Comparison of high-flow nasal cannula oxygen therapy and conventional reserve-bag oxygen therapy in carbon monoxide intoxication: A pilot study.

BACKGROUND: High-flow nasal cannula oxygen (HFNC) creates a positive pressure effect through high-flow rates compared to conventional oxygen therapy. The purpose of this human pilot study is to compare the effects of HFNC and conventional oxygen therapy on the rate of carbon monoxide (CO) clearance from the blood in patients with mild to moderate CO poisoning. METHODS: CO-poisoned Patients randomly received 100% oxygen from a rebreathing reserve mask (NBO2, flow of 15 L/min) or HFNC (flow of 60 L/min). The fraction of COHb value (fCOHb) was measured in 30-min intervals until it fell to under 10%. We determined the Half-life time of fCOHb (fCOHb t1/2). RESULTS: A total of 22 patients had fCOHb levels ≥ 10% at the time of ED arrival, with 9 of them having fCOHb level ranging between 25% and 50%. There was no significant difference in the fCOHbt1/2 between the HFNC group and NBO2 group. However, the mean fCOHbt1/2 in the HFNC group (48.5 ±â€¯12.4 min) has a smaller standard deviation than that in the NBO2 group (99.3 ±â€¯93.38 min). There were significant between-group differences in the mean COHbt1/2 among the patients with fCOHb levels less than 25% (HFNC 43.6 ±â€¯10.6 vs. NBO2 134.2 ±â€¯111.3). CONCLUSIONS: In this pilot randomized controlled trial study, HFNC therapy did not reduce fCOHbt1/2 compared to NBO2 therapy but could be beneficial in maintaining a constant fCOHbt1/2 as well as in reducing fCOHbt1/2 in mild CO poisoning patients compared to conventional NBO2 therapy. However, further studies with a larger number of patients are needed to establish HFNC therapy as an alternative therapy for CO poisoning patients.

The effects of case management program completion on suicide risk among suicide attempters: A 5-year observational study.

BACKGROUND: A prior suicide attempt is known to be the most important risk factor for suicide. Case management programs provide psychosocial support and rehabilitation for suicide attempters. This study aimed to determine whether case management completion is associated with good clinical outcomes for suicide attempters visiting the emergency department (ED). METHODS: A cross-sectional observational study was conducted using risk assessment records for suicide attempters visiting the ED from October 2013 to December 2017. We created two groups according to completion of the case management program. The primary outcome was a decrease in suicide risk. The secondary and tertiary outcomes were untreated stressors and lack of a support system. We calculated the adjusted odds ratio (AOR) of the case management completion for study outcomes adjusting for potential confounders. RESULTS: Among 439 eligible suicide attempters, only 277 (63.1%) participants completed the case management program. Participants who completed the case management program were more likely to have decreased suicide risk (65.3% vs. 46.9%, AOR: 2.13 (1.42-3.20)) and less untreated stressors (49.8% vs. 61.1%, AOR: 0.64 (0.43-0.96)). However, there was no significant difference in lack of a support system (35.4% vs. 45.7%, AOR: 0.68 (0.45-1.03)). CONCLUSION: Completion of a case management program was associated with reduction of suicide risk. Multicomponent strategies to increase compliance with a case management program are needed to prevent suicide reattempt and reduce the health burden of suicide.

Hypoplasia of left vertebral artery with intimal fibromuscular dysplasia in a Korean woman.

We found a case of hypoplasia of vertebral artery with fibromuscular dysplasia in an 82-yr-old Korean female cadaver during a routine dissection course. In the present case, intracranial hypoplasia in left vertebral artery and bilateral origin of posterior inferior cerebellar artery at the vertebrobasilar junction were recognized. Histopathologically, left vertebral artery showed intimal type of fibromuscular dysplasia both in its extracranial and intracranial courses. These results indicate that the association of fibromuscular dysplasia and hypoplasia does exist in the vertebral artery, although the etiologies are not verified yet.