Carbon Monoxide Poisoning and Pregnancy: Critical Nursing Interventions

Palmer, Joseph H.; Rueden, Kathryn Von

doi:10.1016/j.jen.2015.07.013

Cited by 7 publications

(8 citation statements)

References 9 publications

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“…[3,32] The HBOT is typically indicated in patients with myocardial ischemia, loss of consciousness, or seizure, or in pregnant women with a carboxyhemoglobin level of >20% or whose fetus can be harmed with relatively low levels of carboxyhemoglobin. [31,[33][34][35][36] AKI has rarely been documented in the evaluation of the severity of CO poisoning. In this study, the cumulative incidence of AKI was higher in the CO poisoning cohort than in the comparison cohort (Fig.…”

Section: Discussionmentioning

confidence: 99%

Risk of acute kidney injury among patients with carbon monoxide poisoning

et al. 2021

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There is a lack of evidence supporting the association between carbon monoxide (CO) poisoning and acute kidney injury (AKI). Hence, the present study aimed to evaluate the association between CO poisoning and AKI.From 2000 to 2011, we identified patients diagnosed with CO poisoning from the inpatient claims data. Patients aged below 20 years, who had a history of chronic kidney disease or end-stage renal disease before the index date and had incomplete medical information were excluded. Control patients without CO poisoning were randomly selected from all National Health Insurance beneficiaries, and the same exclusion criteria were used. The control group was frequency matched to patients with CO poisoning based on age, sex, and year of CO poisoning diagnosis. Cox proportional hazards regression analyses were conducted to assess the effects of CO poisoning on the risk of AKI. The hazard ratios and 95% confidence interval (CI) were calculated in the models.Compared with the control cohort, patients with severe CO poisoning were 3.77 times more likely to develop AKI (95% CI = 2.20-6.46), followed by those with less severe CO poisoning (adjusted hazard ratio = 2.21, 95% CI = 1.61-3.03).The findings of this nationwide study suggest an increased risk of AKI in patients with CO poisoning.

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Section: Discussionmentioning

confidence: 99%

Risk of acute kidney injury among patients with carbon monoxide poisoning

et al. 2021

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“…It was one of the basic therapy that is achieved at high flow rate (12-15L/min) using a face mask, and which should immediately be started at the premices of the accident. A regular check of the fetal heart beat is practiced for 1h [13], and the oxygen therapy must be continued for 16h or more if no improvement is observed or the hyperbaric oxygen is not available [14]. Eight patients out of the eleven had followed this treatment.…”

Section: Discussionmentioning

confidence: 99%

Unintentional Acute Carbon Monoxide Poisoning During Pregnancy: Five Years of Experience in Bordeaux

Rajaonarison

2018

GJORM

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Introduction:The objective of the study was to assess cases of maternal and fetal prognosis of carbon monoxide (CO) poisoning during pregnancy at the UHC of Bordeaux. Materials and method:A retrospective and descriptive study based on observation of cases of carbon monoxide poisoning in pregnant women was conducted at the University Hospital Centre of Bordeaux which review was completed, from 01/01/2011 to 30/06/2016. Results:The incidence on 24 pregnant women of carbon monoxide poisoning upon the 248 cases reported at the centre was compiled making a rate of 9,67%. Eleven of them were fully monitored. Two patients out of the eleven were tobacco smokers. CO poisoning originated either from: fire (6/11), faulty heating appliances (4/11) or electric short circuit (1/11). Two of the seven patients presenting a COHb level in the blood had an amount of >10%. One patient had suffered with a right bundle block. Eight women out of the eleven were treated with oxygen therapy using face mask on their way to hospital. The centre systematically uses hyperbaric oxygen therapy, which dose and duration vary depending on the case and on the practitioner. Two foetus were affected with in utero growth restriction, and another one with a perinatal asphyxia. Two premature births were admitted to prenatal resuscitation. All along this investigation, no prenatal death were linked to carbon monoxide poisoning. Conclusion:Complications on the foetus resulting from that hazard are serious and unpredictable. A high rate normobaric oxygen therapy with oro-nasal mask is recommended while awaiting the hyperbaric oxygen which therapy must be systematically administered during pregnancy. Obstetrical management is considered case-by-case.

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“…The binding affinity of CO to fetal hemoglobin is even stronger than CO binding to maternal hemoglobin. 2,9 CO crosses the placental barrier via passive diffusion. 30 Additionally, the partial pressure of fetal arterial oxygen is approximately 20 mm Hg, much lower than the partial pressure of maternal arterial oxygen of 100 mm Hg.…”

Section: Mechanism Of Injury To Mother and Fetusmentioning

confidence: 99%

“…44,51,67 Given the extended duration required for fetal clearance of COHb, 100% NBO 2 may need to be administered at a rate of 15 L/min for 16 hours or more. 9 If maternal COHb concentration is in excess of 20% or the burned pregnant patient has at any time lost consciousness, pure oxygen in the setting of a burned pregnant patient may be inadequate for fetal survival, and hyperbaric oxygen therapy can be considered. 38,68…”

Section: Treatmentmentioning

confidence: 99%

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Carbon Monoxide and Cyanide Poisoning in the Burned Pregnant Patient

Culnan¹,

Craft-Coffman²,

Bitz³

et al. 2018

Annals of Plastic Surgery

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Carbon monoxide (CO) is a small molecule poison released as a product of incomplete combustion. Carbon monoxide binds hemoglobin, reducing oxygen delivery. This effect is exacerbated in the burned pregnant patient by fetal hemoglobin that binds CO 2.5- to 3-fold stronger than maternal hemoglobin. With no signature clinical symptom, diagnosis depends on patient injury history, elevated carboxyhemoglobin levels, and alterations in mental status. The standard of care for treatment of CO intoxication is 100% normobaric oxygen, which decreases the half-life of CO in the bloodstream from 5 hours to 1 hour. Hyperbaric oxygen (HBO2) is a useful adjunct to rapidly reduce the half-life of CO to 20 minutes and the incidence of delayed neurologic sequelae. Because of the slow disassociation of CO from hemoglobin in the fetus, there is a far stronger indication for HBO2 in the burned pregnant patient than in other burn patient populations.Cyanide intoxication is often a comorbid disease with CO in inhalation injury from an enclosed fire, but may be the predominant toxin. It acts synergistically with CO to effectively lower the lethal doses of both cyanide and CO. Diagnosis is best made in the presence of high lactate levels, carboxyhemoglobin concentrations greater than 10%, injury history of smoke inhalation from an enclosed fire, and alterations in consciousness. While treatment with hydroxocobalamin is the standard of care and has the effect of reducing concomitant CO toxicity, data indicate cyanide may also be displaced by HBO2.Carbon monoxide and cyanide poisoning presents potential complications impacting care. This review addresses the mechanism of action, presentation, diagnosis, and treatment of CO and cyanide poisonings in the burned pregnant patient and the use of HBO2 therapy.

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Carbon Monoxide Poisoning and Pregnancy: Critical Nursing Interventions

Cited by 7 publications

References 9 publications

Risk of acute kidney injury among patients with carbon monoxide poisoning

Risk of acute kidney injury among patients with carbon monoxide poisoning

Unintentional Acute Carbon Monoxide Poisoning During Pregnancy: Five Years of Experience in Bordeaux

Carbon Monoxide and Cyanide Poisoning in the Burned Pregnant Patient

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