Noninvasive Carbon Monoxide Detection: Insufficient Evidence for Broad Clinical Use

Wilcox, Susan R.; Richards, Jeremy B.

doi:10.4187/respcare.02288

Cited by 9 publications

(10 citation statements)

References 22 publications

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“…In this study, there was not a good correlation between these two measures, a finding that has been seen in other long-term environmental CO monitoring studies [ 27 ]. Lam et al also noted difficulties in correlating solid fuel associated CO exposure with COHgB particularly at lower levels [ 26 ], and in larger scale clinical testing scenarios, accuracy, precision, and correlation with CO levels as measured by the Rad-57 have been variable with reports of both over- and under-estimation [ 28 ]. The poor association in this study is likely due to a number of reasons, including the complex kinetics of COHgB and fluctuating exposure to CO with COHgB reflecting more recent exposure, participants’ levels of exercise and activity, possible lack of precision in COHgB measurements due to field conditions or user error, possible poor compliance with wearing the Lascar monitor, and the lack of accuracy of co-oximeter testing at low levels of CO exposure [ 23 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

The Cooking and Pneumonia Study (CAPS) in Malawi: A Cross-Sectional Assessment of Carbon Monoxide Exposure and Carboxyhemoglobin Levels in Children under 5 Years Old

Havens

Wang

Grigg

et al. 2018

IJERPH

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Household air pollution is estimated to cause half a million deaths from pneumonia in children worldwide. The Cooking and Pneumonia Study (CAPS) was conducted to determine whether the use of cleaner-burning biomass-fueled cookstoves would reduce household air pollution and thereby the incidence of pneumonia in young children in rural Malawi. Here we report a cross-sectional assessment of carbon monoxide (CO) exposure and carboxyhemoglobin (COHgB) levels at recruitment to CAPS. Mean (SD; range) 48-h CO exposure of 1928 participating children was 0.90 (2.3; 0–49) ppm and mean (SD; range) COHgB level was 5.8% (3.3; 0–20.3). Higher mean CO and COHgB levels were associated with location (Chikhwawa versus Chilumba) (OR 3.55 (1.73–7.26)); (OR 2.77 (1.08–7.08)). Correlation between mean CO and COHgB was poor (Spearman’s ρ = 0.09, p < 0.001). The finding of high COHgB levels in young children in rural Malawi that are at levels at which adverse neurodevelopmental and cognitive effects occur is of concern. Effective approaches for reducing exposure to CO and other constituents of air pollution in rural sub-Saharan African settings are urgently needed.

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Section: Discussionmentioning

confidence: 99%

The Cooking and Pneumonia Study (CAPS) in Malawi: A Cross-Sectional Assessment of Carbon Monoxide Exposure and Carboxyhemoglobin Levels in Children under 5 Years Old

Havens

Wang

Grigg

et al. 2018

IJERPH

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“…In clinical settings and generally for living patients, a noninvasive alternative to venous or arterial blood COHb measurement by a BGA or CO-oximetry that has been widely investigated is pulse CO-oximetry [39][40][41][42][43].…”

Section: Analytical Techniquesmentioning

confidence: 99%

“…Being able to diagnose a CO poisoning case quickly is necessary, but if the results obtained over-or underestimate the true COHb levels, this can have severe and potentially fatal consequences. Several studies have reported low precision and accuracy as well as an elevated false positive and negative rate, as opposed to regular blood measurements [5,[39][40][41][42]. Especially for COHb levels above 10%, pulse CO-oximeters significantly underestimated the COHb levels [39].…”

Section: Sources Of Errormentioning

confidence: 99%

What are the limitations of methods to measure carbon monoxide in biological samples?

Oliverio

Varlet

2019

Forensic Toxicol

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Carbon monoxide (CO) is one of the most important toxic gases in the atmosphere. Its high affinity for hemoglobin made carboxyhemoglobin (COHb) the most appropriate biomarker for CO poisonings. COHb is measured using spectrophotometric (UV-spectrophotometry, CO-oximetry) or gas chromatographic (GC) methods hyphenated with flame ionization or mass spectrometry detectors. However, inconsistencies in many cases were reported between measured values and reported symptoms, raising doubts over the suitability of COHb as biomarker together with the accuracy and reliability of its measurement methods. Therefore, we aimed to review the accuracy of current methods to measure CO and to determine their sources of error and their effects on the interpretation process. MethodsA detailed search of PubMed was performed in November 2018 using relevant keywords. After exclusion criteria, 46 articles out of 191 initial hits were carefully reviewed. ResultsWhile optical methods are highly affected by changes of blood quality due to degradation of the samples during storage, GC methods are less affected. However, measurement of COHb does not quantify free CO, which is mainly responsible for toxicity mechanisms other than hypoxia such as inhibition of hemoproteins, thus underestimating the true CO burden. Therefore, measurement of COHb is insufficiently accurate for CO poisoning diagnosis. ConclusionsAn alternative biomarker is required, such as determining the total amount of carbon monoxide in blood. Even though further research is required, we recommend toxicologists to consider all sources of error that can alter COHb concentrations and, in more challenging cases, they should use GC-MS methods to confirm the results obtained by spectrophotometry.

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“…Diese können bereits nach leichten Intoxikationen mit einem COHb-Wert um 10 % entstehen und manifestieren sich bei bis zu 50 % der Betroffenen [10,27]. [10,28,29].…”

Section: Merkeunclassified

Kleinhirninfarkt nach CO-Intoxikation und hyperbarer Sauerstofftherapie

Wick¹,

Schneiker²,

Bele³

et al. 2017

Anästhesiol Intensivmed Notfallmed Schmerzther

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Noninvasive Carbon Monoxide Detection: Insufficient Evidence for Broad Clinical Use

Cited by 9 publications

References 22 publications

The Cooking and Pneumonia Study (CAPS) in Malawi: A Cross-Sectional Assessment of Carbon Monoxide Exposure and Carboxyhemoglobin Levels in Children under 5 Years Old

The Cooking and Pneumonia Study (CAPS) in Malawi: A Cross-Sectional Assessment of Carbon Monoxide Exposure and Carboxyhemoglobin Levels in Children under 5 Years Old

What are the limitations of methods to measure carbon monoxide in biological samples?

Kleinhirninfarkt nach CO-Intoxikation und hyperbarer Sauerstofftherapie

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