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1.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi ; 40(10): 771-775, 2022 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-36348560

RESUMO

Objective: To compare the efficacy of high-flow nasal cannula oxygen therapy (HFNC) and non-rebreather face mask (NRFM) in the treatment of mild acute carbon monoxide poisoning (ACOP) in reducing carboxyhemoglobin (COHb) , and to explore the feasibility of HFNC in the treatment of ACOP. Methods: Patients with mild ACOP with COHb >10% who were admitted to the emergency department of Northern Jiangsu People's Hospital from January 2015 to December 2020 were analyzed, and those with altered consciousness, mechanical ventilation and those requiring hyperbaric oxygen therapy were excluded. The patients were divided into HFNC group and NRFM group according to the oxygen therapy used in the emergency department. The COHb decline value and COHb half-life in the two groups were observed. Results: Seventy-one patients were enrolled, including 39 in the NRFM group and 32 in the HFNC group. The baseline COHb in the HFNC group was 24.8%±8.3%, and that in the NRFM group was 22.5%±7.1%, with no significant difference between the two groups (t=1.27, P=0.094) . At 60 min, 90 min and 120 min of treatment, COHb in both groups decreased, but the COHb in HFNC group was lower than that in NRFM group at the same time point (P<0.05) . After 1 h of treatment, the COHb decrease in the HFNC group (16.9%±4.5%) was significantly higher than that in the NRFM group (10.1%±7.8%) (t=4.32, P=0.013) . The mean half-life of COHb in the HFNC group (39.3 min) was significantly lower than that in the NRFM group (61.4 min) (t=4.69, P=0.034) . Conclusion: HFNC treatment of mild ACOP can rapidly reduce blood COHb level, it is a potential oxygen therapy method for clinical treatment of ACOP.


Assuntos
Intoxicação por Monóxido de Carbono , Insuficiência Respiratória , Humanos , Intoxicação por Monóxido de Carbono/terapia , Cânula , Respiração Artificial , Máscaras , Oxigenoterapia/métodos , Carboxihemoglobina , Oxigênio/uso terapêutico , Insuficiência Respiratória/terapia
2.
J Minim Invasive Gynecol ; 29(11): 1260-1267, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36108914

RESUMO

STUDY OBJECTIVES: To evaluate whether the use of radiofrequency energy during resectoscopy leads to increases in patient blood levels of carboxyhemoglobin (COHb) and investigate procedural variables associated with these elevations. DESIGN: A prospective cross-sectional study of 40 subjects undergoing a hysteroscopic procedure using bipolar radiofrequency energy. SETTING, PATIENTS, AND INTERVENTIONS: The study was conducted at an ambulatory surgery center. Procedures for uterine leiomyoma, septa, products of conception, or a combination of these pathologies were included. We measured blood COHb levels before and immediately after the surgery. Abnormal postoperative COHb level was defined as an increase of plasma COHb ≥3.0%. All patients with abnormal postoperative levels were contacted and screened for carbon monoxide toxicity symptoms. Summary statistics included frequency for categorical variables and averages for continuous variables. p values were reported without modification. MEASUREMENTS AND MAIN RESULTS: A total of 17.5% of subjects met the criteria for abnormal postoperative COHb levels. None of these subjects reported symptoms of carbon monoxide toxicity. One subject with an elevated postoperative COHb level had intraoperative hemodynamic changes possibly related to COHb elevation. An abnormal postoperative COHb level was associated with a higher fluid deficit (p = .024) and greater myoma volume (p = .04). CONCLUSION: This study demonstrates that systemic absorption of carbon monoxide is a reproducible phenomenon in hysteroscopic resections using bipolar diathermy. Greater absorption is associated with a higher fluid deficit and greater myoma volume. Although none of the subjects with an abnormal increase screened positive for symptoms in the postoperative setting and only 1 experienced hemodynamic changes intraoperatively, our study looked at a healthy and young patient population. More research is needed on the safety of this COHb exposure in patients with medical comorbidities. Special consideration should be given to the possibility of carbon monoxide absorption and the uncertain long-term effects when planning extensive hysteroscopic resections.


Assuntos
Intoxicação por Monóxido de Carbono , Mioma , Feminino , Gravidez , Humanos , Carboxihemoglobina/análise , Estudos Prospectivos , Monóxido de Carbono , Histeroscopia/efeitos adversos , Estudos Transversais , Intoxicação por Monóxido de Carbono/complicações , Intoxicação por Monóxido de Carbono/diagnóstico , Mioma/complicações
3.
A A Pract ; 16(8): e01602, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35952338

RESUMO

Loss of consciousness suddenly occurred in 2 healthy and nonsmoking patients undergoing bipolar resection for intramural myomas under spinal anesthesia. One patient had nystagmus and emesis. In both cases, neurological symptoms were of short duration. All other usual causes were excluded. Initial venous carboxyhemoglobin concentrations were 7% and 23%, respectively. These concentrations decreased within several hours with oxygen therapy. Carbon monoxide (CO) is a product of diathermic vaporization and may enter the blood and cause intraoperative cardiovascular symptoms. These are the first cases with neurological presentation. The CO poisoning was probably diagnosed early because the patients were awake.


Assuntos
Raquianestesia , Intoxicação por Monóxido de Carbono , Raquianestesia/efeitos adversos , Intoxicação por Monóxido de Carbono/diagnóstico , Intoxicação por Monóxido de Carbono/terapia , Carboxihemoglobina , Feminino , Humanos , Histeroscopia/efeitos adversos , Oxigenoterapia , Gravidez
4.
Saudi Med J ; 43(8): 891-898, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35964947

RESUMO

OBJECTIVES: To observe the effect of different fresh gas flows (FGF) on carboxyhemoglobin (COHb) levels non-invasively and continuously and to determine the contribution of the smoking status to intraoperative carbon monoxide (CO) accumulation and respiratory complications. METHODS: A total of 64 patients were included in the study. Carboxyhemoglobin level was monitored non-invasively from the fingertip. Patients were divided into 2 according to the FGF as low-flow anesthesia (LFA; Group L) and high flow anesthesia (Group H). Each group was divided again into 2 groups as smokers and non-smokers. Carboxyhemoglobin and and the respiratory complications that occurred in the post-anesthesia care unit were recorded. RESULTS: The mean COHb values were significantly higher in Group L between 30th and 210th minutes. Furthermore, in Group L, intraoperative COHb levels were significantly higher in smokers compared to non-smokers in all periods. In group H, no difference was observed between smokers and non-smokers in terms of COHb levels after 60 minutes and also preoperative COHb levels of the patients developed respiratory complication was higher. CONCLUSION: If the CO2 absorbent is properly preserved in patients who are administered LFA, there will be no risk of CO accumulation even in chronic smokers.ClinicalTrials.gov REG. No.: NCT04832256.


Assuntos
Monóxido de Carbono , Carboxihemoglobina , Humanos
5.
Leg Med (Tokyo) ; 59: 102111, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35802996

RESUMO

Recently, 2-aminothiazoline-4-carboxylic acid (ATCA), a cyanide (CN) metabolite, has been proposed as a stable diagnostic marker of CN poisoning. In this study, liquid chromatography coupled with electrospray ionization - tandem mass spectrometry was used to quantify ATCA concentrations in human postmortem blood samples, and differences in ATCA concentrations according to age and sex were determined. Both age and sex had significant effects on blood ATCA concentrations. Although ATCA concentrations exhibited an inverted U shape with increasing age in men, in women ATCA concentrations plateaued at around 40-59 years of age. There were significant differences between the sexes in ATCA concentrations for the 20-39 and 40-59 year age groups (P < 0.05 and P < 0.01, respectively). Correlations between ATCA concentrations and carboxyhemoglobin (CO-Hb) saturation were also examined in fire victims. ATCA concentrations increased significantly with increasing CO-Hb saturation (r = 0.382, P < 0.01). In addition, ATCA concentrations were also correlated to CN concentrations (r = 0.309, P < 0.05). The results of our study may provide novel information about the contribution of CN poisoning to the cause of death at fire scenes.


Assuntos
Carboxihemoglobina , Cianetos , Incêndios , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carboxihemoglobina/análise , Ácidos Carboxílicos , Cianetos/envenenamento , Caracteres Sexuais , Adulto Jovem , Autopsia
6.
Acta Haematol ; 145(6): 650-654, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35835029

RESUMO

The diagnosis of polycythemia, particularly the secondary forms, can be challenging. The distinction between primary and secondary polycythemia is relevant and has management implications. A systematic diagnostic workup algorithm and a good anamnesis are of paramount relevance. More than one cause may be involved in the development of polycythemia, identifying all of them will be the key to better understanding and eventually solving the polycythemia. We describe a case of a 53-year-old Swiss woman with polycythemia and a high level of carboxyhemoglobin. Her medical story included obesity and obstructive sleep apnea. The anamnesis ruled out the habit of smoking cigarettes; however, the patient reported that she was on a trip to Egypt 10 years before and bought herself a shisha; since then, she used to smoke shisha daily, at home, alone. After drastically reducing and then stopping the shisha smoking, 7 months later her blood count and carboxyhemoglobin completely normalized.


Assuntos
Policitemia , Cachimbos de Água , Humanos , Pessoa de Meia-Idade , Feminino , Policitemia/diagnóstico , Policitemia/etiologia , Carboxihemoglobina , Suíça , Fumar/efeitos adversos
7.
J Gynecol Obstet Hum Reprod ; 51(8): 102431, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35718331

RESUMO

INTRODUCTION: Uterine myomas are the most common benign uterine tumors. Hysteroscopic myomectomy has grown as a standard minimally invasive surgical procedure, but this technique is not free from complications. CASE: An hysteroscopic myomectomy was performed on a 38 years-old woman. During the awakening after the procedure, she presented focal neurological deficits, thus arterial blood gas test and total body computerized tomography (CT) scan were urgently carried out. They revealed a very high carboxyhemoglobin level and abdominal venous air embolism. The patient stayed in Trendelenburg position and under mechanical ventilation with 100% oxygen concentration. Fortunately, a few hours later she was fully awake and was able to be successfully extubated, being discharged to the surgical ward three days later fully recovered. CONCLUSION: Carbon monoxide poisoning during hysteroscopic resection is a rare but potentially fatal complication that anesthetists, gynecologists, and critical care physicians should be aware of.


Assuntos
Intoxicação por Monóxido de Carbono , Embolia Aérea , Miomectomia Uterina , Adulto , Carboxihemoglobina , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/etiologia , Embolia Aérea/terapia , Feminino , Humanos , Histeroscopia/métodos , Oxigênio , Gravidez , Miomectomia Uterina/efeitos adversos , Miomectomia Uterina/métodos
8.
J Obstet Gynaecol ; 42(6): 2540-2541, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35648870

RESUMO

Carbon monoxide (CO) poisoning during pregnancy may cause deleterious effects to the fetus. Hyperbaric oxygen therapy (HBO) in pregnancy is proven to be safe and it is considered to be beneficial, reducing the severity of the fetal injuries. However, a number of issues are still to be discussed, among them the question of the carboxyhemoglobin (COHb) levels that trigger HBO therapy in pregnant CO poisoned patients. In this letter we report some practical suggestions for organizations wishing to develop their own protocols.


Assuntos
Intoxicação por Monóxido de Carbono , Oxigenoterapia Hiperbárica , Monóxido de Carbono , Intoxicação por Monóxido de Carbono/terapia , Carboxihemoglobina , Feminino , Feto , Humanos , Gravidez
9.
Undersea Hyperb Med ; 49(2): 171-177, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35580484

RESUMO

Background: Clinicians often rely on measurement of carboxyhemoglobin (COHb) to confirm or rule out a diagnosis of carbon monoxide (CO) poisoning. Methods: We report two cases of false negative COHb in patients with CO poisoning and one case of false positive COHb in a patient without CO poisoning. Results: In the first case, a 20-year-old male developed headache, confusion, and near-syncope while operating a gasoline-powered pressure washer in an enclosed space. In the emergency department (ED), his COHb was 1.8%, but this level was disregarded, and he was referred for hyperbaric oxygen. His COHb just before hyperbaric oxygen was 4.1%, and later analysis of his blood collected at ED arrival revealed a COHb of 20.1%. The referral ED blood gas machine calibration and controls were within specification. In the second case, a 45-year-old male presented with several others to the ED with symptoms of CO poisoning after exposure at a conference. All others had elevated COHb levels, but his COHb was 2%. He was discharged but returned shortly with continued symptoms and requested his COHb be repeated. The repeat COHb was 17% (84 minutes after the first). After three hours of oxygen, his COHb was 7%. In the final case, an 83-year-old non-smoking male presented to an ED with breathlessness and tachypnea and was diagnosed with COVID-19 pneumonia. His COHb was 7.1%, but he reported living in an all-electric home. Another adult who lived with him and rode with him to the ED was asymptomatic and had a COHb of 3%. Later, COHb of 1.9% was measured from blood collected at ED arrival, and gas chromatography/mass spectrometry confirmed this result (2%). Conclusions: COHb levels are not always accurate. Clinicians should use clinical judgment to manage their patients, including rejecting laboratory values that do not fit the clinical situation.


Assuntos
COVID-19 , Intoxicação por Monóxido de Carbono , Adulto , Idoso de 80 Anos ou mais , Monóxido de Carbono , Intoxicação por Monóxido de Carbono/complicações , Intoxicação por Monóxido de Carbono/diagnóstico , Intoxicação por Monóxido de Carbono/terapia , Carboxihemoglobina/análise , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio , Síncope , Adulto Jovem
10.
Clin Toxicol (Phila) ; 60(9): 1012-1018, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35549585

RESUMO

BACKGROUND: Historically, the first step in treating cyanide (CN-) toxicity utilized antidotes to induce methemoglobinemia. This is concerning in patients who are already hypoxemic or have elevated carboxyhemoglobin. Hydroxocobalamin (OHCbl) is now the first-line antidote for CN- toxicity and is not known to induce methemoglobinemia. We observed elevated methemoglobin (MetHb) levels in several patients treated with OHCbl and sought to investigate the incidence of MetHb formation following administration of OHCbl. METHODS: Chart review: A single-center, retrospective case series of patients who received 5 or 10 g of hydroxocobalamin from 01/01/2011 through 04/30/2019. Data was analyzed using descriptive statistics. In-vitro study: Discarded blood was separated into whole blood and plasma samples. OHCbl and normal saline was added to reach 0×, 1×, 2×, and 4× peak therapeutic concentrations and analyzed at times 0, 2, and 4 h after administration. RESULTS: Chart review: Twenty-seven cases of OHCbl administration were identified. The median age was 53 years (IQR 38 - 64) and 20 (74.1%) were male. Exposure to a house fire or smoke inhalation was the reason for OHCbl administration in 21 (77.8%) patients. Five (18.5%) patients received 10 g of OHCbl while the rest received 5 g. Six (22.2%) patients developed methemoglobinemia, all after 5 g OHCbl administration; four had been exposed to fire and smoke, two received the medication for severe acidosis of unknown etiology not related to fire or smoke. The median peak level was 7.1% (IQR 2.2 - 16.4%) at a median time of 11.4 h post-administration. Two patients received methylene blue (MB), neither responded. Death occurred in 17 (63%) cases. In-vitro study: We observed a dose dependent elevation in total hemoglobin but did not detect any increase in MetHb. CONCLUSION: We observed a noteworthy temporal association between the formation of methemoglobinemia and the administration of hydroxocobalamin. This does not appear to be an artifact of the CO-oximeters. This could have profound implications for patients who are already hypoxemic or have impaired oxygen carrying capacity from carboxyhemoglobin.


Assuntos
Hidroxocobalamina , Metemoglobinemia , Adulto , Antídotos/efeitos adversos , Carboxihemoglobina/análise , Cianetos , Feminino , Humanos , Hidroxocobalamina/uso terapêutico , Masculino , Metemoglobina/análise , Metemoglobinemia/induzido quimicamente , Metemoglobinemia/tratamento farmacológico , Azul de Metileno , Pessoa de Meia-Idade , Oxigênio , Estudos Retrospectivos , Solução Salina , Fumaça
11.
Clin Toxicol (Phila) ; 60(9): 1051-1058, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35635241

RESUMO

INTRODUCTION: Cyanide is a prevalent, lethal chemical. Possible sources of exposure include products of combustion, plant material, industry, chemical warfare and terrorism. METHODS: Retrospective review of UK Poisons Information Database of telephone enquiries to the National Poisons Information Service between 1st January 2008 and 31st December 2019 where cyanide poisoning was considered a possibility. Data extracted included demographics, exposure source, clinical features, Poisoning Severity Score, lactate concentration and antidotes given. RESULTS: A total of 1,252 cases of suspected cyanide poisoning were identified, 239 (19%) involved children under 10 years. The commonest sources of exposure were ingestion of plant material (437 cases; 35%) and smoke inhalation (399; 32%). Smoke inhalation caused the majority of severe and fatal cases (139; 71%). Clinical features associated with fatal outcomes were cardiac arrest (OR 36.4; 95% CI 14.4-92.2), hypotension (15.8; 7.0-35.9), coma (10.8; 5.6-21.0) and lactic acidosis (7.8; 4.1-14.8). 110 patients (9%) were given an antidote and 40 patients (3%) died.Lactate concentrations correlate with Poisoning Severity Score category (r = 0.6, p < 0.0001). Serum lactate <2.0 mmol/L was associated with Poisoning Severity Score None or Minor (sensitivity 76%; specificity 86%) and >11.0 mmol/L was associated with fatal outcome (sensitivity 74%; specificity 80%). 61 cases (5%) had severe carboxyhaemoglobin toxicity (COHb >30%). This was associated with a fatal outcome (OR 7.0; 95% CI 1.5-33.7) and there was positive correlation between carboxyhaemoglobin and Poisoning Severity Score, r = 0.57, p < 0.0001. CONCLUSIONS: Most cases of ingestion of plant material involved children under five years and resulted in no or mild symptoms. In adults smoke inhalation was associated with the most severe poisoning. The lactate cut-off values associated with each severity score calculated in this study are lower than the values used by NPIS on TOXBASE. Analytical conformation of cyanide exposure was unavailable in the majority of case, limiting the strength of these conclusions.


Assuntos
Intoxicação , Venenos , Lesão por Inalação de Fumaça , Adulto , Antídotos/uso terapêutico , Carboxihemoglobina , Criança , Pré-Escolar , Cianetos , Humanos , Serviços de Informação , Ácido Láctico , Intoxicação/diagnóstico , Intoxicação/epidemiologia , Fumaça , Reino Unido/epidemiologia
12.
Am J Emerg Med ; 58: 73-78, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35636046

RESUMO

BACKGROUND: Carbon monoxide poisoning (COP), resulting from accidental and intentional exposure, is a leading cause of fatal poisoning worldwide. Except for early death, neurological sequelae are common and impose a large burden on patients, caregivers, and the society. MATERIALS AND METHODS: This retrospective study included patients who visited the emergency departments (EDs) of the medical institutes of Chang Gung Memorial Hospital after COP with a carboxyhemoglobin level > 10% between January 2009 and October 2018. Patients who experienced out-of-hospital cardiac arrest (OHCA) were excluded. Poor outcome was defined as mortality or a Glasgow coma scale (GCS) <13 at discharge. Stepwise regression analysis was performed, and a receiver operating characteristic (ROC) curve was applied to analyze our newly created scoring system for prognosis prediction. RESULTS: This study enrolled 1171 patients. Fire scene (F) (aOR, 20.635; 95% CI, 8.345-51.023), intentional CO exposure (I) (aOR, 2.634; 95% CI, 1.335-5.196), respiratory failure (R) (aOR, 9.944; 95% CI, 5.533-17.873), every point of reduced GCS (E) (aOR, 1.253; 95% CI, 1.186-1.323), and diabetes mellitus (D) (aOR, 2.749; 95% CI, 1.201-6.292) were identified as predictors of poor outcomes. The FIRED score was created. CONCLUSION: The FIRED score could predict the outcomes of non-OHCA patients with a carboxyhemoglobin level > 10% after COP using five factors that can be obtained by history taking and basic examination. An FIRED score ≥ 10 was associated with a poor outcome (sensitivity, 89.6%; specificity, 82.4%; AUC0.930).


Assuntos
Intoxicação por Monóxido de Carbono , Intoxicação por Monóxido de Carbono/complicações , Intoxicação por Monóxido de Carbono/diagnóstico , Intoxicação por Monóxido de Carbono/terapia , Carboxihemoglobina/análise , Escala de Coma de Glasgow , Humanos , Curva ROC , Estudos Retrospectivos
13.
J Vet Emerg Crit Care (San Antonio) ; 32(5): 637-644, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35442550

RESUMO

OBJECTIVE: To evaluate carboxyhemoglobin (COHb) and methemoglobin (MetHb) levels in dogs and cats with respiratory disease in the ICU. DESIGN: Retrospective study. SETTING: University veterinary teaching hospital. ANIMALS: The ICU census was searched for dogs (n = 466) and cats (n = 97) hospitalized within the ICU between January 2016 and January 2019 in whom blood gas with co-oximetry was performed. Dogs and cats were stratified into those with primary respiratory and nonrespiratory categories; the underlying cause of the disease was also noted. Venous blood gas, co-oximeter, PaO2 /FiO2 (PF ratio), physical examination findings, and outcome were recorded. MEASUREMENTS AND MAIN RESULTS: The median COHb and MetHb in dogs hospitalized in the ICU were 2.6% (0.1%-5.6%) and 1.1% (0.1%-2.9%), respectively. The median COHb and MetHb in cats hospitalized in the ICU were 2.2% (0.1%-5.4%) and 1.0% (0%-2.1%), respectively. Dogs with respiratory disease had a higher COHb than dogs without respiratory disease (median, 2.7% [range, 0.3%-5.0%] vs. 2.5% [0.1%-5.6%]; P = 0.0148). COHb was positively associated with survival in cats (median, 2.2% [range, 0.1%-5.4%] vs. 1.9% [0.1%-3.9%]; P = 0.0433). Both COHb and MetHb were higher in septic dogs than in nonseptic dogs (median COHb, 2.8% [range 0.3%-4.5%] vs. 2.6% [0.1%-5.6%]; P = 0.02 and median MetHb, 1.1% [0.1%-2.9%] vs. 1.1% [0.1%-2.4%]; P = 0.01, respectively). CONCLUSIONS: There may be a positive association between COHb and respiratory disease in dogs; prospective studies are needed to evaluate this further. No association between COHb and respiratory disease in cats or MetHb and respiratory disease in either species was detected. Additional prospective studies are needed to determine whether COHb and MetHb are biomarkers for sepsis in dogs and whether COHb is an indicator of mortality in cats.


Assuntos
Doenças do Gato , Doenças do Cão , Animais , Biomarcadores , Carboxihemoglobina/análise , Gatos , Cães , Hospitais Veterinários , Hospitais de Ensino , Humanos , Metemoglobina/análise , Oximetria/veterinária , Estudos Retrospectivos
14.
Can Respir J ; 2022: 6689805, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35469243

RESUMO

Background: Carboxyhemoglobin (COHb) is a complex formed by the binding of carbon monoxide to hemoglobin in blood. Higher COHb levels have been associated with poor prognosis in a variety of pulmonary disorders. However, little is known regarding the prognostic significance of COHb among individuals with chronic obstructive pulmonary disease (COPD) exacerbation. Methods: In a retrospective study, we evaluated associations of venous COHb levels on hospital admission with the need for invasive mechanical ventilation, in-hospital mortality, and rehospitalization, among 300 patients hospitalized for COPD exacerbation in internal medical wards. Results: Rates of in-hospital death and 1-year recurrent hospitalizations were 11.0% and 59.6%, respectively. COHb levels were not significantly associated with in-hospital mortality (OR = 0.82, P=0.25, 95% CI 0.59-1.15) or with 1-year rehospitalizations (OR = 0.91, P=0.18, 95% CI 0.79-1.04). The mean COHb level did not differ significantly between patients who needed invasive mechanical ventilation and those who were not invasively mechanically ventilated during the current hospitalization (2.01 ± 1.42% vs. 2.19 ± 1.68%, P=0.49). Conclusions: Among patients hospitalized with COPD exacerbation in internal medicine wards, COHb levels on admission were not associated with invasive mechanical ventilation treatment, rehospitalizations, or mortality.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Respiração Artificial , Carboxihemoglobina , Mortalidade Hospitalar , Humanos , Prognóstico , Estudos Retrospectivos
15.
J Forensic Sci ; 67(3): 1294-1299, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35179233

RESUMO

Carbon monoxide (CO) toxicity associated with exposure to an environmental, exogenous source, is routinely investigated in the field of forensics. Paramedics responded to the home of a 60-year-old woman who complained of persistent nausea, dizziness, and fatigue. Her initial carboxyhemoglobin (COHb) saturation was 25% as measured by paramedics in the field via pulse CO-oximetry (SpCO) and was, 2 hours later, confirmed by hospital laboratory spectrophotometric analysis to be 16% after initial treatment in the emergency department. The clinical presentation of environmental CO exposure and subsequent death notification to the North Carolina Office of the Chief Medical Examiner prompted an extensive investigation into the suspected residential source of CO, which ultimately ruled out all exogenous sources. The medicolegal death investigator later discovered an updated hematology consultation note, which determined the actual source of the CO to be endogenously produced from disease. Herein, we report an unusual fatality involving enhanced endogenous CO production caused by warm autoimmune hemolytic anemia. This unique case report and brief literature review of disease-related elevation of endogenous CO will shed light on this lesser-known phenomenon alerting the forensic community to its potential occurrence and need for consideration when sources of environmental exposure have been exhausted.


Assuntos
Anemia Hemolítica , Intoxicação por Monóxido de Carbono , Animais , Monóxido de Carbono , Carboxihemoglobina/análise , Feminino , Peixes , Humanos , Pessoa de Meia-Idade , Oximetria
16.
Actas Esp Psiquiatr ; 50(1): 65-67, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35103300

RESUMO

arbon monoxide (CO) is an odorless, tasteless, colorless and nonirritating gas 1. In Spain, most of the accidents due to CO poisoning are caused by water heaters2,3,4. CO binds to hemoglobin with much greater affinity than oxygen, for- ming carboxyhemoglobin (COHb) and resulting in impaired oxygen transport and utilization.XS In up to 40 percent of patients with significant CO exposure, a delayed neuropsy- chiatric syndrome (DNS) can arise 3 to 240 days after appa- rent recovery, characterized by cognitive deficits, personality changes, movement disorders, and focal neurologic deficits, which may persist for a year or longer.


Assuntos
Intoxicação por Monóxido de Carbono , Disfunção Cognitiva , Intoxicação por Monóxido de Carbono/complicações , Carboxihemoglobina/análise , Humanos , Espanha , Síndrome
17.
Am J Emerg Med ; 55: 226.e1-226.e2, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34974952

RESUMO

Acute carbon monoxide (CO) poisoning due to smoking hookah has been reported and may present similarly to other causes of acute carbon monoxide poisoning with nausea, headache, and loss of consciousness [1]. In the acute poisoned patient, immediate removal from the carbon monoxide source is paramount in addition to administration of oxygen and possible hyperbaric oxygen therapy (HBO) in certain situations. However, cases of chronic CO poisoning, treatment options, and long-term adverse health effects are far less reported but may include atherosclerosis and vague neurologic symptoms [2]. We present a case of a patient who chronically smoked hookah creating a condition of chronic carboxyhemoglobinemia which was discovered during work up for unexplained polycythemia. While being seen in the hematology clinic, he was found to have a blood carboxyhemoglobin of level 33.6% despite being asymptomatic. This is the highest recorded hookah-related carboxyhemoglobin concentration in the medical literature; and the significant chronic carboxyhemoglobinemia explained his polycythemia. This case illustrates that a social history is crucial when assessing the patient with severe carboxyhemoglobinemia as HBO is not indicated in chronic CO poisoning in an asymptomatic patient.


Assuntos
Intoxicação por Monóxido de Carbono , Oxigenoterapia Hiperbárica , Policitemia , Cachimbos de Água , Monóxido de Carbono , Intoxicação por Monóxido de Carbono/complicações , Intoxicação por Monóxido de Carbono/terapia , Carboxihemoglobina , Humanos , Masculino , Policitemia/complicações , Policitemia/terapia , Fumar
18.
Am J Perinatol ; 39(12): 1321-1325, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-33395710

RESUMO

OBJECTIVE: This study aimed to assess whether cord blood carboxyhemoglobin (COHb) levels in jaundiced term neonates with and without a positive direct Coombs test (DCT) and in healthy controls could be used as a predictor of severe hyperbilirubinemia. The percentage of cord blood COHb should be higher among neonates with Coombs-positive ABO hemolytic disease than among those with Coombs-negative ABO incompatibility and higher than that of ABO-compatible control neonates. STUDY DESIGN: This cross-sectional descriptive study of 198 term neonates comprised three subgroups: group I featured 68 DCT-positive ABO-incompatible neonates (ABO + DCT), group II featured 60 DCT-negative ABO-incompatible neonates with hyperbilirubinemia (ABO-DCT), and group III featured 70 healthy controls. COHb was determined by an OSM3 hemoximeter. RESULTS: Group I differed from groups II and III for cord blood bilirubin, cord blood hemoglobin, and cord blood hematocrit. Groups I and II had higher mean total serum bilirubin (TSB) levels than group III, while there was no difference in the mean TSB levels between groups I and II. There was no significant difference between the COHb group means for groups I, II, and III (p = 0.98). The area under the receiver operating characteristic curve calculated for group I/group III and group II/group III were found to be 0.62 and 0.54, respectively. CONCLUSION: COHb levels did not prove to be superior to the DCT for predicting the risk of developing severe hyperbilirubinemia in term neonates. KEY POINTS: · COHb levels do not predict the risk of developing severe hyperbilirubinemia in term neonates.. · COHb levels may predict that ABO incompatibility in early life.. · COHb levels did not prove to be superior to the direct coombs test..


Assuntos
Carboxihemoglobina , Hiperbilirrubinemia Neonatal , Sistema ABO de Grupos Sanguíneos , Bilirrubina , Estudos Transversais , Feminino , Sangue Fetal , Humanos , Hiperbilirrubinemia , Hiperbilirrubinemia Neonatal/diagnóstico , Recém-Nascido
19.
Perfusion ; 37(8): 797-804, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-34233534

RESUMO

INTRODUCTION: Hemolysis is a common complication of extracorporeal membrane oxygenation (ECMO). There are few data on whether carboxyhemoglobin (COHb), a potential marker of hemolysis, are elevated during ECMO support. METHODS: We conducted a single-center, retrospective study comparing peak COHb levels of children pre-, during, and post-ECMO from January 2017 to August 2020. RESULTS: There were 154 ECMO runs in 147 children (154 PICU admissions) included in the study. The median age was 3.5 (IQR 0.2, 39.2) months. Veno-arterial ECMO was the predominant mode: 146/154 (94.8%). Eighty-seven children (56.5%) underwent cardiac surgery. Peak COHb levels during ECMO were statistically significantly higher compared to pre ECMO (COHb 1.8% (IQR 1.4, 2.6) vs COHb 1.2% (IQR 0.7, 1.7), p < 0.001) and post ECMO (COHb 1.6% (IQR 1.3, 2.2), p = 0.009). Children with COHb ⩾2% were younger and had longer duration of ECMO support. Plasma hemoglobin weakly correlated with COHb level (r = 0.14; p = 0.04). CONCLUSIONS: Carboxyhemoglobin levels increased during ECMO support compared to the pre and post ECMO period. Younger age and longer ECMO duration were associated with COHb levels ⩾2%. Plasma hemoglobin weakly correlated with COHb level.


Assuntos
Oxigenação por Membrana Extracorpórea , Criança , Humanos , Pré-Escolar , Oxigenação por Membrana Extracorpórea/efeitos adversos , Estudos Retrospectivos , Carboxihemoglobina , Hemólise , Fatores de Tempo
20.
J Clin Monit Comput ; 36(2): 579-586, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-33871764

RESUMO

Almost since its introduction pulse oximetry was known to overestimate oxygen saturation in cases of carbon monoxide poisoning or elevated methemoglobin (metHb) levels. To eliminate this dangerous behavior some manufacturers have added additional LED emitters to try to increase the number of measured hemoglobin species and to improve measurement accuracy, but have not been very successful. We hypothesized that the use of narrow-band laser light sources would make accurate and precise measurement of the four primary species of hemoglobin possible, even in cases of elevated levels of carboxyhemoglobin (COHb). Calibration and verification studies were performed on a tissue simulator that employed an artificial finger pulsating with whole human blood. This simulator allowed safe generation of 165 different combinations of the levels of oxyhemoglobin (O2Hb), COHb, metHb, and reduced hemoglobin (RHb) for calibration of the laser-based pulse oximeter. A follow-on study used 56 mixed hemoglobin levels for verification and statistical analysis of the performance of this device. This laser-based pulse oximeter measured all four species of hemoglobin accurately and precisely (ARMS ≤ 1.8%) for metHb levels in the clinically normal range. At elevated metHb levels the device continued to provide accurate and precise measurements of metHb and RHb (ARMS ≤ 1.7%). The use of monochromatic laser light sources can create a new generation of highly accurate, multi-parameter, pulse oximeters.


Assuntos
Carboxihemoglobina , Oximetria , Calibragem , Carboxihemoglobina/análise , Hemoglobinas/análise , Humanos , Lasers , Metemoglobina/análise , Oxigênio
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