histopathological studies. The electrocardiograms (ECG) were recorded postexposure to CO and after the completion of insulin treatment period. Histopathological evaluations showed reduction of myocardial necrosis in insulin-treated animals compared to controls. BAX/BCL2 ratio, as a proapoptotic index, was significantly reduced in treatment groups ( p < 0.01). The ECG findings showed no differences among groups; also, compared to control animals, myocardial Akt levels were not markedly affected by insulin. The current study showed that insulin significantly reduces myocardial necrotic and apoptotic indices in CO-poisoned rats.


Assuntos
Intoxicação por Monóxido de Carbono/tratamento farmacológico , Cardiotônicos/uso terapêutico , Insulina/uso terapêutico , Animais , Apoptose/efeitos dos fármacos , Intoxicação por Monóxido de Carbono/metabolismo , Intoxicação por Monóxido de Carbono/patologia , Intoxicação por Monóxido de Carbono/fisiopatologia , Carboxihemoglobina/análise , Eletrocardiografia , Masculino , Miocárdio/metabolismo , Miocárdio/patologia , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Ratos Wistar
4.
Burns ; 45(3): 526-530, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30119873

RESUMO

Carbon monoxide (CO) is a toxic, color-, taste- and odorless gas with fatal consequences if undetected. Intoxication caused by CO is frequent possibly leading to a high morbidity and mortality. The disease involves multiple organ systems without a typical clinical presentation. The clinical picture is furthermore unrelated to levels of carboxyhemoglobin - the routine biomarker. Therefore the diagnosis and treatment can be very demanding. This article in detail reviews epidemiology, symptoms, diagnosis and the therapy of this multidisciplinary challenge.


Assuntos
Intoxicação por Monóxido de Carbono/fisiopatologia , Arritmias Cardíacas , Intoxicação por Monóxido de Carbono/diagnóstico , Intoxicação por Monóxido de Carbono/epidemiologia , Intoxicação por Monóxido de Carbono/terapia , Carboxihemoglobina , Dispneia , Cefaleia , Humanos , Oxigenação Hiperbárica/métodos , Hipotensão , Transtornos Mentais , Isquemia Miocárdica , Náusea , Doenças do Sistema Nervoso , Oxigenoterapia/métodos , Respiração Artificial/métodos , Taquicardia , Disfunção Ventricular Esquerda
5.
Emerg Med Pract ; 20(3): 1-24, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29489306

RESUMO

Smoke inhalation injury portends increased morbidity and mortality in fire-exposed patients. Upper airway thermal burns, inflammation from lower airway irritants, and systemic effects of carbon monoxide and cyanide can contribute to injury. A standardized diagnostic protocol for inhalation injury is lacking, and management remains mostly supportive. Clinicians should maintain a high index of suspicion for concomitant traumatic injuries. Diagnosis is mostly clinical, aided by bronchoscopy and other supplementary tests. Treatment includes airway and respiratory support, lung protective ventilation, 100% oxygen or hyperbaric oxygen therapy for carbon monoxide poisoning, and hydroxocobalamin for cyanide toxicity. Due to its progressive nature, many patients with smoke inhalation injury warrant close monitoring for development of airway compromise.


Assuntos
Lesão por Inalação de Fumaça/complicações , Lesão por Inalação de Fumaça/diagnóstico , Adulto , Broncoscopia/métodos , Queimaduras/complicações , Queimaduras/fisiopatologia , Queimaduras/terapia , Intoxicação por Monóxido de Carbono/etiologia , Intoxicação por Monóxido de Carbono/fisiopatologia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Oxigenação Hiperbárica/métodos , Monitorização Fisiológica/métodos , Respiração Artificial/métodos , Lesão por Inalação de Fumaça/fisiopatologia
6.
Clin Toxicol (Phila) ; 56(9): 856-859, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29519168

RESUMO

BACKGROUND: Recent public health strategies have contributed towards a significant reduction in the incidence of carbon monoxide (CO) poisonings. When events do occur, symptoms can vary dramatically depending on the carboxyhaemoglobin level and individual factors. Most reports to date focus on individual cases or larger retrospective reviews of diverse cohorts. There are very few reports of CO exposure related to scuba diving activities. METHODS: We describe the clinical sequelae experienced by 10 children who were exposed to CO during a scuba diving lesson. We collate patient data in the context of a severely affected individual and employ exponential decay calculations to estimate half-life. RESULTS: Six of the patients exposed to CO were symptomatic. The most severely affected individual suffered multi-organ effects, including myocardial damage, and required intensive care unit admission. The remaining cohort demonstrated notable clinical variability. The half-life of carboxyhaemoglobin on high flow oxygen in this cohort was ∼75 min, in line with previous estimates. CONCLUSION: This work described an uncommon clinical presentation, representing the largest single cohort of its kind. This work exemplifies the variable symptomatology of CO toxicity, of which clinicians should be alert to if patients fall ill after scuba diving.


Assuntos
Intoxicação por Monóxido de Carbono/fisiopatologia , Monóxido de Carbono/efeitos adversos , Mergulho , Adolescente , Estudos de Coortes , Humanos , Masculino , Estudos Retrospectivos
7.
Am J Emerg Med ; 36(6): 1123.e1-1123.e3, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29548522

RESUMO

We report a 24year old female who presented with sudden and severe headaches after recent carbon monoxide poisoning. Imaging revealed an acute cerebral venous thrombosis. Prior studies have suggested that carbon monoxide is a risk factor for an acute hypercoagulable state (i.e. DVT). However, little data is available regarding the correlation between carbon monoxide poisoning and cerebral venous thrombosis. This case demonstrates that such a correlation should be considered in acute intracerebral thrombotic events.


Assuntos
Anticoagulantes/uso terapêutico , Intoxicação por Monóxido de Carbono/diagnóstico , Transtornos da Cefaleia/induzido quimicamente , Trombose Intracraniana/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Varfarina/uso terapêutico , Aspirina/uso terapêutico , Intoxicação por Monóxido de Carbono/complicações , Intoxicação por Monóxido de Carbono/fisiopatologia , Feminino , Transtornos da Cefaleia/diagnóstico por imagem , Transtornos da Cefaleia/fisiopatologia , Humanos , Trombose Intracraniana/induzido quimicamente , Trombose Intracraniana/terapia , Neuroimagem , Resultado do Tratamento , Trombose Venosa/induzido quimicamente , Trombose Venosa/terapia , Adulto Jovem
8.
Intern Emerg Med ; 13(2): 223-229, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29435715

RESUMO

Carbon monoxide (CO) is a colorless, odorless gas that is found in the environment, in the home, and in the human body as a normal part of mammalian metabolism. Poisoning from CO, a common exposure, is associated with significant morbidity and mortality if not recognized and treated in a timely manner. This review evaluates the signs and symptoms of CO poisoning, conditions that present similar to CO poisoning, and an approach to the recognition and management for CO poisoning. CO poisoning accounts for thousands of emergency department visits annually. If not promptly recognized and treated, it leads to significant morbidity and mortality. CO poisoning poses a challenge to the emergency physician because it classically presents with non-specific symptoms such as headache, dizziness, nausea, and vomiting. Due to nonspecific presentations, it is easily mistaken for other, more benign diagnoses such as viral infection. The use of specific historical clues such as exposure to non-conventional heat sources or suicide attempts in garages, as well as the use of targeted diagnostic testing with CO-oximetry, can confirm the diagnosis of CO poisoning. Once diagnosed, treatment options range from observation to the use of hyperbaric oxygen. CO poisoning is an elusive diagnosis. This review evaluates the signs and symptoms CO poisoning, common chameleons or mimics, and an approach to management of CO poisoning.


Assuntos
Intoxicação por Monóxido de Carbono/diagnóstico , Intoxicação por Monóxido de Carbono/fisiopatologia , Intoxicação por Monóxido de Carbono/terapia , Tontura/etiologia , Serviço Hospitalar de Emergência/organização & administração , Fadiga/etiologia , Cefaleia/etiologia , Humanos , Oxigenação Hiperbárica/métodos , Náusea/etiologia , Oximetria/métodos , Síncope/etiologia , Vômito/etiologia
9.
Clin Toxicol (Phila) ; 56(8): 759-764, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29334268

RESUMO

CONTEXT: Acute kidney injury (AKI) can occur after carbon monoxide (CO) intoxication; however, limited data are available. This study aimed to evaluate the prognostic value of the development and progression of AKI in patients with acute CO poisoning. MATERIALS AND METHODS: We conducted a retrospective cohort study using a prospective registry of CO poisoning between January 2010 and December 2015. AKI was defined and classified according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Multivariate logistic regression analysis was conducted to determine the association between AKI and adverse outcomes, defined as neurological deficits at discharge or 28-day mortality. RESULTS: A total of 661 patients were evaluated. According to KDIGO criteria, 114 patients (17.2%) had AKI (initial: stage 1, 70.2%; stage 2, 26.3%; stage 3, 3.5%) on admission and 119 (18.0%) finally developed AKI during their hospital stay (maximum: stage 1, 68.9%; stage 2, 23.5%; stage 3, 7.6%). Almost all patients (99.2%) were diagnosed as having their highest KDIGO stage within three days (median, one day). AKI development was associated with adverse outcomes (odds ratio (OR) 17.53, 95% confidence interval 45.00-77.14). Both initial and maximum AKI stages demonstrated a stepwise increase of adjusted OR for adverse outcomes. AKI stage progression occurred in 8.4% of patients with AKI and was an independent factor for adverse outcomes. CONCLUSION: CO poisoning- related AKI occurred in 18% and was mostly detected within one day after CO intoxication. The development and progression of AKI had a strong association with adverse outcomes and deserve further prospective investigation.


Assuntos
Lesão Renal Aguda/etiologia , Lesão Renal Aguda/fisiopatologia , Intoxicação por Monóxido de Carbono/complicações , Intoxicação por Monóxido de Carbono/fisiopatologia , Adulto , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença
10.
Cardiovasc Toxicol ; 18(2): 175-183, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28986777

RESUMO

Carbon monoxide (CO) poisoning could cause significant cardiac injury. This study aimed to evaluate patients with CO poisoning by using speckle tracking echocardiography (STE), a potentially more sensitive technique, to identify left systolic ventricular dysfunction for the first time in the literature. Seventy-two patients who were exposed to CO poisoning were studied. Blood collection and echocardiography were performed at admission and after patients' discharge on days 10-15 (mean 12 days). Global longitudinal strain (GLS) and global circumferential strain (GCS) were calculated using STE. In order to find the normal strain levels and to compare it to the patient with CO poisoning, 35 healthy subjects were included in the study. Left ventricular ejection fraction was analyzed according to Simpson's method. Patients were divided into two groups based on their LVEF values. LVEF < 55%, Group 1 (n = 24); LVEF ≥ 55%, Group 2 (n = 48). The reduction in Group 1 strain levels decreased in correlation with LVEF (p < 0.001) while in Group 2, there were no significant changes in LVEF but strain levels were significantly reduced (p = 0.091; p < 0.001). Compared with the control group patients, admission GLS and GLC values of CO-poisoned patients were significantly low both in Group 1 and 2. On the contrary, no significant difference was observed when compared with follow-up GLS value. For prediction of CO cardiotoxicity, the cutoff value of GLS was ≥ - 19.1 with a sensitivity of 70.3% and a specificity of 100% [(AUC) 0.840, 95% (CI) 0.735-0.916; p < 0.001] in the ROC curve analyses. GLS was found as independent predictors of cardiotoxicity. Our study demonstrates the potential of using systolic strain values obtained using 2D-STE in determining cardiotoxicity due to CO poisoning. Speckle tracking echocardiography has the potential of demonstrating subtle LV systolic dysfunction even in CO poisoning patients with preserved EF.


Assuntos
Intoxicação por Monóxido de Carbono/diagnóstico por imagem , Monóxido de Carbono/toxicidade , Ecocardiografia Doppler/métodos , Volume Sistólico/efeitos dos fármacos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda/efeitos dos fármacos , Adulto , Fenômenos Biomecânicos , Intoxicação por Monóxido de Carbono/fisiopatologia , Cardiotoxicidade , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Sístole , Disfunção Ventricular Esquerda/induzido quimicamente , Disfunção Ventricular Esquerda/fisiopatologia , Adulto Jovem
11.
Clin Toxicol (Phila) ; 56(8): 751-758, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29239210

RESUMO

OBJECTIVE: This study aimed to investigate whether clinical parameters and serum neuron-specific enolase (NSE) levels measured at emergency department (ED) presentation help stratify the risk of acute or delayed persistent severe neurological sequelae after acute carbon monoxide (CO) poisoning induced by charcoal burning. METHODS: This retrospective study included 236 patients who suffered from CO poisoning. Demographic information, serum NSE levels measured in the ED, treatment, clinical course, and long-term neurological outcomes were recorded. RESULTS: The median serum NSE level at presentation was 15.5 (10.9-22.7) ng/mL. No differences were observed in the duration of CO exposure; the initial Glasgow Coma Scale (GCS) score; the levels of arterial HCO3-, white blood cells (WBCs), C-reactive protein (CRP) or troponin I; or the frequency of abnormal diffusion-weighted imaging finding at presentation among the groups with different serum NSE levels at presentation. The incidences of acute and delayed persistent neurologic sequelae assessed at 22.3 months after acute charcoal CO poisoning were 5.1% and 8.5%, respectively. No difference in the NSE level was observed between patients stratified according to long-term neurological status. According to the multinomial logistic regression analysis, age, serum CRP levels and the initial GCS score were risk factors for the two types of persistent severe neurological sequelae, whereas troponin I levels were associated only with the acute persistent severe neurological sequelae. However, the adjusted NSE level was not a risk factor for any persistent neurological sequelae. CONCLUSIONS: Serum NSE levels at presentation were not correlated with the risk of acute or delayed persistent neurological sequelae. Further studies with blood sampling at optimal time points and serial measurements should be conducted. Age, initial GCS score, and CRP levels may be risk factors for persistent severe neurological sequelae.


Assuntos
Biomarcadores/sangue , Intoxicação por Monóxido de Carbono/sangue , Intoxicação por Monóxido de Carbono/complicações , Carvão Vegetal/administração & dosagem , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/fisiopatologia , Fosfopiruvato Hidratase/sangue , Adulto , Intoxicação por Monóxido de Carbono/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
12.
Basic Clin Pharmacol Toxicol ; 122(5): 470-480, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29151273

RESUMO

Delayed encephalopathy after acute carbon monoxide (CO) poisoning (DEACMP) is the most severe and clinically intractable complication that occurs following acute CO poisoning. Unfortunately, the mechanism of DEACMP is still vague. Growing evidence indicates that delayed cerebral damage after CO poisoning is related to oxidative stress, abnormal neuro-inflammation, apoptosis and immune-mediated injury. Our recent report indicated that methylene blue (MB) may be a promising therapeutic agent in the prevention of neuronal cell death and cognitive deficits after transient global cerebral ischaemia (GCI). In this study, we aimed to investigate the potential of MB therapy to ameliorate the signs and symptoms of DEACMP. Rats were exposed to 1000 ppm CO for 40 min. in the first step; CO was then increased to 3000 ppm, which was maintained for another 20 min. The rats were implanted with 7-day release Alzet osmotic mini-pumps subcutaneously under the back skin, which provided MB at a dose of 0.5 mg/kg/day 1 hr after CO exposure. The results showed that MB significantly suppressed oxidative damage and expression of pro-inflammatory factors, including tumour necrosis factor-α and interleukin (IL)-1ß. MB treatment also suitably modulated mitochondrial fission and fusion, which is helpful in the preservation of mitochondrial function. Furthermore, MB dramatically attenuated apoptosis and neuronal death. Lastly, behavioural studies revealed that MB treatment preserved spatial learning and memory in the Barnes maze test. Our findings indicated that MB may have protective effects against DEACMP.


Assuntos
Antídotos/farmacologia , Encefalopatias/prevenção & controle , Região CA1 Hipocampal/efeitos dos fármacos , Intoxicação por Monóxido de Carbono/tratamento farmacológico , Azul de Metileno/farmacologia , Neurônios/efeitos dos fármacos , Animais , Anti-Inflamatórios/farmacologia , Antioxidantes/farmacologia , Apoptose/efeitos dos fármacos , Comportamento Animal/efeitos dos fármacos , Encefalopatias/metabolismo , Encefalopatias/patologia , Encefalopatias/fisiopatologia , Região CA1 Hipocampal/metabolismo , Região CA1 Hipocampal/patologia , Região CA1 Hipocampal/fisiopatologia , Intoxicação por Monóxido de Carbono/metabolismo , Intoxicação por Monóxido de Carbono/fisiopatologia , Cognição/efeitos dos fármacos , Modelos Animais de Doenças , Mediadores da Inflamação/metabolismo , Interleucina-1beta/metabolismo , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Dinâmica Mitocondrial/efeitos dos fármacos , Neurônios/metabolismo , Neurônios/patologia , Estresse Oxidativo/efeitos dos fármacos , Ratos Sprague-Dawley , Aprendizagem Espacial/efeitos dos fármacos , Fatores de Tempo , Fator de Necrose Tumoral alfa/metabolismo
13.
Undersea Hyperb Med ; 45(6): 673-677, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-31158934

RESUMO

Myocardial injury is a frequent consequence of moderate to severe CO (carbon monoxide) poisoning and a significant predictor of mortality in CO injury. Electrocardiography (ECG) is an easily accessible diagnostic tool for evaluating myocardial damage. Increased QT interval and QT dispersion are related to heterogeneity of regional ventricular repolarization and can develop into arrhythmias. It has been reported that QT interval and QT dispersion increase in patients with CO poisoning. Hyperbaric oxygen (HBO2) therapy has been used successfully in treating patients with CO poisoning. The aim of this study was to investigate change of corrected QT (QTc) interval and QTc dispersion after HBO2 therapy. This study included 31 patients with CO poisoning. QTc dispersion increased in patients with CO poisoning. The mean QTc dispersion was 54.94 milliseconds (ms) on admission. The mean QTc dispersion decreased to 35.74 ms after HBO2 therapy (P=0.003). There was also a correlation between carboxyhemoglobin level and QTc dispersion (P=0.029). HBO2 therapy, which decreases QTc dispersion, may improve the myocardial electrical homogeneity and reduce the risk of ventricular arrhythmia and cardiac death. Physicians should be aware of the effect of HBO2 therapy on myocardial damage when treating patients with CO poisoning. The ECGs should be examined carefully before referring or excluding HBO2 therapy.


Assuntos
Arritmias Cardíacas/terapia , Intoxicação por Monóxido de Carbono/terapia , Oxigenação Hiperbárica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/sangue , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Intoxicação por Monóxido de Carbono/sangue , Intoxicação por Monóxido de Carbono/complicações , Intoxicação por Monóxido de Carbono/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Troponina/sangue , Adulto Jovem
14.
Dtsch Arztebl Int ; 115(51-52): 863-870, 2018 12 24.
Artigo em Inglês | MEDLINE | ID: mdl-30765023

RESUMO

BACKGROUND: The symptoms of carbon monoxide (CO) poisoning are nonspecific, ranging from dizziness and headache to unconsciousness and death. A German national guideline on the diagnosis and treatment of this condition is lacking at present. METHODS: This review is based on a selective literature search in the PubMed and Cochrane databases, as well as on existing guidelines from abroad and expert recommendations on diagnosis and treatment. RESULTS: The initiation of 100% oxygen breathing as early as possible is the most important treatment for carbon monoxide poisoning. In case of CO poisoning, the reduced oxygen-carrying capacity of the blood, impairment of the cellular respiratory chain, and immune-modulating processes can lead to tissue injury in the myocardium and brain even after lowering of the carboxyhemoglobin (COHb) concentration. In patients with severe carbon monoxide poisoning, an ECG should be obtained and biomarkers for cardiac ischemia should be measured. Hyperbaric oxygen therapy (HBOT) should be critically considered and initiated within six hours in patients with neurologic deficits, unconsciousness, cardiac ischemia, pregnancy, and/or a very high COHb concentration. At present, there is no general recommendation for HBOT, in view of the heterogeneous state of the evidence from multiple trials. Therapeutic decision-making is directed toward the avoidance of sequelae such as cognitive dysfunction and cardiac complications, and the reduction of mortality. Smoke intoxication must be considered in the differential diagnosis. The state of the evidence on the diagnosis and treatment of this condition is not entirely clear. Alternative or supplementary pharmacological treatments now exist only on an experimental basis. CONCLUSION: High-quality, prospective, randomized trials that would enable a definitive judgment of the efficacy of HBOT are currently lacking.


Assuntos
Intoxicação por Monóxido de Carbono/diagnóstico , Intoxicação por Monóxido de Carbono/terapia , Oxigênio/administração & dosagem , Adulto , Biomarcadores/análise , Biomarcadores/sangue , Intoxicação por Monóxido de Carbono/fisiopatologia , Carboxihemoglobina/análise , Tontura/etiologia , Feminino , Cefaleia/etiologia , Humanos , Oxigenação Hiperbárica/métodos , Masculino , Oxigênio/uso terapêutico , Estudos Prospectivos
15.
Undersea Hyperb Med ; 44(6): 559-567, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29281193

RESUMO

OBJECTIVE: The aim of this study was to evaluate whether monitoring of acute carbon monoxide-poisoned (COP) patients by means of quantitative Romberg's test (QR-test) during a hyperbaric oxygen (HBO2) therapy regimen could be a useful supplement in the evaluation of neurological status. METHODS: We conducted a retrospective study (2000-2014) in which we evaluated data containing quantitative sway measurements of acute COP patients (n = 58) treated in an HBO2 regimen. Each patient was tested using QR-test before and after each HBO2 treatment. Data were analyzed using linear mixed models (LMM). In each LMM, sway prior to HBO2 therapy was set as the fixed effect and change in sway after HBO2 therapy was set as the response variable. Patient, treatment number, weight and age were set as random effects for all LMMs. RESULTS: From the LMMs we found that larger values of sway prior to HBO2 produced a negative change in sway. We found no correlation between CO level and sway (P=0.1028; P=0.8764; P=0.4749; P=0.5883). Results showed that loss of visual input caused a significant increase in mean sway (P=0.028) and sway velocity (P⟨0.0001). CONCLUSIONS: The Quantitative Romberg's test is a fast, useful supplement to neurological evaluation and a potential valuable tool for monitoring postural stability during the course of treatment in acute COP patients.


Assuntos
Intoxicação por Monóxido de Carbono/diagnóstico , Intoxicação por Monóxido de Carbono/terapia , Oxigenação Hiperbárica , Adulto , Intoxicação por Monóxido de Carbono/fisiopatologia , Dinamarca , Diagnóstico por Computador/métodos , Diagnóstico por Computador/estatística & dados numéricos , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Exame Neurológico/métodos , Exame Neurológico/estatística & dados numéricos , Equilíbrio Postural/fisiologia , Estudos Retrospectivos , Adulto Jovem
16.
Artigo em Chinês | MEDLINE | ID: mdl-29081128

RESUMO

Objective: To study the clinical effect of high pressure oxygen and Butylphthalide in the recovery of cerebral metabolism after carbon monoxide poisoning. Methods: 84 patients treated from May 2014 to May 2016 in our hospital were selected. The subjects were randomly and equally divided into two groups. The control group adopted the conventional therapy and high pressure oxygen; on the basis, the observation group also took Butylphthalide. The clinical effect, duration of coma, recovery of consciousness, incidence rate of delayed encephalopathy was observed. After 1m of treatment, the HDS point was evaluated. Results: The total effective rate of control group (76.19%, 32/42) was lower than that of observation group (95.24%, 40/42) (P<0.05) . The duration of coma for observation group was shorter than that of control group. The percentage for patients with recovery of consciousness and incidence rate of delayed encephalopathy for observation group was better than that of control group (P<0.05) . The HDS point for observation group was even higher than that of control group (P<0.05) . Conclusion: The high pressure oxygen and butylphthalide can improve the clinical effective rate, shorten the duration of coma and promote the patient's recovery of consciousness. It is worthy of clinical promotion.


Assuntos
Benzofuranos/uso terapêutico , Encefalopatias/fisiopatologia , Encefalopatias/terapia , Intoxicação por Monóxido de Carbono/fisiopatologia , Intoxicação por Monóxido de Carbono/terapia , Encefalopatias/complicações , Intoxicação por Monóxido de Carbono/complicações , Humanos , Oxigenação Hiperbárica/efeitos adversos , Oxigênio , Resultado do Tratamento
17.
Cardiol Young ; 27(9): 1662-1669, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28760170

RESUMO

Introduction Carbon monoxide poisoning may cause myocardial toxicity and cardiac autonomic dysfunction, which may contribute to the development of life-threatening arrhythmias. We investigated the potential association between acute carbon monoxide exposure and cardiac autonomic function measured by heart rate variability. METHOD: The present study included 40 children aged 1-17 years who were admitted to the Pediatric Intensive Care Unit with acute carbon monoxide poisoning and 40 healthy age- and sex-matched controls. Carboxyhaemoglobin and cardiac enzymes were measured at admission. Electrocardiography was performed on admission and discharge, and 24-hour Holter electrocardiography was digitally recorded. Heart rate variability was analysed at both time points - 24-hour recordings - and frequency domains - from the first 5 minutes of intensive care unit admission. RESULTS: Time domain and frequency indices such as high-frequency spectral power and low-frequency spectral power were similar between patient and control groups (p>0.05). The ratio of low-frequency spectral power to high-frequency spectral power was significantly lower in the carbon monoxide poisoning group (p<0.001) and was negatively correlated with carboxyhaemoglobin levels (r=-0.351, p<0.05). The mean heart rate, QT dispersion, corrected QT dispersion, and P dispersion values were higher in the carbon monoxide poisoning group (p<0.05) on admission. The QT dispersion and corrected QT dispersion remained longer in the carbon monoxide poisoning group compared with controls on discharge (p<0.05). CONCLUSION: The frequency domain indices, especially the ratio of low-frequency spectral power to high-frequency spectral power, are useful for the evaluation of the cardiac autonomic function. The decreased low-frequency spectral power-to-high-frequency spectral power ratio reflects a balance of the autonomic nervous system, which shifted to parasympathetic components.


Assuntos
Intoxicação por Monóxido de Carbono/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Adolescente , Sistema Nervoso Autônomo/efeitos dos fármacos , Sistema Nervoso Autônomo/fisiopatologia , Carboxihemoglobina/análise , Estudos de Casos e Controles , Criança , Pré-Escolar , Eletrocardiografia/métodos , Eletrocardiografia Ambulatorial/métodos , Feminino , Coração , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Turquia
18.
Acta Anaesthesiol Scand ; 61(9): 1142-1154, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28832892

RESUMO

BACKGROUND: Acute fire smoke inhalation injury involves inflammatory mediators whose roles are poorly understood. We carried out a prospective observational study of fire smoke victims to identify clinical and biochemical markers that may predict pulmonary dysfunction and investigated possible correlations between dysfunction and cytokines in bronchoalveolar lavage (BAL) fluid and blood. METHODS: Forty patients with respiratory and/or neurological symptoms following acute fire smoke inhalation had pulmonary function tests and blood gas analyses performed on admission, at discharge, and after 3 months. Cytokines were measured using BioPlex/XMap technology. RESULTS: On admission, 30 (75%) patients had dyspnea. Patients presenting with bronchial wheezing (n = 14) had significantly lower PEF (201 l/min, 82-360) than non-wheezing patients (406 l/min, 100-683) (n = 16, P = 0.03). Bronchial wheezing predicted need for ICU treatment with OR = 93.3 at 95% CI (P < 0.001) and was associated with gas exchange impairment, with mean pa O2 /FiO2 ratio 34.4 (11.8-49.8) kPa on admission and 21.3 (8.3-44.5) kPa 48 h later. Blood HbCO also predicted ICU treatment, with OR = 1.58 at 95% CI (P < 0.001). Serum CRP, IL-6, IL-8, and MCP-1 were significantly higher in wheezing patients after 12-24 h compared with non-wheezing patients and study controls. Cytokine levels were still elevated after 3 months. BAL fluid had significantly higher levels of IL-8, MCP-1, IL-1ß, and G-CSF compared with healthy controls. CONCLUSION: In victims of fire smoke inhalation, pulmonary wheezing predicts inflammation, pulmonary dysfunction, respiratory failure, and need for intensive care.


Assuntos
Broncopatias/fisiopatologia , Pneumonia/etiologia , Pneumonia/fisiopatologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Sons Respiratórios/fisiopatologia , Lesão por Inalação de Fumaça/complicações , Lesão por Inalação de Fumaça/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Gasometria , Líquido da Lavagem Broncoalveolar , Intoxicação por Monóxido de Carbono/diagnóstico , Intoxicação por Monóxido de Carbono/fisiopatologia , Cuidados Críticos , Citocinas/sangue , Dispneia/etiologia , Dispneia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Valor Preditivo dos Testes , Estudos Prospectivos , Testes de Função Respiratória , Insuficiência Respiratória/diagnóstico , Adulto Jovem
19.
Respir Care ; 62(10): 1333-1342, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28807985

RESUMO

Carbon monoxide (CO) is usually recognized as a toxic gas that can be used to assess lung function in the pulmonary function laboratory. The toxicity of CO relates to its high affinity for hemoglobin and other heme molecules, producing carboxyhemoglobin (HbCO). Despite that blood HbCO levels are commonly measured in patients with CO poisoning, the clinical presentation often does not correlate with the HbCO level, and clinical improvement in the patient's condition does not correlate with HbCO clearance. In patients with CO poisoning, administration of 100% O2 is standard practice. If available, hyperbaric O2 can be used, although this is controversial. Measurement of exhaled CO might be useful to estimate HbCO, such as in smoking cessation programs, but assessment of HbCO using pulse oximetry can be misleading. Endogenous CO is generated as the result of heme oxygenase activity. It is becoming increasingly recognized that the results of heme oxygenase activity, specifically CO production, might have important physiologic functions. These include effects on vascular function, inflammation, apoptosis, cell proliferation, and signaling pathways. Given the abundance of basic science supporting a therapeutic role for CO, clinical trials are exploring this potential.


Assuntos
Monóxido de Carbono/fisiologia , Monóxido de Carbono/uso terapêutico , Gasotransmissores/fisiologia , Gasotransmissores/uso terapêutico , Intoxicação por Monóxido de Carbono/fisiopatologia , Carboxihemoglobina/análise , Heme Oxigenase (Desciclizante)/fisiologia , Humanos
20.
Med Sci Monit ; 23: 1501-1506, 2017 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-28352069

RESUMO

BACKGROUND Delayed encephalopathy after acute carbon monoxide (CO) poisoning (DEACMP) is one of the most serious complications after CO poisoning. This study was conducted to explore the efficacy of the combined application of N-Butylphthalide and hyperbaric oxygenation therapy (HBO) on cognitive dysfunction in patients with DEACMP. MATERIAL AND METHODS A total of 184 patients with DEACMP were randomly assigned to either receive HBO or N-Butylphthalide and HBO. Meanwhile, all patients received conventional treatment. The total remission rate (RR) was used to assess the clinical efficacy. The Mini-Mental State Examination (MMSE) was used to assess the cognitive function, and the National Institutes of Health Stroke Scale (NIHSS) was used to assess the neurological function. RESULTS Finally, there were 90 and 94 patients in the control and experimental groups, respectively. After eight weeks of treatment, the total RR in the experimental group (47.9%) was significantly higher than that in the control group (33.3%). Compared to the control group, significantly more patients in the experimental group had MMSE scores of 24-30. The lower NIHSS score in the experimental group showed that N-Butylphthalide had the effect of preservation and restoration of neurological function. No obvious drug toxicity or liver and kidney dysfunction was observed, and there was no significant change in the level of blood glucose and blood lipids. CONCLUSIONS These results indicated that the combined application of N-Butylphthalide and HBO could significantly improve the cognitive dysfunction of patients with DEACMP and have great clinical efficacy, which should be further studied.


Assuntos
Benzofuranos/uso terapêutico , Encefalopatias/fisiopatologia , Encefalopatias/terapia , Intoxicação por Monóxido de Carbono/fisiopatologia , Intoxicação por Monóxido de Carbono/terapia , Disfunção Cognitiva/terapia , Doença Aguda , Encefalopatias/complicações , Intoxicação por Monóxido de Carbono/complicações , Disfunção Cognitiva/complicações , Demografia , Feminino , Humanos , Oxigenação Hiperbárica/efeitos adversos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Indução de Remissão , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA